Norihito Taki

Application of peroral cholecystoscopy in a case of cholecystocolic fistula

A patient with a cholecystocolic fistula, complicating cholecysto‐choledocholithiasis, was treated endoscopically with gallbladder observation by peroral cholecystoscopy (POCCS). The patient was a 71‐year‐old female admitted to our hospital for investigation and treatment of biliary stones and a cholecystocolic fistula. Endoscopic lithotripsy and extracorporeal shock wave lithotripsy (ESWL) were performed after endoscopic sphincterotomy, and the gallbladder was subsequently investigated using a duodenoscope/ cholangioscope of the mother and baby type. Full distension of the gallbladder with saline solution allowed POCCS observation of the entire surface. The gallbladder mucosa was smooth, and neither stones nor tumors were observed. Though the cholecystocolic fistula itself could not be observed, we concluded that it had resulted from cholecystitis. Peroral cholecystoscopy is thus a useful method of investigating the gallbladder in such cases.

A New Peroral Cholecystoscopy Method Utilizing a Shape Memory Alloy Bending Catheter‐Report of Two Cases

For the purpose of improving the ease and reliability of catheter insertion into the cystic duct and gallbladder, we developed a new combination method utilizing an ultrathin fiberscope (miniscope, 0.8 mm), a guidewire (0.25 inches) and a shape memory alloy, bendable, catheter (SMA catheter, 2.6 mm). The main feature of the SMA catheter, which incorporates a micro‐actuator, is that its tip can be bent by remote control as desired. The SMA catheter could be inserted successfully into the cystic duct using a guide‐wire under direct miniscope vision in two patients with gallbladder lesions.