CRITERIA FOR GASTROSCOPIC DIAGNOSIS OF ESOPHAGEAL HIATAL HERNIA

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Because of recent improvement in diagnostic method, esophageal hiatus hernia is found more often now. For the X-ray and endoscopic diagnosis of esophageal hiatal hernia, various authors have made different. classifications, but no clear-cut endoscopic diagnostic criteria have been made so far. We have investigated the relationship between gastric wall distensibility of the upper part of stomach and intragastric pressure controlled by air insufflation. We have reported the normal opening process of the esophago-gastric junction. The esophago-gastric junction can be identified endoscopically. by the difference in tint When the junction is observed by the reverse turn technigue of a FGS, it starts to open when the intragastric pressure reaches 11 mmHg, and when completely open, the opening will be 22mm in diameter, and the junction can then be clearly identified. In this respect, we have studied the endoscopic picture of cases diagnosed as esophageal hiatals hernia by X-ray and esophagoscope in this institute, by obser-ing the dynamics of the hernia opening under pressure control with intra-gastric pressure stabilizer. technique. By using the stabilizer, the esohageal hiatal hernia can be classified into 3 grades by the state of the hiatal margin in relation to intragastric pressure. Grade : The opening of the hital margin becomes visible at pressure of 15cm H2O. Grade 2 : The opening is complete but the distention of the hernia pouch is still incomplete at 15 cm H2O. Grade 3: The opening and hernia pouch are recognizable at 5 cm H2O. Endoscopic view of the herniation under maximal dilatation can be classified into 3 types, that is, simple type, concentric type and complex type. In this respect comparison between endoscopic and radiologic findings was made. Most the simple types were in general, the small sliding type. Concentric types showed moderate size of hiatal margin, radiologically seen as the Bell hernia. Complex type corresponded with the eccentric short esphageal type and redundant esophageal type as described radiologically by Zaino. Gastroscopy permits visualization of a hernia pouch but the concomitant use of controlled intra-gastric pressure appears to aid in the demonstration of small hernias. Furthermore, this endoscopic examination makes it possible infer the radiologic findings of these. hernia types.
社団法人日本消化器内視鏡学会の論文

CRITERIA FOR GASTROSCOPIC DIAGNOSIS OF ESOPHAGEAL HIATAL HERNIA

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