Post written by Naminatsu Takahara, MD, PhD, from the Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.

Diagnosing gallbladder neoplasms is challenging because of difficulties in direct visualization and tissue sampling of the tumor. As a result, cholecystectomy is sometimes performed as a diagnostic procedure, but it can result in unnecessary surgery, which carries risks such as biliary or vascular injury.

Consequently, less-invasive diagnostic and therapeutic approaches are urgently needed to improve clinical management for gallbladder neoplasms. Recently, EUS-guided gallbladder drainage (EUS-GBD) using lumen-apposing metal stents (LAMSs) has emerged as an alternative for acute cholecystitis in patients unfit for emergent cholecystectomy. With the substantial diameter of the LAMS, EUS-GBD offers effective drainage and potentially allows transmural access into the gallbladder, facilitating subsequent endoscopic interventions.

However, few studies have investigated the feasibility of peroral cholecystoscopy (POCCS)-guided interventions through LAMSs. Therefore, we aimed to investigate the potential of POCCS-guided interventions through a LAMS in a swine model.

The study successfully demonstrated the feasibility of POCCS and target biopsy through the LAMS immediately after EUS-GBD, without adverse events. In addition, POCCS-guided mucosal resection was technically feasible, and all resected specimens were pathologically evaluable, suggesting the potential application of POCCS-guided interventions for gallbladder lesions.

Yet, only a limited area of the gallbladder could be visualized by gastroscope because of its limited maneuverability within the gallbladder through the LAMS. This limitation hinders POCCS-guided intervention on the duodenal side of the gallbladder. The use of a multibending scope or a combination of an ultrathin endoscope and dedicated devices might offer a potential solution to access to the duodenal side.

In conclusion, POCCS and its guided interventions through LAMSs are feasible after EUS-GBD, suggesting its potential clinical application. Further research is required to optimize these techniques and integrate POCCS-guided interventions into clinical practice.

Peroral cholecystoscopy through a lumen-apposing metal stent (LAMS) immediately after EUS-guided gallbladder drainage in the index procedure. A, Endoscopic image of insertion of the cholangioscope (Spyglass DS; Boston Scientific, Marlborough, Mass, USA) into the gallbladder through the LAMS. B, Fluoroscopic image of insertion of the cholangioscope (Spyglass DS) into the gallbladder through the LAMS. C, Fluoroscopic image of insertion of the esophagogastroduodenoscope (GIF-H290T; Olympus Medical Systems, Tokyo, Japan) into the gallbladder after balloon dilation of the LAMS. D, Peroral cholecystoscopic image of the cystic duct orifice using the cholangioscope (Spyglass DS). E, Peroral cholecystoscopic white-light image of the body of the gallbladder under narrow-band imaging. F, Peroral cholecystoscopic narrow-band image of the body of the gallbladder.

Visit iGIE’s Facebook, X/Twitter, and YouTube accounts for more content from the ASGE peer-reviewed journal that launched in December 2022.

Read the full article online.

The information presented in Endoscopedia reflects the opinions of the authors and does not represent the position of the American Society for Gastrointestinal Endoscopy (ASGE). ASGE expressly disclaims any warranties or guarantees, expressed or implied, and is not liable for damages of any kind in connection with the material, information, or procedures set forth.