FLUORESCENCE ENDOSCOPY TO DETECT SCARRING OF A GASTRIC OR DUODENAL ULCER

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• One of the troublesome problems in treating patients with a peptic ulcer is when we should stop the administration of antiulcer drugs, for it is still debatable which finding may signify complete healing of an ulcer though many authors have discussed this problem. In our previous study on fluorescence endoscopy for the active gastric or duodenal ulcers, the amout of fluorescence mainly reflected local mucosal blood flow and a decrease of fluorescence at the margin of an ulcer strongly suggested the hardness of healing. In order to apply this method for the estimation of the complete healing of an ulcer, patients with a gastric or a duodenal ulcer scar were investigated in this paper. Materials and methods: The method of fluorescence endoscepy was previously reported by the author, as an modification of original Katsu's method. The amount of f lurescence was measured using a light sensor (cadmium sulfate, Cds) on the films which were taken endoscopically about five seconds after the appearance of the fluorescent light on the scarring mucosa (Fs) and surrounding intact mucosa (Fi) (Fig. 1, 3). Fs/Fi ratio was called "healing index" since it may indicate maturity of scarring tissue . Materials were three canines with gastriculcer induced by acetic acid, 14 patients with a gastric ulcer scar (18 cases with red scar and two cases with white scar) and eight patients with a duodenal ulcer scar (ten with scar I and two with scar II). Results: 1) Experimental study; Healing indeces were low in the first and second week of scarring period, but later increased rapidly and became close to the value of 1.0 (Fig. 4). 2) Clinical study; Majority (16 of 18 cases) of gastric red scar showed healing indeces lower than 0. 8, on the other hand, in two cases with white gastric scars the indeces were higher than 0.8. Four cases with a long-standing ulcer scar showed low healing indeces continusly, and one of them relapsed two months later (Fig. 7, 8). In cases of duodenal ulcer scar, the indeces were higher than those in cases of gastric ulcer scars (Fig.6). From these results, it is suggested that the healing index may well indicate the grade of regeneration in the scarring tissue, and that the probability of recurrence would be higher when the value remains low for a long time.

• 社団法人 日本消化器内視鏡学会の論文

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