Post written by Atsushi Saito, MD, Shugo Fujibayashi, MD, PhD, Tamaki Momoi, MD, and Tsuneshi Fujii, MD, PhD, from the Department of Gastroenterology, Japanese Red Cross Asahikawa Hospital, Asahikawa, Hokkaido, Japan.

We discussed 3 cases of successful biliary cannulation using precutting with TeXture and color enhancement Imaging (TXI) in patients with obstructive jaundice caused by pancreatic head cancer. In all 3 cases, the incision surface created by precutting was more clearly visualized with TXI than with white-light imaging, aiding in identification of the biliary orifice.

With ERCP, precutting is often performed in cases of difficult biliary cannulation, but it is a high-risk procedure associated with potential adverse events. TXI, a new image enhancement mode available on the EVIS X1 system (Olympus Marketing, Tokyo, Japan), can be easily used with the push of a button.

Many reports address its use in GI regions, but those focusing on its application in pancreatobiliary endoscopy are limited. In addition, although TXI is anticipated to be useful for precutting, few detailed video reports show how the incision site appears under TXI during the procedure.

This article provides a detailed video demonstration of how the incision surface created by precutting is visualized using TXI. It was observed that TXI offers clearer visualization of the layered structure of the incision surface and the bile duct mucosa than with white-light imaging. In this regard, this study is considered valuable.

Detailed observation of the incision site is critically important during precutting. TXI may be useful in this regard and is easy to use, making it a valuable option to be aware of.

Compared with WLI, both TXI mode 1 and mode 2 help visualize the incision surface more clearly. TXI mode 1 enhances texture, brightness, and color, whereas mode 2 enhances texture and brightness. Red arrows denote the bile duct orifice. TXI, TeXture and color enhancement Imaging; WLI, white-light imaging.

Read the full article online.

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