Observation and cholangioscopic biopsy of resectable gallbladder cancer using a new ultra-slim cholangioscope

Observation and cholangioscopic biopsy of resectable gallbladder cancer using a new ultra-slim cholangioscope Endoscopic ultrasound (EUS)-guided tissue acquisition and percutaneous biopsy are not recommended for the preoperative diagnosis of resectable gallbladder cancer because of the risk of dissemination [1].Definitive diagnosis using imaging tests is difficult, and transpapillary fluoroscopic biopsy and cytology lack high accuracy [2].Direct observation and biopsy are desirable for a more accurate diagnosis; however, advancing a cholangioscope into the gallbladder through the narrow cystic duct is impractical.We report a case of successful direct observation and biopsy of a gallbladder cancer using a new ultraslim cholangioscope.An 83-year-old woman was referred for a suspected gallbladder tumor based on a computed tomography scan ( Fig. 1).EUS revealed irregular wall thickening of the gallbladder and cystic duct, with con-E-Videos Fig. 1 Computed tomography showing irregular wall thickening with enhancement in the gallbladder.a Axial, plane.b Axial, early phase.c Axial, portal phase.d Axial, delayed phase.e Coronal, early phase. Fig. 2 Endoscopic ultrasound images.a B mode imaging showing irregular wall thickening in the gallbladder.b and c Color doppler and contrast harmonic imaging confirmed blood flow within the lesion.d B mode imaging showing the cystic duct and common bile duct with mild wall thickening.