Abstract
Many studies have been made on the relation between the lesions and the function of the stomach. In this study, we endoscopically investigated how the function of the pylorus changes when there are some lesions in the pylorus and the peripyloric area. Especially, some instrumental managements were added to the fibergastroscope (FGS).(1) The peripyloric lesions and the contourr of the pyloric ring We classified the contour of the pyloric ring according to its size and the degree of deformity. The pyloric ring as large as the opened biopsy forceps (6mm), larger than it or smaller than it, is respectively labeled as "average, " "larage" or "small." About the deformity, the pyloric ring always drawing a smooth arc is classified as "no deformity, " and when there is any small degree of distortion, it is called as "deformity." The result was that the size showed no particular influence by the lesions, except, in the cases of the prepyloric ulcer, the size was always "large." and that the pyloric ring "deformity" was frequently seen in the cases of duodenal ulcer, erosive gastritis and prepyloric ulcer.(2) The peripyloric lesions and pyloric insufficiency When the pylorus remains open during the observa-tion by FGS, we call it "pyloric insufficiency." "Pyloric insufficiency" was frequent in the cases of duodenal ulcer and prepyloric ulcer, and in these cases, the pyloric ring was often "deformity.''(3) Peristaltic rhythm and peripyloric lesions Peristaltic rhythm was observed under the set intra-gastric pressure, by FGS connected to the intra-gastric pressure stabilizer, but no particular phenomenon was detected concerning the peristaltic rhythm under the intra-gastric pressure of 15cm H2O.(4) Emptying time, lesions and the contour of the pyloric ring We measured the emptying time of the 300ml of water dyed with methylene blue from the stomach. As a result, no definite tendecy could be seen between the emptying time and the lesions. In respect of the contour, however, the cases of the pyloric ring "deformity" often showed rather short emptying time.(5) Emptying time and peristaltic rhythm The examination was made on the relation between the emptying time and the peristaltic rhythm to each case. In the cases "deformity, " the emptying time tended to be short without regard to the peristaltic rhythm.(6) Duodenal regurgitation We inserted a polyethylene tube, about 10cm into the duodenum, in direct vision of FGS, injected 1 ml of Phenolsulf onphthalein (PSP) and then immediately took out the tube. After 20 minutes, we drew out all the gastric juice in direct view of FGS and measured the quantity of PSP regurgitated. By this method, which we named "PSP-Regurgitation Test, " we could recognize the quantity of the duodenal juice regurgi-tated into the stomach. The regurgitated PSP was large in quantity in the lesions of duodenal ulcer, erosive gastritis, prepyloric polyp and severe chronic gastritis and also in the cases of the pyloric ring "deformity" and pyloric insufficiency. By the way, in one case which had both deformity and pyloric insu-fficiency, the quantity was remarkably large, when this examination was made to the resected stomach.(7) Pressure waves of the pyloric ring We inserted a balloon of 1×3cm and of capacity 2nd into the pyloric ring in direct view of FGS andd recorded the pressure waves of the pyloric ring. In the cases of pyloric insufficiency, the pressure waves were even and evidently different from those of the normal cases.
