Clinical and Experimental Studies on Diagnostic Limits of the Endoscopical Examination to the Gastric Ulcerative Lesions
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To know the limit of the reliability of endoscopical diagnosis of the gastric lesions, the author picked up the minor changes such as the erosions in the stomach as a subject of this study. The endoscopical features of gastric erosions were analysed and compared with that of the proved tiny early gastric cancers, and furthermore the minor changes in color as well as the diagnostic limits of the gastric ulcerations produced in the dogs by means of thermocautery procedures were studied on the series of gastro-camera films which were taken on every 2-4 days. The results were as follows. 1. On the 22 resected stomachs, 93 erosions were found macroscopically, among which 82 were noted as erosion or erosion-like on the gastro-camera films. 2. The gastric erosions more than 1 mm in diameter were classified into 4 types according to the features of their bulging borders (R<SUB>1</SUB> or R<SUB>0</SUB>) and marginal demarcations (U<SUB>1</SUB> or U<SUB>0</SUB>). 3. In 93 erosions, 39 were classified into R<SUB>1</SUB> type and 54 into R<SUB>0</SUB> type. The erosions were ranged from 1 mm to 80 mm in diameter, but almost of them were distributed within 2-8 mm. Seventy three per cent of the erosions distributed within the region of the gastric incisura and antrum, and there were no differences as to the R classification. 4. Thirty four erosions out of 93 found in resected specimen were identified with those erosions on the gastro-camera films taken within 24 hours prior to operations and their endoscopical features were compared with histological ones. As characteristics of R<SUB>1</SUB> type, localized swelling, reddening of mucosal folds and white or yellowish coating at the top of swelling were found endoscopically. In R<SUB>0</SUB> type, slightly demarcated reddening and hemorrhage were observed. 5. Eighty two lesions of erosion in gastro-camera films were analysed by RU classification to determine how many lesions could be diagnosed before operation. Applying such endoscopical criteria, endoscopical diagnostic accuracies of R<SUB>1</SUB>, R<SUB>0</SUB> and U<SUB>1</SUB>, U<SUB>0</SUB> types were 24/32, 10/50 and 25/50, 9/32 respectively. U<SUB>1</SUB> means distinct margin and U<SUB>0</SUB> indistinct one. In total, 34 lesionsr of erosions were diagnosed correctly by endoscopy before operation. 6. Nine cases with tiny early gastric cancers of depressed type were detected by us sof ar. As the endoscopical characteristics, interruption, bulging and irregular swelling of the terminal of converging mucosal folds, abnormal reddening, lack of uniformity in color, unevenness of the surface, roughness of the margin, irregular shape of the central depression and islands-like abnormal reddening were observed. Among those findings, irregular margin, irregular shape in central depression and lack of uniformity in color were most important for diagnosis. 7. By the methods of thermocautery procedures, numerous mucosal defects ranging from erosion to ulcers in various type were produced in dogs and were followed endoscopically at 2-4 days intervals successively. Hemorrhages with localized mucosal swelling were found in a few days after thermocauterization. After the hemorrhages disappeared, persisting localized mucosal swelling and white coating at the top of ulcer were observed. Most of the mucosal swelling disappeared on 14th-16th day after thermocauterization, although there still remained patchy mucosal reddening. On the 20th day after thermocauterization, color of central parts changed into grayish-white and thereafter whitish discoloration, which persisted about 2 months. Then, they recovered to similar tone in color to the sorrounding mucosa. 8. From the results above mentioned, it is possible to diagnose the minor lesions of few mm in diameter such as erosions in the stomach by endoscopical examination. Also, the degree of mucosal epithelizations could be determined endoscopically by observing the minor changes in color
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