A Study on Gastrocamera Findings of Gastric Ulcer; Precise Comparison between Gastrocamera Photographs and Pathohistological Findings
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概要
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The material consisted of benign ulcer caces in which resection was performed within 3 days following gastrocamera examination. The resected specimens were semi-serially sectioned and compared with the gastrocamera photographs in regard to 1) the tran sectional diagram, 2) the base, 3) regenerating mucosa, and 4) marginal elevation. It should be emphasized that each view of transection was compared in detail with the corresponding part of gastrocamera photographs.1. The transectional diagram Ulcer was divided into four forms depending on the pattern of transection as follows; 1) Undermined type, 2) Right angle type, 3) Inclining type, and 4) Flat type. It was then revealed that these types could be accurately demonstrated by the gastrocamera. Compared with the histopathological findings, relationships between the above mentioned patterns and the histological depth of ulcer was analysed.2. Ulcer base Color of the base was compared with its histolcgical structure. 1) If the base is uniformly white endoscopically, the first layer of the base (the layer of exsudate) rarely contained erythrocytes, and the layer mainly consisted of leucocytes and the second layer (the layer of fibrinoid necrosis) showed minimal development. 2) When the base was uniformly dark brown or white mixed with dark brown parts, the dark brown usually represented the presence of erythrocytes in the first layer. The second layer was also well developed in these cases. 3) When the base appeared white mixed with pinkish red color, the first layer was thinn and the second layer was absent. The pinkish red portion was consistent with exposure of the third or fourth layer (the layer of granulation tissue or the layer of scar tissue).3. Regenerating mucosa The regenerating mucosa was deviled into three grades acording to the stage of development ; the regenerating epithelium only, immature regenerating mucosa, and fully mature regenerating mucosa. Then, redness as seen by the gastrocamera appeares to be related tothe grade of development. Cases showing redness tended to contain immature regenerating mucosa, and vice versa. The mature regerating mucosa was difficult to differentiate endoscopically from the adjacent mucosa.4. Marginal elevation Elevation of the ulcer margines as seen endoscopically was divided into three grades ; marked, moderate and slight, and compared with thickness of the specimen. Naturally, endoscopic and actual thickness corresponded well with each other. The thickness of the margines mainly depended upon the amount of fibrosis in the subserosal layer.5. Conclusion Based on the above findings, an attempt was made to show endoscopic characteristics of ulcers with little healing tendency and with healing tendency.
- 社団法人 日本消化器内視鏡学会の論文