Biliary cannulation under texture and color enhanced imaging (TXI)

Backgroud and aim: Image-enhanced enteroscopy (IEE) has been considered useful for the diagnosis of gastrointestinal disease; however, the efficacy of IEE in pancreatobiliary field has not been well discussed. Recently, newly developed IEE called texture and color enhanced imaging (TXI;Olympus, Japan) that enhances texture, brightness, and color has been released. Herein, we demonstrate our experience of the biliary cannulation under TXI with video.
Methods and patients: Forty patients who underwent biliary cannulation using TXI from November 2021 to February 2022 were included in the study. The site of biliary cannulation was native papilla in 26, papilla after precutting in 12, and choledochojejunal anastomosis in 2. The visibility of bile duct orifice (BDO) and the achievement of biliary cannulation were evaluated.
Results: The visibility of BDO under TXI was better as compared to that under white light imaging (WLI) in 77.5% of cases, and successful biliary cannulation under TXI was achieved in all cases. Among them, a case with intradiverticulta papilla whose BDO was unclear under WLI underwent successful biliary cannulation under TXI, which enhanced the brightness and texture of unevenness on the surface of papilla. Biliary cannulation was also achieved under TXI in another case after precutting. In this case, a reddish hole opening on the sphincter muscle suggesting BDO was well recognized under TXI.
Conclusions: TXI improved the visibility of BDO, which may help successful biliary cannulation.