Preoperative diagnosis and management of thick-walled gallbladder based on bile cytology obtained by endoscopic transpapillary gallbladder drainage tube

BackgroundIt is often difficult to distinguish gallbladder cancers (GBC) from benign gallbladder diseases, which show thickened walls.ObjectivesTo evaluate the efficacy of bile cytology using endoscopic transpapillary gallbladder drainage (ETGD) and CT.DesignRetrospective study.SettingDivision of Gastroenterology, Tokyo Medical University, Tokyo, Japan.Patients and InterventionsEighty-five patients with gallbladder diseases, consisting of 27 GBC and 58 benign gallbladder diseases, were reviewed. A pigtail-type nasobilliary drainage tube was left indwelling in the gallbladder, and through this drainage tube washing cytology was performed with an ETGD tube.Main Outcome MeasurementsDiagnostic accuracy of CT and cytology. Complications and outcome were also evaluated.ResultsCT and cytology with the ETGD tube had 81% and 81% sensitivity, 91% and 83% specificity, and 88% and 82% accuracy, respectively (P > .05). Looking only at the 71 successful ETGD cases, CT and ETGD cytology had 82% and 100% sensitivity, 92% and 98% specificity, and 89% and 99% accuracy, respectively (P = .036 and .025, respectively). Four patients with GBC in whom CT showed benign findings underwent open cholecystectomy because ETGD cytology revealed malignant findings. In contrast, 4 patients with benign diseases in whom CT suggested malignant finding underwent LC because the findings of ETGD cytology suggested benign disease.ConclusionsCytology using an ETGD tube is very useful in the diagnosis and management of gallbladder diseases.