Clinical evaluation of a novel fluoroscopic mode for improving visibility during interventional endoscopic ultrasound (with video).

Background: Interventional endoscopic ultrasound (I-EUS), including EUS-guided biliary drainage, is now widely performed, but it becomes challenging if the visibility of devices is inadequate. A novel visibility enhancement mode, termed "Accent mode," has recently become available for use with a fluoroscopic system.

Objective: To compare the visibility of each device and pancreato-biliary ducts between Accent mode and Original mode during I-EUS.

Design: A single-center non-randomized evaluation study.

Methods: Patients who underwent I-EUS under Accent mode were prospectively enrolled. All evaluations were performed using recorded procedural videos. The visibility score was graded on a five-item scale, with evaluations performed by three experts and seven trainees.

Results: Twenty patients (Accent group) and 24 patients (Original group) were enrolled. Mean guidewire visibility scores were significantly higher in the Accent group (4.95 and 4.95 in the expert and trainee observers, respectively) than in the Original group (2.53 and 2.32, respectively; p < 0.001). For the dilation device, visibility scores were significantly higher in the Accent group (4.47 and 4.58 in the expert and trainee observers, respectively) than in the Original group (2.68 and 2.53, respectively; p < 0.001). Stent visibility scores were significantly higher in the Accent group (4.16 and 4.32 in the expert and trainee observers, respectively) than in the Original group (2.89 and 2.68, respectively; p < 0.001). Procedure time was significantly shorter in the Accent group than in the Original group (10.3 vs 17.2 min, p = 0.0012).

Conclusion: In conclusion, Accent mode appears to reduce I-EUS procedure time. It is necessary to confirm these findings in a prospective, randomized, controlled trial.