Cholangioscopy-assisted endoscopic mucosal resection for gallbladder polyp and stone extraction for cholecystocholedocholithiasis.

A 58-year-old man with cholecystocholedocholithiasis was assessed in our hospital. Preoperative computerized tomography (CT) showed a 0.6-cm common bile duct (CBD) stone combined with sediment-like gallstones. Therefore, we performed cholangioscopy-assisted extraction through papillary stent [1] for him.

First, biliary intubation was conducted and a single dumbbell-style papillary support was placed in the CBD and papilla. The cholangioscope (eyeMax, 9 F; Micro-Tech, Nanjing, China) was then inserted into the CBD and a black stone was found. A basket was inserted into the CBD through the working channel of cholangioscope and frapped the stone ([Fig. 1]). We subsequently removed the stone from the CBD by withdrawing the cholangioscope and basket together. The cholangioscope was then inserted into gallbladder through the cystic duct over a guidewire, and the sediment-like gallstones were removed by the aspiration function under direct vision. An approximately 0.2-cm gallbladder polyp was found ([Fig. 2]). We then performed cholangioscopy-assisted endoscopic mucosal resection (CA-EMR) [2] for the gallbladder polyp using a snare with the electrocision function (Jiangsu Changmei Medtech; Changzhou, China), which can pass through the working channel of a cholangioscope ([Fig. 3], [Fig. 4]). Finally, naso-gallbladder drainage was performed ([Video 1]). The patient’s recovery was smooth.

Fig. 1 A basket was inserted into the common bile duct (CBD) through the working channel of cholangioscope and frapped the stone firmly under direct vision.

Fig. 2 An approximately 0.2-cm gallbladder polyp was found.

Fig. 3 The specially designed snare was inserted into the CBD, and the polyp was resected successfully using the snare by the electrocision function.

Fig. 4 The appearance of the postoperative wound.

The procedures of cholangioscopy-assisted endoscopic mucosal resection for a gallbladder polyp and stone extraction for cholecystocholedocholithiasis.Video 1

With the improvement and popularization of radiological techniques, more and more polypoid lesions in the biliary duct and gallbladder have been found [3]. Patients with polypoid lesions in the biliary system often faced a dilemma. Surgical treatment for polypoid lesions was accompanied by relatively major trauma; on the other hand, follow-up observation came with the risk of progression of the lesions. Recently, our team introduced CA-EMR for CBD mucosa in the porcine model [2]. Subsequently, we successfully performed this technique for a patient with a polypoid lesion in the clinic [4] ([Fig. 5]). In this study, we further confirmed the feasibility of CA-EMR for a gallbladder polyp in the clinic. Moreover, this study verified that it was feasible to perform cholangioscopy-assisted extraction through papillary stent for CBD stones combined with sediment-like gallstones.

Fig. 5 We performed a cholangioscopy-assisted endoscopic mucosal resection for another patient with a CBD polypoid lesion.

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Conflict of Interest

The authors declare that they have no conflict of interest.

• References

• 1 Zhang W, Chai N, Zhai Y. et al. Cholangioscopy-assisted extraction of choledocholithiasis and partial sediment-like gallstones through papillary support: A pilot exploration for super minimally invasive surgery. Endoscopy 2023; 55: E274-E275
• 2 Zhang W, Chai N, Zhang B. et al. Cholangioscopy-assisted endoscopic mucosal resection for bile duct lesions through papillary support: A pilot exploration for super minimally invasive surgery in a porcine model. Endoscopy 2023; 55: E1230-E1231
• 3 Politano SA, Hamiduzzaman N, Alhaqqan D. Diseases of the gallbladder and biliary tree. Prim Care 2023; 50: 377-390
• 4 Zhang W, Chai N, Feng Y. et al. Cholangioscopy-assisted endoscopic mucosal resection for a mildly dysplastic lesion of the common bile duct: a pilot exploration for super minimally invasive surgery. Endoscopy 2024; 56: E166-E167

Publication History

Article published online:
03 April 2024