Post written by Yuki Tanisaka, MD, PhD, from Saitama Medical University International Medical Center, Saitama, Japan.

A 61-year-old woman was referred to our hospital for obstructive jaundice because of unresectable pancreatic cancer. We performed endoscopic sphincterotomy before fully covered self-expandable metallic stent placement.

The following day, the patient presented with tarry stools. Endoscopic examination was performed because post–endoscopic sphincterotomy bleeding was suspected.

A new-generation image-enhanced endoscopy processing system (EVIS X1; Olympus Marketing, Tokyo, Japan) was used for examination. Upon reaching the papilla, fresh blood was observed. However, no active bleeding was viewed, and the bleeding point could not be detected on white-light imaging.

Therefore, we switched to texture- and color-enhancement imaging (TXI) to identify bleeding points such as vessels. A visible vessel thought to be a bleeding point was identified.

Subsequently, endoscopic hemostasis was performed using a hemostatic clip (SureClip; Micro-Tech Co, Ltd, Nanjing, China). The vessel protruded compared with the surrounding area, and it was identified on TXI. Even when there is no active bleeding, TXI can aid with endoscopic hemostasis, particularly in identification of visible vessels.

TXI, which is equipped in EVIS X1, facilitates the identification of structural changes such as bile and pancreatic duct orifices and vessels. In this case, we could demonstrate the usefulness of TXI for identifying the visible vessels that were the cause of bleeding.

In conclusion, EVIS X1 would aid in endoscopic pancreatobiliary procedures. EVIS X1 is so useful, so please try it out!

The new-generation endoscopy system with new technologies of texture- and color-enhancement imaging and red dichromatic imaging.

Read the full article online.

The information presented in Endoscopedia reflects the opinions of the authors and does not represent the position of the American Society for Gastrointestinal Endoscopy (ASGE). ASGE expressly disclaims any warranties or guarantees, expressed or implied, and is not liable for damages of any kind in connection with the material, information, or procedures set forth.