A Study on the Diagnosis of Chronic Gastritis by the Use of Gastrocamera:--Evaluation of the Granular Appe-arance of the Gastric Mucosa--
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概要
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Among the recent progress in endoscopy, that of gastrocamera is paticularly noteworthy. Because of its f ascility of operation and clear color photograph of the gastric mucosa which can be kept in file for public discussion, it has received a wide reception throughout Japan. Gastrocamera is superior to radiological examination in many respects particularly for the diagnosis of chronic gastritis. However, interpretation of gastrocamera photographs with regard to gastritis is somewhat difficult and many discussions about the diagnostic criteria would not appear to be conclusive. The purpose of this paper is to revaluate granularity of the gastric mucosa as seen in gastrocamera photographs frequently associated with chronic gastritis. Gastrocamera findings and histopathological diagnosis were compared. Histological survey was performed in 138 sections taken from corresponding portions of the resected stomachs totaling to 105 cases in whom gastritic granules were noted in preoperative gastrocamera photographs. Some basic experiments, as follows, were first carried out to determine whether or not mucosal granules as seen in photographs could actually represent granules which were seen in formalin fixed specimen. (1) A relationship between the amount of air inflated into the stomach and thereby produced intragastric pressure was studied in 10 patients. It was noted that intragastric pressure remains zero until a certain point where the maximum size of the stomach was reached without streching of its wall. When the muscularis propria only was extended, a slight increase in pressure occured, whereas streching of the mucosa caused a sudden and marked increase. (2) Gastrocamera photographs taken under various intragastric pressure showed only a little change in the form and the distribution of gastric rugae with no further alteration in the mucosal appearance per se. The effect on mucosal granules of distension of the stomach at the time of the examination is virtually negligible. (3) The resected specimen fixed in 10% formalin over 24 hours were found to show practically the same picture as seen in the gastrocamera photographs or immediately following resection. (4) To see if tension given at the time of fixation to the gastric wall results in changes in mucosal structure, the anterior and posterior wall of fresh specimens were stretched out on a board under different tensions for comparison prior to immersion of these specimens into formalin. It was confirmed that a stretching as much as to eliminate mucosal folds gave no effect on mucosal findings. Based on the above facts, a comparison of gastrocamera photographs with histopathogical findings of the gastric mucosa prepared in an usual way is assumed to be meaningful. Mucosal granularity as observed by gastrocamera was classified into two types, namely, coares granules or papillary granules of various sizes and flattened granules of an equal size or granules with the appearance of stone-flooring or a stone fence. The latter was subdivided into two groups, the one in which granules are limited to the concave zone Between gastric rugae and the other in which granules were seen on gastric rugae as well as in between. In each of these three types of graunles, its gastrocamera characteristics correspond well to histopathological characteristics derived from statistical analysis of measurement of the granules. It was found that the first group of granules were associated with atrophic changes of chronic gastritis in 90% of cases whereas the latter two were with superficial changes in 70%. Tharefore, we would suggest to name the first group as "granules of atrophic type" and the latter two as "granules of areolar type." The gastrocamera diagnosis of chronic gastritis in our series made under above considerations along with other mucosal findings was histologically proved to de correct in 90% of cases.
- 社団法人 日本消化器内視鏡学会の論文