LAUSR

Although the effectiveness of image-enhanced endoscopy (IEE) has been widely reported in the management of gastrointestinal tract lesions [1], its effectiveness in the pancreaticobiliary region is not yet established. Recently, a novel IEE tool called texture and color enhancement imaging (TXI; Olympus, Tokyo, Japan) has been launched; TXI has two modes: mode 1, which enhances brightness, texture, and color contrast; and mode 2, which enhances brightness and texture [2]. Herein, we report two cases in which we successfully detected the sites of choledochojejunal and pancreaticojejunal anastomotic strictures using TXI (▶Video 1). A 76-year-old woman underwent endoscopic retrograde cholangiopancreatography using balloon-assisted enteroscopy (BE-ERCP) for cholangitis with intrahepatic stones due to a choledochojejunal anastomotic stricture after livingdonor liver transplantation with Roux-enY reconstruction (▶Fig. 1). We successfully reached the end of the Roux limb; however, we could not detect the anastomosis under white-light imaging (WLI) because of the obstruction at the anastomotic site. While observing the afferent limb under TXI, we noticed a subtle whitish scar, suggestive of the choledochojejunal anastomotic stricture (▶Fig. 2). Biliary intervention was attempted at this site, and the intrahepatic bile duct stones were completely removed after balloon dilation of the choledochojejunal anastomotic stricture. ▶ Fig. 1 Computed tomography and magnetic resonance cholangiopancreatography images of a choledochojejunal anastomotic stricture in a patient who had undergone liver transplantation. Video 1 Texture and color enhancement imaging (TXI) is used to assist in detecting the sites of choledochojejunal and pancreaticojejunal anastomotic strictures, with the algorithm improving visualization of the endoscopic features by amplifying the visibility of subtle structural changes.