Endoscopic selfexpandable metal stent (SEMS) place ment has become a standard palliative therapy for pa tients with malignant biliary obstruction. Acute cholecys titis after SEMS placement is a serious complication. We report a patient with an acute cholecystitis after covered SEMS placement, who was managed successfully with endoscopic transpapillary gallbladder drainage (ETGBD) and replacement of the covered SEMS. An 85yearold man with pancreatic cancer suffered from acute chole cystitis after covered SEMS placement. It was impossible to perform percutaneous transhepatic gallbladder drain age. After removal of the covered SEMS with a snare, a 7Fr double pigtail stent was placed between the gall bladder and duodenum, subsequently followed by an other covered SEMS insertion into the common bile duct beside the gallbladder stent. The cholecystitis improved immediately after ETGBD. ETGBD with replacement of the covered SEMS thus proved to be effective for treat ment of patients with acute cholecystitis after covered SEMS placement.