Background and study aims: Contact endoscopy is a technique allowing detailed magnified imaging of living epithelium, used extensively to assess tissues of gynecological and laryngeal origan. We used this technique during cholecystectomy to investigate its potential value for staging laparoscopy in gallbladder cancer. Patients and methods: Eight patients with gallbladder cancer, four with mucosal hyperplasia, two with benign polyps and nine with gallstones were evaluated. During surgery, the lens of the contact endoscope (8715AA, 5.5 mm in diameter with a 0° angle) was placed in contact with the serosa of the gallbladder and observations were performed at magnifications of 60 × and 150 ×. Results: Enlarged color images of the subserosal layer of the gallbladder were obtained. In normal mucosa, a fine vascular network with flowing erythrocytes was observed in the subserosal layer. Subserosal fat appeared as tortoiseshell-like markings, shown histologically to be clumps of fat cells surrounded by fine fibrous tissue. A gap between the deep vessels and the superficial vessels in the subserosal fat was also observed. The same findings were detected in gallbladder cancer patients where invasion was limited to the muscular layer. However, in patients with advanced gallbladder cancer, with invasion beyond the muscular layer, both the vessel gap and the fat tissue markings were absent. There was also encasement of the vessels and decreased intravascular flow of erythrocytes. Conclusions: The contact endoscope can be useful in differentiating between early and advanced gallbladder cancer and has some potential for use in staging laparoscopy for gallbladder cancer.