Open AccessDistinguishing the papilla of Vater during biliary cannulation using texture and color enhancement imaging: A pilot study
Author(s) -
Miyaguchi Kazuya,
Mizuide Masafumi,
Tanisaka Yuki,
Fujita Akashi,
Jinushi Ryuhei,
Hiromune Katsuda,
Ogawa Tomoya,
Saito Yoichi,
Tashima Tomoaki,
Mashimo Yumi,
Imaeda Hiroyuki,
Ryozawa Shomei
Publication year - 2023
Publication title -
den open
Language(s) - English
Resource type - Journals
ISSN - 2692-4609
DOI - 10.1002/deo2.125
Subject(s) - major duodenal papilla , mcnemar's test , medicine , kappa , bile duct , cohen's kappa , concordance , radiology , ampulla of vater , cadaveric spasm , white light , nuclear medicine , gastroenterology , surgery , pathology , mathematics , statistics , geometry , carcinoma , physics , optics
Abstract Objectives Understanding the exact morphology of the bile duct opening is important for determining the success of bile duct cannulation. Texture and color enhancement imaging (TXI) has been reported to enhance slight changes in color tone and structure that are difficult to see with white light imaging. This study investigated whether TXI mode1 could improve papillary recognition by trainees inexperienced in endoscopic retrograde cholangiopancreatography. Methods We included 31 patients with naive papilla of Vater at a single institution in the study. Trainee endoscopists (n = 4) evaluated and identified the papilla according to the Inomata classification using white light imaging and TXI. The degree of agreement with the evaluation of supervising physicians ( n = 4) was examined using the McNemar test. Results In the trainee group, the kappa coefficient agreements were κ = 0.346 and κ = 0.754 for white light imaging and TXI, respectively. When further evaluated, the separate and septal types of papilla groups showed an increased concordance rate in one of the four trainees (76.67%–96.67%, p = 0.031, respectively). Moreover, comparison for two‐group evaluation showed an increased kappa coefficient in two of four trainees (0.34–0.92, p = 0.010, 0.45–0.92, p = 0.024). Conclusions Observation of the duodenal papilla using TXI improved papillary differentiation and suggested the potential of TXI as a clinical tool. Further study of this method is necessary; it is expected to help reduce cannulation time and the incidence of pancreatitis.