Zhang DY, Yang S, Geng HX, Yuan YJ, Ding CJ, Yang J, Li MY. Real-time continuous image guidance for endoscopic retrograde cholangiopancreatography based on 3D/2D registration and respiratory compensation. World J Gastroenterol 2023; 29(20): 3157-3167 [PMID: 37346159 DOI: 10.3748/wjg.v29.i20.3157]
Corresponding Author of This Article
Ming-Yang Li, PhD, Chief Physician, Doctor, Department of Gastroenterology, The First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China. mingyangli_pla@163.com
Research Domain of This Article
Surgery
Article-Type of This Article
Observational Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Da-Ya Zhang, Ming-Yang Li, Department of Gastroenterology, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
Shuo Yang, Hai-Xiao Geng, Yu-Jia Yuan, Chi-Jiao Ding, Jian Yang, School of Optics and Photonics, Beijing Institute of Technology, Beijing 100081, China
Author contributions: Yang S and Zhang DY designed the registration algorithm and finished the manuscript; Geng HX designed the experiment and revised the manuscript; Ding CJ and Yuan YJ collected the data; Yang J and Li MY made corrections to the article. Zhang DY and Yang S contributed equally to this work, and they are co-first authors; Li MY and Yang J contributed equally to this work, and they are co-corresponding authors.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee of the General Hospital of the Chinese People’s Liberation Army (approval No. S2021-415-01).
Informed consent statement: All study participants or their legal guardian(s) provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
Data sharing statement: All data and materials involved in the manuscript are available upon request.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ming-Yang Li, PhD, Chief Physician, Doctor, Department of Gastroenterology, The First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China. mingyangli_pla@163.com
Received: February 27, 2023 Peer-review started: February 27, 2023 First decision: March 28, 2023 Revised: April 7, 2023 Accepted: April 18, 2023 Article in press: April 18, 2023 Published online: May 28, 2023 Processing time: 87 Days and 23.5 Hours
Abstract
BACKGROUND
It has been confirmed that three-dimensional (3D) imaging allows easier identification of bile duct anatomy and intraoperative guidance of endoscopic retrograde cholangiopancreatography (ERCP), which reduces the radiation dose and procedure time with improved safety. However, current 3D biliary imaging does not have good real-time fusion with intraoperative imaging, a process meant to overcome the influence of intraoperative respiratory motion and guide navigation. The present study explored the feasibility of real-time continuous image-guided ERCP.
AIM
To explore the feasibility of real-time continuous image-guided ERCP.
METHODS
We selected 2 3D-printed abdominal biliary tract models with different structures to simulate different patients. The ERCP environment was simulated for the biliary phantom experiment to create a navigation system, which was further tested in patients. In addition, based on the estimation of the patient’s respiratory motion, preoperative 3D biliary imaging from computed tomography of 18 patients with cholelithiasis was registered and fused in real-time with 2D fluoroscopic sequence generated by the C-arm unit during ERCP.
RESULTS
Continuous image-guided ERCP was applied in the biliary phantom with a registration error of 0.46 mm ± 0.13 mm and a tracking error of 0.64 mm ± 0.24 mm. After estimating the respiratory motion, 3D/2D registration accurately transformed preoperative 3D biliary images to each image in the X-ray image sequence in real-time in 18 patients, with an average fusion rate of 88%.
CONCLUSION
Continuous image-guided ERCP may be an effective approach to assist the operator and reduce the use of X-ray and contrast agents.
Core Tip: Three-dimensional imaging allows easier identification of bile duct anatomy and intraoperative guidance of endoscopic retrograde cholangiopancreatography (ERCP). Continuous image-guided ERCP may be an effective means to assist the operator and reduce the use of X-ray and contrast agents.
