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

Abstract

Background: It is often difficult to distinguish gallbladder cancers (GBC) from benign gallbladder diseases, which show thickened walls.

Objectives: To evaluate the efficacy of bile cytology using endoscopic transpapillary gallbladder drainage (ETGD) and CT.

Design: Retrospective study.

Setting: Division of Gastroenterology, Tokyo Medical University, Tokyo, Japan.

Patients and interventions: Eighty-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 measurements: Diagnostic accuracy of CT and cytology. Complications and outcome were also evaluated.

Results: CT 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.

Conclusions: Cytology using an ETGD tube is very useful in the diagnosis and management of gallbladder diseases.