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Abstract Objectives Endoscopic transpapillary gallbladder drainage (ETGBD) is a highly technical procedure, but few studies have evaluated factors that predict its technical success. Therefore, in this study, we sought to identify predictors of technically successful ETGBD. Methods One hundred and eighty‐two patients who underwent ETGBD for acute cholecystitis at our hospital were retrospectively investigated. Factors associated with technical failure were identified by focusing on clinical characteristics, anatomical features (direction of the cystic duct branch and course of the cystic duct), and procedural factors (cystic duct and gallbladder with or without contrast and cystic duct injury). Results The technical success rate was 84.6% (154/182) and the clinical success rate was 96.1% (148/154). The adverse event rate was 11.0% (20/182; cystic duct injury in 13 patients, pancreatitis in six, and liver abscess in one. Univariate and multivariate analyses identified the right cranial direction and spiral‐type course of the cystic duct to be significant anatomical features and cystic duct injury to be a significant procedural feature contributing to the technical failure of ETGBD. Conclusions ETGBD is a highly practical procedure for patients with acute cholecystitis. However, difficulty is encountered in some cases because of anatomical and procedural factors. Our results suggest that ETGBD may be difficult and thus should not be performed in cases with the right cranial direction or spiral‐type course of the cystic duct or those with cystic duct injury.

Abstract Objective Few reports have explored the application of urinary trypsinogen‐2 measurement in the early diagnosis of post‐endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis, and none have demonstrated the benefits of noninvasive testing. This study aimed to evaluate the clinical application of the rapid urinary trypsinogen‐2 dipstick test (Nipro, Japan) compared with serum amylase and lipase levels for the early diagnosis of post‐ERCP pancreatitis (PEP). Methods A total of 100 consecutive patients (54 men and 46 women) who were admitted and underwent ERCP at Tokyo Medical University Hospital from August 2021 to December 2021 were recruited. All patients underwent rapid urinary trypsinogen‐2 measurement using the dipstick test before and after ERCP. Measurements were taken 24 h before ERCP for pre‐ERCP and 1–4 h after ERCP for post‐ERCP. Additionally, serum amylase and lipase levels were measured at 8:00 a.m. of the day after ERCP (at least 8 h after ERCP), and their diagnostic abilities for PEP were compared and evaluated. Results PEP occurred in 5/100 patients (5%). The sensitivity, specificity, positive predictive value, and negative predictive value of the dipstick test for diagnosing PEP were 100%, 83.2%, 23.8%, and 100%, respectively. These results were comparable to the diagnostic performance of serum amylase and lipase levels at 8:00 a.m. on the day after ERCP (at least 8 h after ERCP). However, false positives must be considered. Conclusion The dipstick test may be useful in clinical practice as a noninvasive screening test for the early prediction of PEP.

High-intensity focused ultrasound (HIFU) is a novel advanced therapy for unresectable pancreatic cancer (PC). HIFU therapy with chemotherapy is being promoted as a novel method to control local advancement by tumor ablation. We evaluated the therapeutic effects of HIFU therapy in locally advanced and metastatic PC. PC patients were treated with HIFU as an optional local therapy and systemic chemotherapy. The FEP-BY02 (Yuande Bio-Medical Engineering) HIFU device was used under ultrasound guidance. Of 176 PC patients, 89 cases were Stage III and 87 were Stage IV. The rate of complete tumor ablation was 90.3%, while that of symptom relief was 66.7%. The effectiveness on the primary lesions were as follows: complete response (CR): n = 0, partial response (PR): n = 21, stable disease (SD): n = 106, and progressive disease (PD): n = 49; the primary disease control rate was 72.2%. Eight patients underwent surgery. The median survival time (MST) after diagnosis for HIFU with chemotherapy compared to chemotherapy alone (100 patients in our hospital) was 648 vs. 288 days (p < 0.001). Compared with chemotherapy alone, the combination of HIFU therapy and chemotherapy demonstrated significant prolongation of prognosis. This study suggests that HIFU therapy has the potential to be a novel combination therapy for unresectable PC.

Abstract Pancreatic duct stenting is a well-established method for reducing post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis. However, there is no consensus on the optimal type of plastic stent. This study aimed to evaluate the feasibility and safety of a new 4-Fr plastic stent for pancreatic duct stenting. Forty-nine consecutive patients who placed the 4-Fr stent into the pancreatic duct (4Fr group) were compared with 187 consecutive patients who placed a conventional 5-Fr stent (control group). The primary outcome was technical success. Complications rate, including post-ERCP pancreatitis (PEP) were the secondary outcomes. Propensity score matching was introduced to reduce selection bias. The technical success rate was 100% in the 4Fr group and 97.9% in the control group (p = 0.315). Post-ERCP amylase level was significantly lower in the 4-Fr group than the control group before propensity score matching (p = 0.006), though without statistical significance after propensity score matching (p = 0.298). The rate of PEP in the 4Fr group (6.1%) was lower than the control group (15.5%), though without statistical significance before (p = 0.088) and after (p = 1.00) propensity score matching. Pancreatic duct stenting using a novel 4-Fr plastic stent would be at least similar or more feasible and safe compared to the conventional plastic stent.

Abstract This study aimed to determine the clinicopathological features of the subtypes of ampullary carcinoma (AC) to explore the indications for endoscopic papillectomy (EP) in early AC. Fifty-seven patients with AC who underwent curative resection were retrospectively reviewed. The 0/IA stages were significantly more common in the intestinal type (I-type) than in the mixed and pancreatobiliary type (M&PB-type) (90.7% vs 35.7%, P

Primary Sjogren’s syndrome (pSS) is a chronic progressive autoimmune disease with clinical phenotypic “Sicca symptoms”. In some cases, the diagnosis of pSS is delayed by 6–7 years due to the inefficient differential diagnosis of pSS and non-SS “Sicca”. This study aimed to investigate the difference between these two diseases, and in particular, their immunopathogenesis. Based on their gene expression profiles, we systematically defined for the first time the predicted disease-specific immune infiltration pattern of patients with pSS differentiated from normal donors and patients with non-SS “Sicca”. We found that it was characterized by the aberrant abundance and interaction of tissue-infiltrated immune cells, such as a notable shift in the subpopulation of six immune cells and the perturbed abundance of nine subpopulations, such as CD4+ memory, CD8+ T-cells and gamma delta T-cells. In addition, we identified essential genes, particularly long non-coding RNAs (lncRNAs), as the potential mechanisms linked to this predicted pattern reprogramming. Fourteen lncRNAs were identified as the potential regulators associated with the pSS-specific immune infiltration pattern in a synergistic manner, among which the CTA-250D10.23 lncRNA was highly relevant to chemokine signaling pathways. In conclusion, aberrant predicted disease-specific immune infiltration patterns and relevant genes revealed the immunopathogenesis of pSS and provided some clues for the immunotherapy by targeting specific immune cells and genes.

Background and study aims Endoscopic ultrasonography-guided pancreatic duct drainage (EUS-PD) has been reported as an alternative for failed conventional endoscopic retrograde cholangiopancreatography (ERCP). However, there are few dedicated devices for EUS-PD. Recently, we have developed a new plastic stent dedicated to EUS-PD and have conducted a feasibility study to evaluate its efficacy. In the current study, we evaluated the long-term efficacy of this new plastic stent. Patients and methods Thirty patients (61 ± 14.3 years old, 14 men) with acute recurrent pancreatitis caused by a stricture in the main pancreatic duct (MPD) or stenotic pancreatoenterostomy were treated at our institution using our recently developed 7Fr plastic stent between August 2013 and April 2017. Results The stent was placed successfully in all patients (30/30) and early clinical success was achieved in all of them. Early adverse events (AEs) occurred in seven patients (23.3 %), namely, self-limited abdominal pain (n = 5), mild pancreatitis (n = 1), and bleeding which required transcatheter arterial embolization (n = 1). Two patients died of primary disease and three were lost to follow-up. The remaining 25 patients were followed up after initial EUS-PD for a median of 23 months (range, 6 – 44 months). Twenty patients required regular stent exchange (3 times; range, 1 – 12 times). Spontaneous stent dislodgement was observed in six patients. Four patients wanted their stents removed 1 year after the initial intervention. Twelve patients (48 %) had regular stent exchange 1 year after the initial intervention. Three patients converted to standard transpapillary pancreatic duct stenting by conventional ERCP. Finally, nine patients (36 %) had complete stent removal either intentionally or by spontaneous dislodgement without any symptoms. Conclusion The new plastic stent for EUS-PD was associated with not only short-term technical success but also long-term clinical success in the majority of patients evaluated in this study.

BACKGROUND: Management of human teeth has moved from a surgical to a more conservative approach of inhibiting or preventing lesion progression. Increasing enamel mineralization is crucial in this regard. A potential difficulty is the preferential mineralization of the outermost portion of the enamel that can prevent overall mineralization. We describe a strategy for increasing the mineralization potential of dental enamel. METHODOLOGY/PRINCIPAL FINDINGS: Extracted human premolar teeth enamel (n = 5) were exposed to a high concentration of hydrogen peroxide with an energizing source. Samples were stored in artificial saliva at 37 degrees C for 1 wk. A desktop X-ray micro-CT system was used to evaluate the mineral density of samples. Mineral distribution was polarized between the lower and the higher mineralized portion of enamel by charged oxygen free radicals due to activation of permeated hydrogen peroxide. The kinetics of energy absorption in the deeper enamel region demonstrated improvement of preferential mineralization into the region without restricting overall mineralization of the enamel. Subsequent increasing mineralization, even in the dense mineralized outer portion of enamel, was also achieved. CONCLUSIONS/SIGNIFICANCE: This increased mineralization may promote resistance to acidic deterioration of the structure. The present study is one of the primary steps towards the development of novel application in reparative and restorative dentistry.

Background/Purpose: A peroral cholangioscope (POCS) can allow direct visualization of the biliary mucosa and its use is becoming more widespread due to improvements in functionality, image quality, and operability, as well as the development of related devices. Recently, a novel mother- baby peroral cholangioscope (nMB-POCS) with a large (2-mm) accessory channel has been developed. In this study, we evaluated the feasibility of this novel POCS in a dry simulation and animal model. Methods: We evaluated the ease of insertion and maneuverability of the nMBPOCS, the image quality, and the passage of the devices into the accessory channel and into the common bile duct in a dry and live porcine model. Results: In both models, the nMB-POCS could be easily inserted into the duodenoscope and into the distal bile duct and hilum. The image quality was good, and it was possible to observe the surface structure and the vascular network of the bile duct mucosa in detail. Conclusions: The nMB- POCS with its larger accessory channel is expected to improve the efficiency of diagnosis and treatment, and reduce the procedure time. Clinical studies in patients are warranted. [ABSTRACT FROM AUTHOR]

Background/Purpose: Shear wave elastography (SWE) is a clinical method used to evaluate liver hardness. In this study, we assessed its applicability in assessing the pancreas and its potential for diagnosing chronic pancreatitis. Methods: We performed SWE on 59 patients who underwent abdominal ultrasound, and measured the computed tomography (CT) values of the pancreas. Patients were classified as having a normal pancreas (NP), early chronic pancreatitis (ECP), or chronic pancreatitis (CP). SW elasticity (SWe), SW dispersion (SWd), and CT values between groups were analyzed. Results: SWe significantly differed between the CP and NP/ECP groups (NP vs CP; P = 0.001, ECP vs CP; P = 0.026,), while SWd showed a significant difference only between the NP and CP group (NP vs CP; P = 0.001). The CT values were significantly different between the CP and NP/ECP groups (NP vs CP; P = 0.0006, ECP vs CP; P = 0.0027). Conclusion: Pancreatic SWE and CT values were helpful in the diagnosis of chronic pancreatitis. SWd may reveal status changes in ECP. [ABSTRACT FROM AUTHOR]

Stent migration occurs in ERCP-related procedures with a frequency of 5%-10%, but gastrointestinal or transmural perforation is rare. We report a case of duodenal transmural perforation caused by a dislodged pigtail plastic stent with benign biliary stricture. A 73-year-old man was referred for examination of biliary stricture. Cholangiography showed a short-segment stricture in the lower bile duct. Biopsy specimens were collected and a 7 Fr×7 cm pigtail plastic stent was placed through the stricture. The biopsy showed no malignancy. One month later, the patient presented with transient tarry stools and abdominal pain. X-ray showed stent dislodgement and computed tomography showed the stent apparently caught in the duodenal mucosa. With a single-balloon endoscope, the proximal and distal tips were visible in the ascending duodenum, but the middle portion had penetrated the duodenal mucosa. The stent was retrieved using grasping forceps, and there was no contrast medium leakage into the retroperitoneal space. Compared with straight stents, pigtail stents have a lower risk of perforation due to their tip shape. There have been two reported cases of pigtail stent perforation. In one, the stent was placed for common bile duct stones and became lodged in multiple small bowel diverticula, leading to perforation. In the other, following stent placement for post-liver transplantation anastomosis stricture, the proximal tip migrated deep into the intrahepatic bile duct and the distal tip perforated the duodenal mucosa. In our case, no malignancy was detected and the stricture was loose, suggesting distal migration. The distal tip likely lodged into the duodenal mucosa, and peristaltic movements exerted pressure on the stent tip, causing submucosal perforation. After migrating into the submucosa, the stent perforated into the intestinal lumen. To prevent the stent from dislodging, placing the proximal end in the intrahepatic bile duct is recommended. [ABSTRACT FROM AUTHOR]

This study evaluated the clinical use of serum metabolomics to discriminate malignant cancers including pancreatic cancer (PC) from malignant diseases, such as biliary tract cancer (BTC), intraductal papillary mucinous carcinoma (IPMC), and various benign pancreaticobiliary diseases. Capillary electrophoresismass spectrometry was used to analyze charged metabolites. We repeatedly analyzed serum samples (n = 41) of different storage durations to identify metabolites showing high quantitative reproducibility, and subsequently analyzed all samples (n = 140). Overall, 189 metabolites were quantified and 66 metabolites had a 20% coefficient of variation and, of these, 24 metabolites showed significant differences among control, benign, and malignant groups (p < 0.05; Steel–Dwass test). Four multiple logistic regression models (MLR) were developed and one MLR model clearly discriminated all disease patients from healthy controls with an area under receiver operating characteristic curve (AUC) of 0.970 (95% confidential interval (CI), 0.946–0.994, p < 0.0001). Another model to discriminate PC from BTC and IPMC yielded AUC = 0.831 (95% CI, 0.650–1.01, p = 0.0020) with higher accuracy compared with tumor markers including carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9), pancreatic cancer-associated antigen (DUPAN2) and s-pancreas-1 antigen (SPAN1). Changes in metabolomic profiles might be used to screen for malignant cancers as well as to differentiate between PC and other malignant diseases. [ABSTRACT FROM AUTHOR]

We report the viscoelastic properties of core-shell-structured, hemicellulose-rich nanofibrillated cellulose (NFC) in dispersion and wet-film states. The hemicellulose-rich NFC (hemicellulose neutral sugars 23%, carboxylate 0.2 mmol g-1), prepared from Japanese persimmons, had a core crystallite thickness of 2.3 nm and unit fibril thickness of 4.2 nm. A carboxylate-rich NFC (hemicellulose neutral sugars 7%, carboxylate 0.9 mmol g-1) with crystallite and fibril widths of 2.5 and 3.3 nm, respectively, was used as a reference. The solid-concentration dependencies of the storage moduli of gel-like water dispersions of the hemicellulose-rich NFC were weaker than those of carboxylate-rich NFC, and the dispersions were loosely flocculated even at high salt concentrations and low pH values. The viscoelastic properties of wet NFC films were similar to those of their dispersions; the hemicellulose-rich NFC films were significantly less sensitive to salt concentration and pH and were soft and swollen at high salt concentrations and low pH values. [ABSTRACT FROM AUTHOR]

We report that the intrinsic viscosity [η] of nanocellulose dispersions can be solely expressed as a function of the aspect ratio p of the nanocellulose. Both short rod-like nanocrystalline and long spaghetti-like nanofibrillated celluloses were prepared as dispersions in water. The influence of the flexibility and dimensions of the nanocelluloses on the flow properties of their dispersions was investigated by experimental and theoretical approaches using seven nanocellulose samples with different widths (2.6-14.4 nm) and aspect ratios (23-376). As the aspect ratio of a nanocellulose increases, it becomes more flexible, and its dispersion has higher viscosity. Irrespective of the flexibility and dimensions of these nanocelluloses, the relationship between [η] and p was ρ[η] = 0.15 × p1.9, where ρ is the density of the nanocellulose. [ABSTRACT FROM AUTHOR]

There are currently no plastic pancreatic duct stents that have been designed for endoscopic ultrasonography (EUS)-guided placement. This study prospectively evaluated the feasibility and efficacy of a new, single-pigtail, plastic stent. Eight patients with main pancreatic duct stricture or stenotic pancreatojejunostomy underwent EUS-guided placement of the pancreatic duct stent. The stent was placed successfully in all cases (8/8). Treatment success was achieved in all cases (8/8). A mild adverse event associated with the procedure was observed in one patient but there were no other adverse events during a mean follow-up of 7.4 months. This new pancreatic duct stent appears to be feasible and effective for EUS-guided stenting. [ABSTRACT FROM AUTHOR]

Background and study aims: Recently, a novel fully covered and biflanged metal stent (BFMS) dedicated to the drainage of walled-off necrosis (WON) was developed. The aim of this study was to retrospectively evaluate the safety, efficacy, and cost performance of drainage of WON using the novel BFMS compared with a traditional plastic stent. Patients and methods: A total of 70 patients with symptomatic WON were treated under endoscopic ultrasound (EUS) guidance. Initial drainage was conducted using the single gateway technique with placement of one or more plastic stents or a single BFMS. If drainage was unsuccessful, direct endoscopic necrosectomy (DEN) was performed. Results: There were no statistically significant differences in rates of technical success, clinical success, and adverse events between plastics stents and BFMS, despite the size of WON in the BFMS group being significantly larger than that in the plastic stent group (105.6 vs. 77.1 mm; P=0.003). The mean procedure times for the first EUS-guided drainage and for re-intervention were significantly shorter in the BFMS group than in the plastic stent group (28.8±7.1 vs. 42.6±14.2, respectively, for drainage, P<0.001; and 34.9±8.5 vs. 41.8±7.6, respectively, for re-intervention, P< 0.001). There was no statistically significant difference in the total cost between plastic stent and BFMS use in the treatment of WON ($5352 vs. $6274; P=0.25). Conclusions: Plastic stents and BFMS were safe and effective for the treatment of WON. In particular, BFMS placement appeared to be preferable for initial EUS-guided drainage and additional reintervention (e.g. DEN) as it reduced the procedure time. Prospective randomized controlled trials are warranted. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 44-year-old man who was taken to the emergency room because of vomiting and abdominal pain and had a history of pancreatoduodenostomy for pancreatic head cancer.

Background. The resistance of bleached enamel to demineralization has not been elucidated fully. In this study, the authors aimed to examine the level of in vitro demineralization of human tooth enamel after bleaching by using two common bleaching regimens: home bleaching (HB) and offi ce bleaching (OB) with photoirradiation. Methods. The authors bleached teeth to equivalent levels by means of the two bleaching regimens. They used fl uorescence spectroscopy to measure the reduction in enamel density and the release of calcium into solution after storing the treated teeth in a demineralizing solution for two weeks. They also visualized and quantifi ed mineral distribution in demineralized bleached enamel over time by using a desktop microcomputedtomographic analyzer. Results. Enamel subjected to HB or to photoirradiation without bleaching showed increased demineralization. In contrast, enamel treated with OB was more resistant to demineralization. This resistance to demineralization in teeth treated with OB presumably is due to peroxide's permeating to deeper layers of enamel before being activated by photoirradiation, which enhances mineralization. Conclusions. The mineral distribution pattern of enamel after treatment plays a critical role in providing resistance to demineralization in whitened teeth. Practical Implications. OB confers to enamel signifi cant resistance to in vitro demineralization. Dentists should supervise the nightguard HB process. [ABSTRACT FROM AUTHOR]

Background/Aims In endoscopic ultrasound (EUS)-guided fine needle aspiration (EUS-FNA), a Franseen needle has been developed and the concept of EUS-guided fine needle biopsy (EUS-FNB) has become established. More tissue samples are collected, and higher accuracy is achieved with fewer punctures, and fewer punctures are expected to reduce the incidence of adverse events. In this study, we evaluated the usefulness and safety of EUS-FNB with a Franseen needle for pancreatic masses. Methods The study design was a single-center, retrospective study. Two hundred and sixty- eight consecutive patients (272 EUS-FNB) with pancreatic masses who underwent EUS-FNB with 22-gauge or 25-gauge Franseen needles were included in the study. ROSE was not performed, and the number of punctures was completed once if a white sample was obtained macroscopically, and additional punctures were performed if the amount of tissue collected was inadequate macroscopically. Results The mean age was 64.5 years, and the puncture route was 157 cases by the transgastric and 115 cases by the transduodenal route. The mean tumor diameter was 25.3 mm. The final diagnosis was pancreatic cancer in 182 cases, NEN in 28 cases, AIP in 22 cases, chronic pancreatitis in 27 cases, SPN in five cases, metastatic pancreatic cancer in two cases, SCN in one case, and LEC in one case. In 262 patients with 22-gauge needles and 10 patients with 25-gauge needles, the mean number of punctures was 2.2 (range, 1 to 5) times. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 94.6%, 98.0%, 99.5%, 80.6%, and 95.2%, respectively. Adverse events occurred in 1.5% (4/272) of patients with pancreatitis in two patients (both pancreatic cancer, 15 mm and 19 mm in size), bleeding in one patient, and pancreatic leakage in one patient. Conclusions EUS-FNB with a Franseen needle safely provides accurate pathological diagnosis for pancreatic masses with fewer punctures, and is useful in clinical practice. [ABSTRACT FROM AUTHOR]

Background. Recent diagnostic imaging tests contribute to improving the diagnosis of pancreatobiliary cancers. However, it is not practical to perform these tests for all patients as screening. Thus, less-invasive and simple screening tests are still required. A method to detect the IgG antibody induced in serum against the p53 protein accumulating due to p53 gene mutation, as a biomarker, was developed around 1990. Method. 35 patients with pancreatic cancer, 12 patients with biliary tract cancer, and 31 patients with benign pancreatobiliary diseases were entered into this study. Measurement of serum anti-p53 antibody was conducted in all patients. In addition, the rate of p53 protein overexpression was examined in those cases that could be examined pathologically. Result. Among all patients in the pancreatic cancer and biliary tract cancer groups, there was no patient with serum anti-p53 antibody positive value that exceeded the standard value. The rate of p53 protein overexpression was 48.0% in the patients with pancreatobiliary cancers and 0% in the benign pancreatobiliary diseases group. Conclusion. Serum anti-p53 antibody measurement does not contribute to the diagnosis of pancreatobiliary cancers. Instead, traditional p53 immunostaining still appears to be valuable in combination with standard procedures. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the safety and clinical application of high-intensity focused ultrasound (HIFU) therapy for unresectable pancreatic cancer (PC)., Methods: Thirty PC patients (16 cases in stage III and 14 cases in stage IV) with visualized pancreatic tumors were admitted for HIFU therapy as an optional local therapy in addition to systemic chemotherapy or chemoradiotherapy. Informed consent was obtained. This study began at the end of 2008 and was approved by the ethics committee of our hospital [Institutional Review Board (IRB): 890]. The HIFU device used was the FEP-BY02 (Yuande Bio-Medical Engineering, Beijing, China)., Results: The mean tumor size after HIFU therapy changed to 30.9 ± 1.7 mm from 31.7 ± 1.7 mm at pre-therapy. There were no significant changes in tumor size, mean number of treatment sessions (2.7 ± 0.1 mm), or mean total treatment time (2.4 ± 0.1 h). The rate of symptom relief effect was 66.7%. The effectiveness of primary lesion treatment was as follows: complete response, 0; partial response, 4; stable disease, 22; progressive disease, 4. Treatment after HIFU therapy included 2 operations, 24 chemotherapy treatments, and 4 best supportive care treatments. Adverse events occurred in 10% of cases, namely pseudocyst formation in 2 cases and mild pancreatitis development in 1. However, no severe adverse events occurred in this study., Conclusion: We suggest that HIFU therapy is safe and has the potential to be a new method of combination therapy for PC.

Aim: To evaluate the usefulness of real-time virtual sonography (RVS) in biliary and pancreatic diseases., Methods: This study included 15 patients with biliary and pancreatic diseases. RVS can be used to observe an ultrasound image in real time by merging the ultrasound image with a multiplanar reconstruction computed tomography (CT) image, using pre-scanned CT volume data. The ultrasound used was EUB-8500 with a convex probe EUP-C514. The RVS images were evaluated based on 3 levels, namely, excellent, good and poor, by the displacement in position., Results: By combining the objectivity of CT with free scanning using RVS, it was possible to easily interpret the relationship between lesions and the surrounding organs as well as the position of vascular structures. The resulting evaluation levels of the RVS images were 12 excellent (pancreatic cancer, bile duct cancer, cholecystolithiasis and cholangiocellular carcinoma) and 3 good (pancreatic cancer and gallbladder cancer). Compared with conventional B-mode ultrasonography and CT, RVS images achieved a rate of 80% superior visualization and 20% better visualization., Conclusion: RVS has potential usefulness in objective visualization and diagnosis in the field of biliary and pancreatic diseases.