Endoscopic Study on Gastric Ulcer and Scar using with Dye-Spreading Method

Abstract

The present study represents an attempt to establish a new endoscopic method for the pursuit of morphologic changes of the gastric mucosa by means of sprinkling a dye solution over the mucosa aiming three dimensional effect, which makes clear a minute alteration of the mucosal surface using this method, fibergastroscopy could give much more information than that from the ordinary method. With a confirmation of the endoscopic findings by this method applied for a series of one hundred cases with gastric ulcer and seventy cases with ulcerativescars, a study was made about some problems concerning the ulcerative and healing process of the gastric mucosa. The morphologic attributes subjected to the present fibergastroscopic study including the shape, size and depth of the ulcer, an outlook of the exposed raw surface of the submucosa, color of the coating, periulcerative excavation and eminence, edema, fine granular changes, diffuse reddishness, red hallos and erosions of the mucosa and convergency of the mucosal folds in the case of ulceration, whereas in the case of healing scars, the findings lncluding white coating, depression, fine cicatricial lines, rubor, red hallos, fine granular changes, fine mucosal convergence, area gastrica, convergence of mucosal folds and deformities of the gastric wall were carefully checked. The cases with gastric ulceration were classified into two major groups according to the stage of healing ; i.e. one was the ordinary healing group in which the course of events comprised active stage, regressive stage and regressive cicatricial stage and another was the protracted healing group in which the findings consisted of prolonged active stage, prolonged progressive stage and stage of linear ulceration The endoscopic findings were eventually characteristic of the two differant processes of ulceration. With the ordinary healing group, large, deep, and round or elliptical ulcers with a diffuse reddishness, edema and erosions which all represent inflammatory reactions, were evident together with excavation and eminence of the mucosa in periulcerative regions as well as a profound convergence of thick folds at the active stage. As time went on, the ihflammatory changes became replaced with marked red hallo formation at the regressive stage. Subsequently, the ulcers became markedly shrunk with substantially reduced depth, and the bottom of the ulcer showing clean and irregular shape at the following stage had convergence of fine mucosal folds which increased in extent. With the protracted healing group, in contrast, the ulcers became to take round, rather than irregular, shape and shrank with a concomitant subsidence in inflammatory reaction over the prolonged active stage and the following prolonged regressive stage. There also existed a tendency to increase red hallos and fine granular changes. In cicatricial cases of gastric ulcer, patients were classified according to the fibergastroscopic findings into the following three groups in view points of the presence or absence of white coat and roubor in the center of the cucerated area, i.e. coating stage, rubor stage and subsidence stage. At the coating stage, depressions and fine f osses were evident thereby indicating that proliferation of new epithelium had not been completed. In a majority of cases at the rubor stage, the fibergastroscopic findings were similar to those at the foregoing stage. Narrow mucosal folds converging toward areas adjoining the depressions and fine fosses of the ulcer were observed at both stages, which we designate under the name of fine mucosal convergence. This, representing proliferation of new epithelium at a certain stage of cicatrization, has been demonstrated at outer edges of gastric ulcers in regressive process in a majority of cases studied as well. The center of healing scars at the rubor and subsidence stages in some instance was found to be covered with tissues identical in appearance to area gastica which s