Use of bromthymol blue, a pH indicator, for detecting the pancreatic duct orifice after resection of the head of the pancreats

Abstract

Postoperative pancreatography after resection of the head of the pancreas often provides important morphologic information. However, the orifice of the residual pancreatic duct is often difficult to detect endoscopically. We evaluated the use of bromthymol blue (BTB), a pH indicator that changes color from orange to a purplish-blue when exposed to alkaline conditions, to assist in the detection of the postoperative orifice. Pancreatography was performed in 46 patients who underwent resection of the head of the pancreas, and the utility of BTB in identifying the orifice of the pancreatic duct during endoscopy was studied. Twenty-one patients underwent endoscopy with the use of BTB. The series consisted of 8 patients who had received a pyloruspreserving pancreaticoduodenectomy with a pancreaticogastrostomy (PPPD-PG), 6 patients who had had pyloruspreserving pancreaticoduodenectomy with a pancreaticojejunostomy (PPPD-PJ), and 7 patients who had undergone a duodenum-preserving resection of the head of the pancreas with a pancreaticoduodenostomy (DPPHR-PD). The remaining 25 patients underwent conventional pancreatography without the use of BTB. This group consisted of 12 patients given a PPPD-PG, 6 patients who had received a PPPD-PJ, and 7 patients who had undergone a DPPHR-PD. The success of the postoperative endoscopic pancreatography was compared in the two groups. In all 21 patients, postoperative pancreatography with BTB resulted in a success rate of 100%, compared to success in only 10 patients who had conventional endoscopy (success rate 40%). This study demonstrated that the use of BTB significantly enhanced the success rate of endoscopic retrograde pancreatography after resection of the head of the pancreas.