PubMed · 9831840
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Y C Peng, W K Chow, G H Chen. 1998. Duplicated gallbladder with cholelithiasis.. https://doi.org/10.1016/s0016-5107(98)70093-8
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Gastrointestinal endoscopy comprises gastroscopy, colonoscopy, and endoscopic retrograde cholangiopancreatography (ERCP). Endoscopic ultrasonography and small bowel enteroscopy are also available, although not in all endoscopy units. The diagnostic accuracy of gastrointestinal endoscopy is very high. Scientific activities include evaluation of methods/regimens where diagnostic gastroscopy can be replaced by non-invasive Helicobacter screening for certain patients, the use of non-invasive alternatives to ERCP (e.g. magnetic resonance), small bowel enteroscopy without the use of an endoscope, and virtual colonoscopy with computer tomography or magnetic resonance techniques. The move away from traditional endoscopic procedures towards more non-invasive techniques is taking place along with the development of new endoscopic procedures to replace traditional surgical techniques, e.g. endoscopic placement of colonic metal stents in acute colonic obstruction.
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Diagnosis of gallbladder cancer in terms of invasion depth and spread is an important factor in determining cumulative survival after surgical treatment. However, diagnostic methods available at present occasionally fail to judge staging correctly. We report a case of gallbladder cancer which showed extreme discrepancy between the preoperative macroscopic and imaging diagnosis (positive direct invasion to the liver and invasion to the bile duct and duodenum through the serosal layer; S3, Hinf3, Binf2, and stage IV by the Japanese Society of Biliary Surgery classification) and the pathological findings (limited in vasion within the subserosal layer; ss, hinf0. binf0, and stage II). This discrepancy allowed us to perform curative treatment by hepatopancreatoduodenectomy, including extended right lobectomy of the liver, external bile duct resection, resection of the mesocolon, and lymph node dissection. Surgeons should aim for curability of advanced gallbladder cancer by radical resection until accurate methods for the preoperative diagnosis of cancer spread are available, because the clinical picture may be modified by inflammatory changes.