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Selective intra-arterial methylene blue injection: a novel method of localizing gastrinoma.
Gastroenterology. 1992 Mar; 102(3):1062-4.G

Abstract

A 40-year-old woman had persistent Zollinger-Ellison syndrome despite excision of a 4-cm duodenal gastrinoma. Localizing studies including ultrasonography, computed tomography, magnetic resonance imaging, duodenal endoscopy, endoscopic ultrasonography, and intraoperative endoscopic transillumination of the duodenum failed to detect a tumor. Selective intra-arterial methylene blue injection was used to identify a 6-mm gastrinoma in the duodenum, which was locally excised. Postoperatively, the patient had a negative secretin provocative test result. This novel method uses selective arterial secretin injection with hepatic venous gastrin sampling to identify the vessel feeding the gastrinoma. An angiographic catheter is then positioned in this artery. At laparotomy, methylene blue is injected through this catheter to selectively stain the gastrinoma, facilitating its identification. Selective intra-arterial methylene blue injection can enhance intraoperative detection of small gastrinomas and may improve the rate of curative resection in the Zollinger-Ellison syndrome. Further evaluation of this novel localizing technique is warranted.

Authors+Show Affiliations

Department of Surgery, Stritch School of Medicine, Loyola University, Maywood, Illinois.No affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

1537497

Citation

Ko, T C., et al. "Selective Intra-arterial Methylene Blue Injection: a Novel Method of Localizing Gastrinoma." Gastroenterology, vol. 102, no. 3, 1992, pp. 1062-4.
Ko TC, Flisak M, Prinz RA. Selective intra-arterial methylene blue injection: a novel method of localizing gastrinoma. Gastroenterology. 1992;102(3):1062-4.
Ko, T. C., Flisak, M., & Prinz, R. A. (1992). Selective intra-arterial methylene blue injection: a novel method of localizing gastrinoma. Gastroenterology, 102(3), 1062-4.
Ko TC, Flisak M, Prinz RA. Selective Intra-arterial Methylene Blue Injection: a Novel Method of Localizing Gastrinoma. Gastroenterology. 1992;102(3):1062-4. PubMed PMID: 1537497.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Selective intra-arterial methylene blue injection: a novel method of localizing gastrinoma. AU - Ko,T C, AU - Flisak,M, AU - Prinz,R A, PY - 1992/3/1/pubmed PY - 1992/3/1/medline PY - 1992/3/1/entrez SP - 1062 EP - 4 JF - Gastroenterology JO - Gastroenterology VL - 102 IS - 3 N2 - A 40-year-old woman had persistent Zollinger-Ellison syndrome despite excision of a 4-cm duodenal gastrinoma. Localizing studies including ultrasonography, computed tomography, magnetic resonance imaging, duodenal endoscopy, endoscopic ultrasonography, and intraoperative endoscopic transillumination of the duodenum failed to detect a tumor. Selective intra-arterial methylene blue injection was used to identify a 6-mm gastrinoma in the duodenum, which was locally excised. Postoperatively, the patient had a negative secretin provocative test result. This novel method uses selective arterial secretin injection with hepatic venous gastrin sampling to identify the vessel feeding the gastrinoma. An angiographic catheter is then positioned in this artery. At laparotomy, methylene blue is injected through this catheter to selectively stain the gastrinoma, facilitating its identification. Selective intra-arterial methylene blue injection can enhance intraoperative detection of small gastrinomas and may improve the rate of curative resection in the Zollinger-Ellison syndrome. Further evaluation of this novel localizing technique is warranted. SN - 0016-5085 UR - https://www.unboundmedicine.com/medline/citation/1537497/Selective_intra_arterial_methylene_blue_injection:_a_novel_method_of_localizing_gastrinoma_ DB - PRIME DP - Unbound Medicine ER -