Sodium morrhuate delivery to the lung during endoscopic variceal sclerotherapy

We determined quantitatively the amount of sodium morrhuate that reaches the pulmonary vascular bed during endoscopic variceal sclerotherapy to ascertain whether this affects the diffusing capacity of the lung to carbon monoxide (DLCO). Eleven patients had measurements of DLCO and specific diffusing capacity (DLCO/VA) before and after sclerotherapy. In ten of these patients sclerotherapy was done using sodium morrhuate mixed with 99mTc-labeled albumin microspheres followed by quantitative radionuclide scanning. Most of the sodium morrhuate, 80 +/- 18% (SD) of the total dose, remained in the region of the esophagus. Only 20% of the injected dose reached the pulmonary circulation. There were no changes in DLCO or DLCO/VA. We conclude that most of the sclerosing solution injected during endoscopic variceal sclerotherapy remains at the site of injection. As a result, the pulmonary endothelium is exposed to small amounts of sodium morrhuate and no change in diffusing capacity occurs.