A STUDY OF PERORAL CHOLECYSTOSCOPY (POCCS)

Abstract

The problems in observation and insertion of peroral cholecystoscopy (POCCS) were investigated. Seven cases, five males and two females, underwent POCCS for gallbladder disease : cholecystolithiasis, 5 cases ; gallbladder carcinoma, 1 case ; and adenomyomatosis, 1 case. Age ranged from 41 to 78 years, and the average age being 64 years. Endoscopic sphyncterotomy had previously been performed in 6 cases suffering from choledocholithiasis to extract calculi. After insertion of the baby scope into the common bile duct through the mother scope, the ostium of the cystic duct was clearly visualized in 6 cases. The guidewire was straightly inserted into the gallbladder via the cystic duct as deeply as possible through the guidewire channel of the baby scope, and then the baby scope was inserted into the gallbladder along the guidewire. The baby scope could be inserted into the gallbladder in 5 cases. In two of these 5 cases, a catheter was needed to dilate the cystic duct or straighten the guidewire. On the other hand, it was impossible to insert the baby scope into the gallbladder in the remaining 2 cases. In one of them, although it was possible to insert the guidewire into the gallbladder, the 8-Fr dilation catheter could not be inserted into the gallbladder through the cystic duct because of severe bending at the distal portion of the cystic duct. In the other case, only the tip of the guidewire was inserted into the cystic duct, because it branched off at an abrupt angle. In five cases in which the insertion of the baby scope was successful, stones and adenomyomatosis could be observed. Furthemore, the findings characteristic of normal mucosa of the gallbladder, such as superficial small vessels and fine reticular patterns were visualized with close-up view. This suggests that POCCS would be useful in diagnosis of gallbladder mucosal diseases. However, the endoscopic image was not so clear due to insufficient light with more distant view.