Texture and color enhancement imaging facilitates the identification of pancreatic and bile duct orifices after endoscopic papillectomy

Endoscopic papillectomy has been previously reported for the treatment of localized ampullary adenomas; however, pancreatitis and cholangitis can occur as endoscopic papillectomy-related adverse events [1]. For the prevention of these endoscopic papillectomy-related adverse events, endoscopic pancreatic duct and biliary stenting have been reported as being useful [1] [2] [3]. Pancreatic or biliary cannulation after endoscopic papillectomy is however sometimes difficult as the identification of these orifices can be unclear. Herein, we report a case of endoscopic papillectomy using texture and color enhancement imaging (TXI) as part of a new-generation endoscopy system (EVIS X1; Olympus Medical Systems, Japan) [4], which facilitated the identification of the pancreatic and bile duct orifices.

A 77-year-old man with a 20-mm ampullary adenoma was referred to our facility ([Fig. 1]). Radical treatment was performed with endoscopic papillectomy ([Video 1]). The ampullary adenoma was resected using snare forceps. Subsequently, we attempted to perform pancreatic and biliary cannulation for pancreatic duct and biliary stenting; however, the orifices of the pancreatic duct and bile duct were unclear on white-light imaging ([Fig. 2 a]). To identify the orifices, we therefore applied TXI, which made them clearer ([Fig. 2 b]). Pancreatic and biliary cannulation were performed easily using TXI, which allowed complete pancreatic and biliary duct stenting ([Fig. 3]).

Fig. 1 Endoscopic views showing a 20-mm ampullary adenoma: a on white-light imaging; b with texture and color enhancement imaging (TXI).

Video 1 Successful endoscopic papillectomy using texture and color enhancement imaging, which facilitated the identification of the pancreatic and bile duct orifices.

Fig. 2 Endoscopic views showing: a the orifices of the pancreatic and bile duct are unclear on white-light imaging; b the orifices of the pancreatic duct (green arrow) and bile duct (red arrow), which are much clearer on texture and color enhancement imaging (TXI).

Fig. 3 Endoscopic view showing a pancreatic duct stent (green arrow) and biliary stent (red arrow), which were easily placed after identification of the orifices.

TXI is an imaging technique that optimizes three mucosal surface elements: structure, color, and brightness. It contributes to the improved observation of lesions [4]. TXI has also been reported to improve the ability of endoscopists to identify the papilla of Vater and for selective biliary cannulation [5]. In this case, TXI was extremely useful in identifying the orifices of the pancreatic and bile ducts after endoscopic papillectomy. Therefore, TXI could contribute to reducing the rate of endoscopic papillectomy-related adverse events, such as pancreatitis and cholangitis.

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Competing interests

The authors declare that they have no conflict of interest.

Acknowledgments

We would like to thank Editage (www.editage.com) for English language editing.

• References

• 1 Itoi T, Shomei R, Akio K. et al. Clinical practice guidelines for endoscopic papillectomy. Dig Endosc 2022; 34: 394-411
• 2 Harewood GC, Pochron NL, Gostout CJ. Prospective, randomized, controlled trial of prophylactic pancreatic stent placement for endoscopic snare excision of the duodenal ampulla. Gastrointest Endosc 2005; 62: 367-370
• 3 Kobayashi M, Ryozawa S, Iwano H. et al. The usefulness of wire-guided endoscopic snare papillectomy for tumors of the major duodenal papilla. PLoS One 2019; 14: e0211019
• 4 Sato T. TXI: texture and color enhancement imaging for endoscopic image enhancement. J Healthc Eng 2021; 2021: 5518948
• 5 Miyaguchi K, Mizuide M, Tanisaka Y. et al. Distinguishing the papilla of Vater during biliary cannulation using texture and color enhancement imaging: A pilot study. DEN Open 2023; 3: e125

Publication History

Article published online:
16 September 2022