Background <p>The stent placement in malignant biliary obstruction (MBO) carries the risk acute cholecystitis. We studied if prophylactic endoscopic gallbladder stenting (EGBS) reduces the risk of acute cholecystitis in MBO patients receiving metal stents.</p> Methods <p>We searched multiple databases to select studies which compared the risk of acute cholecystitis in MBO patients which received prophylactic EGBS Vs. no-stent group. We studied the odds of acute cholecystitis, acute pancreatitis, acute cholangitis, and overall adverse event rate between prophylactic EGBS Vs. no-stent group. We calculated the pooled odds with 95% CI for categorical variables and standardized mean difference (SMD) with 95% CI for continuous variables.</p> Results <p>We included four studies, consisting of 509 (prophylactic EGBS, n = 87, no-stent, n = 422) patients. The rate of acute cholecystitis in prophylactic EGBS group was 3.0% (95% CI 0.9–9.9, I² 0%) compared to 20.9% (95% CI 17.3–25, I² 0%) in the no-stent group. The rate of acute pancreatitis in prophylactic EGBS and no-stent group was 10.5% (95% CI, 3.6 -27, I² 45%) and 8.6% (6.2 -11.7, I² 0%), respectively. Pooled rate of acute cholangitis was 3.5% (95% CI 1.1 – 10.2, I² 0%) and 1.8% (95% CI 0.7- 4.9, I² 7%) in prophylactic EGBS Vs. no-stent group, respectively. Prophylactic EGBS resulted in 89% lower pooled odds (0.11, 95%CI 0.03–0.41, I² 0%) of acute cholecystitis. There was no difference in the odds of overall adverse events (0.63, 95% CI 0.26–1.54, I² 34%), acute pancreatitis (1.82, 95%CI 0.81–4.08, I² 0%), and acute cholangitis (2.66, 95%CI 0.53–13.35, I² 5%) between groups.</p> Conclusion <p>Prophylactic EGBS is safe and reduces the risk of acute cholecystitis before placing metal stents in MBO patients.</p>