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Sonography ( ultrasound ) in women with abnormal uterine bleeding is easier to perform when gel is used to distend the uterus rather than saline, a Belgian group reports -- and results are just as accurate. Dr. Thierry Van den Bosch, of University Hospitals Leuven, and colleagues note that adequate distension can be difficult to maintain with saline instillation, and it's possible that transtubal flow could seed malignant cells into the abdominal cavity. Gel instillation could overcome these problems.

For the study reported online July 7th in Fertility and Sterility, the research team evaluated 402 women with abnormal bleeding using saline instillation sonography, and then the next 402 women using gel instillation.

Technically, the gel procedure was more successful. The procedural failure rate was 5.0% for saline instillation versus 1.8% for gel instillation, and corresponding failure rates due to inadequate distension were 1.5% versus 0.3%.

The authors found endometrial hyperplasia, polyps, cancer, or intracavitary myomas in 49% of the saline group versus 40.2% of the gel group; the difference was not statistically significant.

The sensitivity was 77.8% with saline and 85.0% with gel, and the negative predictive values were 79.1% and 88.6%, respectively.

The authors say one drawback of gel instillation is the potential to misdiagnose blood clots as polyps, because saline can be used to flush away clots. Dr. Van den Bosch added a couple of other cautions in an e-mail to Reuters Health:

--For gel instillation sonography in a fertile woman, perform the examination just after the menses, before possible ovulation, and use a gel without additives.

--Don't perform gel instillation sonography in an actively bleeding patient after miscarriage or in the early postpartum; the image quality will be bad (due to blood clots) and there is a theoretical danger of intravascular injection of gel (through large open veins).

While he and his associates acknowledge that both the saline and gel techniques are feasible and accurate, they prefer the gel.

"Gel has some advantages over saline: stable filling of the uterine cavity, no need for balloon catheters, improved patient comfort, and, theoretically, a lower risk for intraperitoneal dissemination of malignant cells," the authors conclude. "Therefore, we recommend...gel instillation sonography instead of saline instillation sonography."

Source: Reuters Health