Pancreatobiliary cases

This video demonstrates the utility of a new image enhanced endoscopy system in identifying bile acid-rich ampullary lesion. A well-defined ampullary lesion was observed in white-light imaging (WLI), but detailed observation was difficult in narrow-band imaging (NBI) due to the interference from bile acid. TXI modes provided more information of surface structural features including hyperemic microvasculature beneath circular fold with less interference from bile acid. RDI mode 3 provided detailed information of ampullary lesion for targeted forceps biopsy without any interference from bile acid. After forceps biopsy, RDI mode 1 could more easily identify the hemostatic status of the ampulla of Vater, making it easier to determine whether there are bleeding points requiring endoscopic hemostasis compared to NBI. When detailed observation using NBI is difficult due to bile acid, applying TXI and RDI modes can be helpful for accurate evaluation of abnormalities of ampulla of Vater.