A new approach to the diagnosis of ulcers in the upper part of the stomach
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概要
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Much difficulty has been encountered in the diagnosis of lesions in the upper part of the stomach by ordinary X-ray or gastroscopic observation. The development of a backward photographing technique by using a flexible head gastrocamera enabled us to make a great improvement in diagnosis of lesions in this area. A review of my experience in 63 cases, which had been surveyed by combination of this technique and X-ray observation is reported in this paper. In most of the cases the observation was confirmed by surgical operation or by autopsy findings. The upper part of the stomach comprises cardia, fornix and the proximal third of the body of the stomach.Ordinary manipulation of gastrocamera or gastroscope is not suitable for seeing lesions in the upper part of the stomach because most of this region makes a blind area of the scope. Flexible head gastrocamera becomes useful for diagnosis of lesions in this part, when these apparatus are manipulated with a balloon inserted in the stomach so that the scope head faces cardiac area. The use of an apparatus equipped with a head which can be manipulated from outside was found to be most applicable. By using this technique, one can even see the oral boundery of the gastric cancer in this area. Unevenness of lesions in the upper part of the stomach is often exaggerated in a close up figure by ordinary techinique, but an exact figure can be obtained by using a flexible gastrocamera.About 10% of all the gastric ulcers were located in the upper part of the stomach. About one half of these distributed on the lesser curvature, one tenth on the anterior wall and the rest on the posterior wall. Kissing ulcers were very frequently found in the upper part of the stomach. Average age of the patients having ulcers in this part was higher than the average age of those having ulcers in the other part of the stomach. The upper gastric ulcer seems to be relatively difficult to heal. However, the upper gastric ulcer never resulted in perforation. Bleeding around the ulcer was seen in 35% of the cases with lesions in the upper part, while it happened only in 7% of the cases with lesions in the other part of the stomach. High folds and gothic arch formation of the high fold are valuable indirect signs for gastric ulcer. These were found in 36% of the cases of the upper gastric ulcer. Deformity of the cardiac ring, which can be seen only by use of a flexible head gastrocamera, was found to be another important indirect sign of the ulcer in cardiac area.
- 財団法人 日本消化器病学会の論文