Gastroduodenal ulceration following hepatic arterial chemotherapy: the role of methylene blue endoscopy in the investigation of pain.

BACKGROUND: Unintended perfusion of the gastroduodenum may complicate hepatic arterial chemotherapy leading to mucosal ulceration. PATIENTS AND METHODS: In a review of 233 consecutive hepatic artery catheters placed, 61 patients were investigated for chemotherapy-related epigastric pain. Investigations included catheter imaging, upper gastrointestinal endoscopy with methylene blue injection via the hepatic artery catheter and angiography. RESULTS: Twenty patients (33%) demonstrated blue staining of the gastroduodenum. Angiography performed in 15 of these patients confirmed a misperfusing vessel in 13.The aberrant artery was successfully embolised and infusional chemotherapy recommenced in 11 patients. Forty-one patients had a negative dye test, of whom three had gastroduodenal ulcers, 14 had oesophagitis or gastroduodenitis, ten had catheter complications (leak n=2, arteritis n=5, pseudoaneurysm n=1, sepsis n=1), three had liver collections, five had floxuridine cholangitis and one had myocardial ischaemia. No cause could be found in 8 patients. No patient with a negative dye test developed unintended perfusion on repeat investigation.

Lipiodol avid liver metastases from adrenocortical carcinoma; prospects for therapy?

A young lady with liver metastases from adrenocortical carcinoma was given a tracer dose of lipiodol into the hepatic artery and her liver metastases were shown to be extremely lipiodol avid. A therapeutic dose of lipiodol I131 was then given. There was not, however, any evidence of response to this treatment.