ArticleBMC gastroenterology2026
Duct-focused digital subtraction pancreatography for pancreatic duct visualization: a retrospective pilot study.
Article in BMC gastroenterology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundDigital subtraction pancreatography (DSP) has been proposed as a technique to reduce background interference and facilitate pancreatic duct visualization during endoscopic procedures. However, objective evaluation of DSP image interpretability and its clinical applicability remains limited.
methodsThis single-center retrospective cohort study included 21 pancreatic ductography procedures performed between September 2022 and October 2025, comprising 11 DSP cases and 10 conventional pancreatography cases. Two independent endoscopists evaluated DSP images using predefined criteria for main pancreatic duct (MPD) visualization, background suppression, and branch duct visualization on a 3-point scale. Interobserver agreement was assessed. Secondary outcomes included technical feasibility, radiation exposure, and procedure-related adverse events.
resultsDSP was technically feasible in all cases (11/11, 100%), with successful acquisition of subtracted images using a single acquisition per procedure. In intra-individual image assessment of the 11 DSP cases, MPD visualization scores were identical between conventional and DSP images (2.91 vs. 2.91, p = 1.000), whereas branch duct visualization showed a numerical improvement with DSP (2.00 vs. 1.73, p = 0.063). Interobserver agreement assessed by weighted kappa demonstrated substantial reliability for branch duct visualization (κ = 0.74) and moderate reliability for background suppression (κ = 0.49). Median total radiation dose did not differ significantly between the DSP and conventional groups (31.0 vs. 48.3 mGy, p = 0.65). No procedure-related adverse events were observed.
conclusionsDSP provided generally interpretable pancreatic duct visualization with background suppression and was feasible without increasing radiation exposure. Although no clear advantage over conventional pancreatography was demonstrated, DSP may serve as a supplementary imaging technique in selected cases where background interference limits duct visualization. Further studies are warranted to define its clinical indications.
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