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Real-time visualization of pancreatic juice leakage

Novel approach to preventing critical complications after surgery


University Hospital

Surgery sometimes results directly or indirectly in the formation of a fistula, a connection between organs or parts of the body that should not otherwise be connected. The formation of a pancreatic fistula (PF) remains the most serious complication after surgery on the digestive tract, and is caused by protease activity in leaking pancreatic juice. PFs are very difficult to prevent because there is no means of visualizing the leakage of pancreatic juice during surgery, or of evaluating the protease activity of any leaking fluid.

Visualization of the leakage of pancreatic juice using chymotrypsin probe.
Images on the left, middle and right show respectively the gross appearance of the pancreatic stump, monochrome appearance of the ?lter paper immediately after placement on the pancreatic stump, and ?uorescence images of the ?lter paper obtained 1 minute after spraying with the chymotrypsin probe.
© Suguru Yamashita, Tomoyo Sakabe, Takeaki Ishizawa,
Yasuteru Urano, Norihiro Kokudo.

Todai researchers at the University Hospital have designed and developed a new rapidly-activated high-fluorescence probe for the protease chymotrypsin. When the chymotrypsin probe was sprayed onto filter paper that had been placed on the resected pancreatic stump during pancreatic resection, the leakage of pancreatic juice was clearly visualized using blue-light illumination and a yellow filter. The chymotrypsin probe enabled the protease activity in the drained pancreatic fluid samples to be determined and allowed the real-time visualization of the leakage of pancreatic juice during surgery.

Symptomatic PFs developed only in patients where the present technique detected the leakage of pancreatic juice, indicating that this new fluorescent probe will be of great value to surgeons in preventing the formation of postoperative PFs.

The results of this study were published in the British Journal of Surgery Online (13 June 2013, UK). This research was supported by the Japan Science and Technology Agency.

Press release (Japanese)


S. Yamashita, M. Sakabe, T. Ishizawa, K. Hasegawa, Y. Urano, N. Kokudo,
“Visualization of the leakage of pancreatic juice using a chymotrypsin- activated fluorescent probe”,
British Journal of Surgery Online Edition: 2013/6/13, doi: 10.1002/bjs.9185.
Article link


The University of Tokyo Hospital

Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine (Japanese)

Laboratory of Chemical Biology and Molecular Imaging, Graduate School of Medicine

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