Successful detection of choledochojejunal and pancreaticojejunal anastomotic strictures using a novel form of texture and color enhancement imaging

In clinical cases of pancreas divisum, endoscopic retrograde cholangiopancreatography often necessitates cannulation of the pancreatic duct through the minor papilla. Nevertheless, this procedure can be challenging because of the small size of the minor papilla and the difficulty in visualizing the ductal orifice. A new image‐enhanced endoscopy technique called texture and color enhancement imaging (TXI) has been developed, which enhances texture, brightness, and color compared with white‐light imaging, resulting in subtle differences in the surface mucosa. Herein, we describe the case of a 73‐year‐old man with pancreas divisum in whom TXI was useful in identifying the orifice of the minor papilla. He was referred to our hospital with repetitive acute exacerbation of chronic pancreatitis. Since contrast‐enhanced computed tomography revealed a pancreatic stone in the main pancreatic duct, endoscopic retrograde cholangoepancreatography was performed as a therapeutic intervention. Despite the initial difficulty in identifying the orifice of the minor papilla on white‐light imaging, TXI enhanced its visibility successfully, enabling dorsal pancreatic duct cannulation via the minor papilla. Subsequently, endoscopic pancreatic sphincterotomy was performed and a 6Fr plastic stent was placed. Post‐endoscopic therapy, the patient's abdominal pain was relieved. TXI was useful in identifying the minor papilla orifice and led to successful cannulation.

Section: Discussionmentioning

confidence: 99%

The usefulness of texture and color enhancement imaging to identify the minor papilla orifice

Goda,

Irie,

Anan

et al. 2024

“…TXI can be used in combination with a therapeutic short‐type single‐balloon enteroscope, such as the SIF‐H290S (Olympus Co.) and EVIS X1. Toyonaga et al., 41 Tanisaka et al., 42 and Takenaka et al. 43 have reported that TXI is useful in identifying difficult cholangio‐jejunal anastomotic stenoses.…”

Section: Mechanisms and Equipment Of Ieementioning

confidence: 99%

“…(a) White light imaging and (b) texture and color imaging Mode 1. [Reprinted with permission from Georg Thieme Verlag KG, originally published in Endoscopy 2022 41 ]…”

Section: Mechanisms and Equipment Of Ieementioning

confidence: 99%

Recent advancements in image‐enhanced endoscopy in the pancreatobiliary field

Toyonaga,

Hayashi,

Hama

et al. 2024

Self Cite

Image‐enhanced endoscopy (IEE) has advanced gastrointestinal disease diagnosis and treatment. Traditional white‐light imaging has limitations in detecting all gastrointestinal diseases, prompting the development of IEE. In this review, we explore the utility of IEE, including texture and color enhancement imaging and red dichromatic imaging, in pancreatobiliary (PB) diseases. IEE includes methods such as chromoendoscopy, optical‐digital, and digital methods. Chromoendoscopy, using dyes such as indigo carmine, aids in delineating lesions and structures, including pancreato‐/cholangio‐jejunal anastomoses. Optical‐digital methods such as narrow‐band imaging enhance mucosal details and vessel patterns, aiding in ampullary tumor evaluation and peroral cholangioscopy. Moreover, red dichromatic imaging with its specific color allocation, improves the visibility of thick blood vessels in deeper tissues and enhances bleeding points with different colors and see‐through effects, proving beneficial in managing bleeding complications post‐endoscopic sphincterotomy. Color enhancement imaging, a novel digital method, enhances tissue texture, brightness, and color, improving visualization of PB structures, such as PB orifices, anastomotic sites, ampullary tumors, and intraductal PB lesions. Advancements in IEE hold substantial potential in improving the accuracy of PB disease diagnosis and treatment. These innovative techniques offer advantages paving the way for enhanced clinical management of PB diseases. Further research is warranted to establish their standard clinical utility and explore new frontiers in PB disease management.

“…37,38 Furthermore, attempts have been made using texture and color enhancement imaging. 39,40 Double-balloon-assisted ERP (DBERP) using transparent long cap-fitted endoscope (DBERP-LC)…”

Section: Technical Tips For Pancreatic Approachesmentioning

confidence: 99%

“…However, recently, novel techniques using BAE for endoscopic approaches pancreatic duct have been reported, introducing the use of a transparent long cap 36 and gel immersion endoscopy 37,38 . Furthermore, attempts have been made using texture and color enhancement imaging 39,40 …”

Section: Technical Reviews Of Bae‐ercpmentioning

confidence: 99%

Advanced technical tips and recent insights in ERCP using balloon‐assisted endoscopy

Shimatani,

Mitsuyama,

Yamashina

et al. 2023

Pancreatobiliary endoscopic interventions using balloon‐assisted endoscopes have been widely acknowledged as the first‐line therapy for pancreatobiliary diseases in postoperative patients with reconstructed gastrointestinal anatomy (excluding the Billroth I procedure). However, there are many technical difficulties, and the procedural completion rates vary in a wide range among institutions, indicating the procedural technique is yet to be standardized. This article aims to provide technical tips of procedures and insights into the advanced aspects, including the management of extremely difficult cases and troubleshooting of endoscopic retrograde cholangiopancreatography using balloon endoscopy, along with a review of recent advancements in this field.