Abstract
Background
Visualization of the pancreatobiliary junction is one of the challenges faced by endoscopic ultrasonography (EUS). The water-filling technique, which allows for the observation of the ampulla at a suitable distance by injecting water into the lumen of the duodenum, was used for this purpose. However, a new gel immersion technique has recently been introduced for visualizing the gastrointestinal tract. This study investigated the effectiveness of visualizing the pancreatobiliary junction in EUS by comparing both water filling and the new gel immersion technique in identical cases.
Methods
The study ran from June to December 2021. Ten images from each technique were retrospectively compared by three independent researchers. The primary result of the study was the number of images depicting the “Pancreatic and Biliary Ducts Penetrating the Duodenal Muscularis Propria” (defined as Excellent observation) in each technique. The secondary outcome was defined as gel immersion technique’s safety and impact on duodenal lumen distension.
Results
Ten patients used the gel immersion technique. All patients underwent the water-filling technique first, followed by gel injection after the water was completely aspirated. The average number of pictures rated as “Excellent observation,” which is the primary outcome, was significantly higher with the gel immersion technique than with water filling, and no adverse events were observed. The subanalysis revealed that both convex and radial echoendoscopes are equally effective at depicting the ampulla with the gel immersion technique.
Conclusions
The ability to depict the pancreatobiliary junction using the gel immersion technique is superior to that of the water-filling method, which may allow for a more detailed assessment of the ampullary region with both radial and convex echoendoscopes. This can be a useful EUS technique for diagnosing pancreaticobiliary maljunction or periampullary tumors.
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Conceptualization: Hiroki Sato and Mikihiro Fujiya, Data collection: Hiroki Sato, Shugo Fujibayashi, Hidetaka Iwamoto, Yohei Kitano, Takuma Goto, and Hidemasa Kawabata, Formal analysis and investigation: Hiroki Sato, Kenji Takahashi, Hidetaka Iwamoto, and Hidemasa Kawabata, Supervision: Mikihiro Fujiya, Yusuke Mizukami, and Toshikatsu Okumura, Writing, review, and editing: Hiroki Sato and Hidemasa Kawabata, All authors contributed to the critical review and approved the final version of the manuscript.
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Mikihiro Fujiya disclosed the following conflicts of interest: Personal fees: OLYMPUS Co., Ltd., Boston Scientific Corporation, FUJIFILM Corporation, Otsuka Pharmaceutical Co., Ltd.Grants: FUJIFILM Corporation and Otsuka Pharmaceutical Co., Ltd.Payment for lectures: OLYMPUS Co., Ltd., Boston Scientific Corporation, and Otsuka Pharmaceutical Co., Ltd. Hiroki Sato, Hidemasa Kawabata, Hidetaka Iwamoto, Tetsuhiro Okada, Shugo Fujibayashi, Kenji Takahashi, Yohei Kitano, Takuma Goto, Yusuke Mizukami, and Toshikatsu OKumura have no conflicts of interest or financial ties to disclose.
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464_2024_10762_MOESM1_ESM.jpg
Supplementary file1 Flowchart for Performing EUS and Image Assessment The patient initially underwent a water-filling technique during EUS. Following the EUS observation with the water-filling technique, the gel was sprayed. All images were sequentially uploaded to PACS. The endoscopist submitted 10 images for each technique, which were evaluated by independent researchers (JPG 86 KB)
464_2024_10762_MOESM2_ESM.eps
Supplementary file2 Definition of EUS images for duodenal insufflation. A and B are excellent; C and D are good; and E and F are poor. A, C, and E are captured with a radial echoendoscope; while B, D, and F are captured with a convex echoendoscope. The white arrow represents the biliary duct, while the yellow arrow represents the pancreatic duct (EPS 6817 KB)
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Sato, H., Kawabata, H., Iwamoto, H. et al. New gel immersion endoscopic ultrasonography technique for accurate periampullary evaluation. Surg Endosc 38, 2297–2304 (2024). https://doi.org/10.1007/s00464-024-10762-6
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DOI: https://doi.org/10.1007/s00464-024-10762-6