Does the addition of methylene blue to the sclerosant improve the accuracy of injections during variceal sclerotherapy?

Abstract

We evaluated the possibility that the addition of methylene blue to the sclerosant would improve the accuracy of intravariceal injections during endoscopic variceal sclerotherapy. Four patients had eight sessions of endoscopic variceal sclerotherapy with a sclerosant containing a combination of 3% sodium tetradecyl and 60% renograffin. For four sessions, 1 ml of methylene blue was added to 9 ml of sclerosant. The endoscopist judged each injection to be intravariceal or paravariceal. This was confirmed by fluoroscopy. There were 57 injections (28 with methylene blue, 29 without) in the eight sclerotherapy sessions. Intravariceal injections were confirmed fluoroscopically in 64.9% of injections (60.7% with methylene blue 69% without). The endoscopist correctly assessed intravariceal versus paravariceal injections 66.7% of the time (71.4% with methylene blue, 62% without). None of the differences approached statistical significance. The addition of methylene blue to the sclerosant does not improve the accuracy of intravariceal injections or the endoscopist's ability to recognize paravariceal injections during sclerotherapy of esophageal varices.