Gel-instillation versus saline infusion during sonohysterography: Any advantages?

Abstract

Objective To evaluate if gel-instillation sonography (GIS) is superior to saline infusion, during sonohysterography performed in patients to investigate the endometrial cavity. Design A prospective observational study. Setting The Outpatient Clinic, the Ultrasonography Department and the Office Hysteroscopy Clinic of Cairo University Medical School Hospital, Kasr El Eini. Patients We included 100 women aged 20-45 years, presenting to the outpatient clinic of our University Hospital. Interventions Two groups of patients were included, in the first (53 patients) saline infusion sonography (SIS) was performed, in the second (47 patients), we did GIS. The patients then underwent office diagnostic hysteroscopy (DH). Main outcome measures The procedure time, uterine distension time, pain scoring, the sensitivity and the specificity of each test. Results Mean procedure time was significantly shorter in the saline group than in the gel group (10.23 ± 1.69 and 14.45 ± 1.62 min, respectively, P-value = 0.0001). The uterine distention time was significantly longer in the second group (21.94 s ± 2.28), while in the first it was 7.96 ± 2.37 (P-value = 0.0001). The pain score was higher in the second group (mean = 1.45 ± 0.72) compared to 1.13 ± 0.68 in the first (P-value of 0.007). The specificity of testing with saline was 100% and the sensitivity was 64.28%, whereas in the gel group they were 97.22% and 81.81%, respectively. Conclusions Using GIS increased the procedure time, uterine distension time and patients' discomfort without effect on diagnostic accuracy. Both tests are highly specific, but the sensitivity of gel is higher.