Confocal laser endomicroscopy distinguishing benign and malignant gallbladder polyps during choledochoscopic gallbladder-preserving polypectomy: A case report

Abstract

BACKGROUND In the last decade, confocal laser endomicroscopy (CLE) has emerged as a new endoscopic imaging modality for real-time in vivo histological examination at the microscopic level. CLE has been shown to be useful for distinguishing benign and malignant lesions and has been widely used in many digestive diseases. In our study, we used CLE for the first time to examine the morphology of cholesterol polyps as well as the different parts of normal gallbladder mucosa. CASE SUMMARY A 57-year-old woman was diagnosed by ultrasound with a polyp of 21 mm in the gallbladder wall. She consented to polyp removal by laparoscopic choledo-choscopy. During laparoscopic cholecystectomy combined with choledochoscopic polyp resection, CLE was used to observe the morphology of the polyp surface cells. The appearance of the mucosa and microvessels in various parts of the gallbladder were also observed under CLE. Through comparison between postoperative pathology and intraoperative CLE diagnosis, the reliability of intraoperative CLE diagnosis was confirmed. CLE is a reliable method to examine living cell pathology during cholecystectomy. Based on our practice, CLE should be prioritized in the diagnosis of gallbladder polyps. CONCLUSION Compared with traditional histological examination, CLE has several advantages. We believe that CLE has great potential in this field.

Gallbladder-preserving polypectomy for gallbladder polyp by embryonic-natural orifice transumbilical endoscopic surgery with a gastric endoscopy

“…Secondly, the lesion can be completely removed to reduce gallbladder cancer risk, and the pathological diagnosis of polyps can be obtained to develop further treatment or follow-up strategies. Thirdly, compared with traditional laparoscopic-assisted gallbladder-preserving polypectomy [ 13 , 22 , 23 ], the main advantage of E-NOTES is that the umbilical cord is the weakest part of the abdominal wall, and transumbilical puncture can not only reduce the injury of the abdominal wall, but also relieve the pain of the surgical wound. Furthermore, the 2–4 incisions in the abdomen of the traditional laparoscopic surgery can be transformed into a small incision of 10 mm in the umbilical cord.…”

Current considerations for the surgical management of gallbladder adenomas

“…Minimally invasive procedures for polypectomy alone, in which the gallbladder is preserved and is functional, have recently gained increasing interest[ 31 ]. These methods include: (1) Ultrasound-guided radiofrequency for adenoma ablation[ 32 - 34 ]; (2) endoscopic cholecystostomy under ultrasound guidance, which serves as a bridging procedure to endoscopic polypectomy through the gallbladder wall[ 35 , 36 ]; (3) laparoscopic-assisted transumbilical gastroscopy for gallbladder-preserving adenoma resection[ 37 - 39 ]; (4) peroral choledochoscopic gallbladder-preserving adenoma resection[ 40 , 41 ]; and (5) transgastric endoscopic gallbladder preserving surgery[ 42 ]. However, there are still no adequate data available, and these novel approaches require expertise and further evaluation, including further evaluation of the long-term outcomes.…”