title: Pancreatic intubation facilitated by methylene blue injection decreases the risk for postpapillectomy acute pancreatitis.
abstract: OBJECTIVE
  Endoscopic snare papillectomy (ESP) is a viable alternative to surgical treatment of ampullary adenomas and T1N0 stage ampullary carcinomas. The main drawback of this technique is the high risk of acute pancreatitis post procedure.The aim of this study was to assess the efficacy, safety, and long-term results of this procedure, and to determine whether routine pancreatic intubation facilitated by intraductal methylene blue (MB) injection reduces the risk for pancreatitis.
  
  
  METHODS
  Between 2004 and 2011, 56 consecutive patients underwent ESP. Before resection, the pancreatic duct was cannulated, and MB was injected intraductally to facilitate stent placement after ampullectomy.
  
  
  RESULTS
  ESP was performed en bloc in 45 patients with histological findings of low-grade dysplasia (39%), high-grade dysplasia (25%), carcinoma (32.5%), and others (3.5%). The morbidity rate was 19.5%: acute pancreatitis (n=6), bleeding (n=4), perforation (n=1), and sepsis (n=1). Pancreatic intubation was performed in 89% of the patients. Postprocedure pancreatitis occurred significantly less in the patients with a pancreatic stent than in those without: 3/49 versus 3/6, P=0.013. ESP was considered as curative in 39 patients (75%). Of the 12 recurrences (25%), 10 were managed endoscopically, but with higher morbidity (acute pancreatitis=40%).
  
  
  CONCLUSIONS
  Endoscopic papillectomy is safe and effective in the hands of experts. Pancreatic-duct stent placement in fewer cannulation attempts could be facilitated by injection of MB before papillectomy, and this decreases the risk for postprocedure pancreatitis. Recurrences can be managed endoscopically, but with a higher risk for pancreatitis.
authors: Departments of aDigestive Diseases bPathology cClinical Research Unit dBiostatistics Unit, DRCI, University Hospital of Clermont-Ferrand eJean Perrin Centre, Clermont-Ferrand, France.
authors: Laurent
authors: L
authors: Poincloux
authors: Julien
authors: J
authors: Scanzi
authors: Marion
authors: M
authors: Goutte
authors: Bruno
authors: B
authors: Pereira
authors: Hervé
authors: H
authors: Devaud
authors: Juliette
authors: J
authors: Joubert
authors: Michel
authors: M
authors: Dapoigny
authors: Gilles
authors: G
authors: Bommelaer
authors: Armand
authors: A
authors: Abergel
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater; D004396:Coloring Agents; D003138:Common Bile Duct Neoplasms / Q000601:surgery*; D004384:Duodenoscopy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D007440:Intubation / Q000379:methods; D008297:Male; D008751:Methylene Blue; D008875:Middle Aged; D010183:Pancreatic Ducts; D010195:Pancreatitis / Q000209:etiology / Q000517:prevention & control*; D040242:Risk Reduction Behavior; D015607:Stents; D055815:Young Adult
chemical_list: D004396:Coloring Agents; D008751:Methylene Blue