title: Gastroduodenal ulceration following hepatic arterial chemotherapy: the role of methylene blue endoscopy in the investigation of pain.
abstract: BACKGROUND
  Unintended perfusion of the gastroduodenum may complicate hepatic arterial chemotherapy leading to mucosal ulceration.
  
  
  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.
authors.affiliation: Liver Unit, UNSW Department of Surgery, St George Hospital, Sydney, Australia.
authors.forename: M L
authors.initials: ML
authors.lastname: Talbot
authors.forename: J R
authors.initials: JR
authors.lastname: Clark
authors.forename: P C
authors.initials: PC
authors.lastname: Clingan
authors.forename: D L
authors.initials: DL
authors.lastname: Morris