Kill two birds with one stone: Flexible cholangioscopy for treatment of common bile duct stone and identification of suspicious gallbladder wall thickening

A 76-year-old man suffered from recurrent abdominal pain and distention. The contract-enhanced computed tomography (CT) and endoscopic ultrasound (EUS) exams revealed the presence of a stone in common bile duct (CBD) ([Fig. 1] a) and concerning evidence of gallbladder wall thickening, suggestive of either gallbladder adenomyosis or gallbladder carcinoma ([Fig. 1] b, c). In order to distinguish benign adenomyosis from malignant carcinoma, together with treatment of the CBD stone, we sequentially performed endoscopic basket retrieval and target biopsies of the gallbladder.