Transpapillary gallbladder biopsy using newly designed device delivery system

Background/Aims: Transpapillary gallbladder biopsy has been reported for the diagnosis of gallbladder disease, and it requires special biopsy forceps or a large-diameter pusher catheter. Herein, we report transpapillary gallbladder biopsy method using a newly designed device delivery system. Method: We retrospectively examined five cases that underwent transpapillary gallbladder biopsy using a device delivery system (Endosheather; Piolax Medical Device, Kanagawa, Japan). Endoscopic procedure: After cholangiography, a guidewire was coiled into the gallbladder. Subsequently, Endosheather was inserted into the gallbladder, and multiple biopsies were performed using biopsy forceps (Radial Jaw 4P; Boston Scientific, Natick, MA, USA). A pigtail-shaped nasogallbladder drainage tube was placed in the gallbladder for bile juice cytology. Result: The median age was 74 (53-81). The median number of biopsies was 3 (3-6), and the mean time from insertion to removal of the Endosheather was 455 seconds. There were no adverse events associated with the procedure. The biopsy results were as follows : atypical gland: 1, xanthogranulomatous reaction: 1, and no neoplastic lesion: 3. Postoperative pathological findings were as follows : gallbladder cancer: 1, xanthogranulomatous cholecystitis: 1, BilIN-2: 1, adenomyomatosis: 1, and chronic cholecystitis: 1. Conclusions: Transpapillary gallbladder biopsy using the Endosheather is technically feasible. Adding transpapillary gallbladder biopsy might be considered when performing bile juice cytology using nasogallbladder drainage for the diagnosis of gallbladder disease.