Endoscopic transpapillary approach to the gallbladder for diagnosing gallbladder cancer.
OBJECTIVE
Gallbladder cancer (GBC) has a poor prognosis that is related to delayed diagnosis. The present study evaluated the efficacy of the transcystic ductal approach in diagnosing GBC.


METHODS
A catheter was introduced into the gallbladder endoscopically via the cystic duct to obtain bile for cytology. Subsequently, cytology specimens were collected using a brush, and intraductal ultrasonography (IDUS) was performed using a miniature probe in patients suspected of having GBC.


RESULTS
Bile cytology was performed successfully in 23 of 25 patients (92%). The sensitivity, specificity and accuracy of cytology were 44.4%, 100% and 78.3%, respectively. Brush cytology and IDUS were successful in six of eight (75%) and nine of 15 (60%) patients, respectively. Brush cytology was positive in two of five patients with GBC. In all four patients with invasive cancer, IDUS showed an irregularity or disruption of the outermost hyperechoic layer.


CONCLUSIONS
The endoscopic transpapillary approach to the gallbladder was useful for the diagnosis of GBC. Brush cytology and IDUS may improve diagnostic efficacy and provide more useful information.
Matsubara
S
S
Department of Gastroenterology, University of Tokyo, Tokyo, Japan.
Arizumi
T
T
Togawa
O
O
Sasaki
T
T
Yamamoto
N
N
Nakai
Y
Y
Sasahira
N
N
Hirano
K
K
Tsujino
T
T
Isayama
H
H
Toda
N
N
Tada
M
M
Kawabe
T
T
Omata
M
M
D000368:Aged; D014670:Ampulla of Vater; D003937:Diagnosis, Differential; D016145:Endoscopy, Digestive System / Q000379:methods*; D019160:Endosonography / Q000379:methods*; D005260:Female; D005706:Gallbladder Neoplasms / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012189:Retrospective Studies