title: Use of methylene blue to identify the minor papilla or its orifice in patients with pancreas divisum.
abstract: BACKGROUND
  In some patients with pancreas divisum, minor papilla cannulation is difficult because of uncertain identification of the papilla or its orifice, even after pancreatic secretory stimulation with secretin or cholecystokinin agonist.
  
  
  METHODS
  Two techniques with methylene blue were used to identify the minor papilla and its orifice more clearly in a series of patients: spraying methylene blue over duodenal mucosa in the region suspected to contain the minor papilla with/without secretin or cholecystokinin agonist administration, and injection of contrast medium containing methylene blue into the ventral pancreatic duct by means of the major papilla in cases of incomplete pancreas divisum. Results were reviewed retrospectively.
  
  
  RESULTS
  From January 2001 to May 2002, minor papilla cannulation with conventional methods initially failed in 38 of 305 patients with pancreas divisum because of an inconspicuous minor papilla orifice. Methylene blue was used to identity the minor papilla orifice in 14 of 38 patients (spraying, 13; injection, 1). Minor papilla cannulation was successful in 12 of 14 (86%) patients (spraying 11, injection 1). Mild pancreatitis developed in 1 patient.
  
  
  CONCLUSIONS
  Methylene blue spraying or injection appears to be a helpful technique for identification of the inconspicuous minor papilla orifice in patients with pancreas divisum.
authors.affiliation: Division of Gastroenterology/Hepatology, Indiana University Medical Center, Indianapolis, Indiana 46202, USA.
authors.forename: Sang-Heum
authors.initials: SH
authors.lastname: Park
authors.forename: Mario
authors.initials: M
authors.lastname: de Bellis
authors.forename: Lee
authors.initials: L
authors.lastname: McHenry
authors.forename: Evan L
authors.initials: EL
authors.lastname: Fogel
authors.forename: Laura
authors.initials: L
authors.lastname: Lazzell
authors.forename: Lois
authors.initials: L
authors.lastname: Bucksot
authors.forename: Stuart
authors.initials: S
authors.lastname: Sherman
authors.forename: Glen A
authors.initials: GA
authors.lastname: Lehman
mesh_terms: D002404:Catheterization / Q000379:methods; D002760:Cholangiopancreatography, Endoscopic Retrograde; D004384:Duodenoscopy; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology; D008297:Male; D008751:Methylene Blue; D008875:Middle Aged; D010179:Pancreas / Q000002:abnormalities*; D010183:Pancreatic Ducts / Q000473:pathology*
chemical_list: D008751:Methylene Blue