Efficacy of gel immersion endoscopic ultrasonography for delineating the duodenal papilla and pancreatobiliary ducts: A retrospective study with video

Abstract

Objectives Endoscopic ultrasonography is an important examination for periampullary diseases. The duodenum is filled with water to ensure a clear image and distend the duodenal wall without burying the papilla within duodenal folds; however, peristalsis frequently makes it difficult to maintain water within the duodenum. The gel immersion method (intestine is filled with viscosity gel) has recently been attracting attention. We evaluated the usefulness of using this method for endoscopic ultrasonography to detect and delineate the major duodenal papilla. Methods Fifty‐nine consecutive patients who underwent gel immersion‐endoscopic ultrasonography between February and March 2021 were included retrospectively. The papilla was observed by filling the duodenum with clear viscosity gel. Outcomes were the rate of duodenal distention, delineation rates of the papilla, the time required for delineation, volume of the gel used, and adverse events. Results Duodenal distention was excellent, good, and poor in 58%, 34%, and 7% of cases, respectively. The delineation rates of the papilla in the axial and longitudinal views were 98% and 66%, respectively. The median time required to delineate the papilla in each view was 3.1 (range, 1.0–1.4) and 7.9 (1.9–28.6) min; the median volume of the gel used was 80 (30–150) ml and 100 (50–200) ml, respectively. No adverse events were noted. Conclusions Gel immersion‐endoscopic ultrasonography provided sufficient duodenal distention, leading to high rates of detection and delineation of the papilla using a small volume of gel within a short time. This method may be useful for the evaluation of the ampullary region.

Covered self‐expandable metallic stent placement for tumor bleeding from duodenal invasion in patients with unresectable pancreatic cancer

“…Complications associated with CSEMS placement, except food impaction in one patient, were absent, consistent with prior reports. 8,9 In conclusion, CSEMS placement is moderately useful for tumor bleeding in patients with uPC. Although its sustained hemostatic efficacy was limited, it proved safe and was beneficial in some cases, making it worthy of consideration in this setting with limited treatment options.…”

“…Yamashita et al reported that deployment of a duodenal CSEMS is a useful salvage therapy for bleeding caused by advanced pancreatobiliary cancer, with a hemostasis rate of 100%. 8 Other than that, only a few successful cases in patients with duodenal cancer and hepatocellular carcinoma have been reported. 9 In our study, hemostasis was achieved in four out of the six patients (67%).…”

“…Among the four patients in whom hemostasis was achieved, two developed rebleeding, contrasting previous studies with no rebleeding reports. 8,9 Both patients with rebleeding were undergoing uncovered SEMS placement for severe duodenal stenosis, suggesting a higher risk of rebleeding. Rebleeding can be addressed by PRT, as demonstrated in No.…”

“…However, the treatment outcomes have been reported from only a limited number of case reports of patients with a variety of cancers. [7][8][9] Herein, we report a series of 6 patients with uPC with tumor bleeding treated by CSEMS placement. This study was conducted with the approval of the institutional review board of National Cancer Center Hospital East (No.…”

Gel immersion technique in interventional endoscopic ultrasound for pancreatobiliary lesions

“…Yet, iEUS presents challenges due to anatomical factors, posing a risk of serious complications. For observational pancreaticobiliary EUS, studies have shown that utilizing a high viscosity gel (Viscoclear; Otsuka Pharmaceutical, Tokushima, Japan) instead of water to fill the duodenal lumen yields clearer EUS images and effectively maintains the luminal dilatation for an extended period 1 2 3 . Recently, a handful of reports have explored the gel immersion technique within iEUS 4 5 .…”