Gastroenterological Endoscopy
Online ISSN : 1884-572X
ISSN-L : 0387-1207
EVALUATION OF THE ENDOSCOPIC PYLORUS
H. SUZUKIK. YAMADAT. TAKEMOTO
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JOURNAL FREE ACCESS

1973 Volume 15 Issue 4 Pages 343-354_1

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Abstract

We used to have considered endoscopically that the pyloric ring is a circular ring seen in most anal portion of stomach. However, the pyloric ring must be recognized not as a ring, but as a tube having some length. This portion was named as "pyloric tube". Farmerly, we have observed the pyloric ring endo-scopically from both sides (gastric side and duodenal side), and it was reported that the mucosal gastro-duodenal junction was in duodenal side of pylorus. Biopsies from pyloric tube was made in 10 cases, and it was found that mucosal gastroduodenal junction was in center of pyloric tube in one case, and the edge-mucosa of pylopic tube in gastric and duodenal side consisted of the respective mucosa. Investigating the operated specimen, the mucosal gastroduodenal junction was observed near the center of pyloric tube in 60.8%, and on the gastric side in 1.6%. The marking was made on a point of greater curvature of endoscopic pyloric ring, and the moving of the point owing to slightly preconstructive move of pyloric tube was measuued, and it was observed that the mucosa of the pyloric tube move 3.87mm on an average in human. And next, the pyloric tube of the resected specimen was investigated. It must recognized in these cases that the resected specimen has shrinkage of about 20-30% to the stomach of living body. The pyloric tube of the fixed specimen dyed from hematoxillin being observed macroscopically, the mucosal gastroduodemal junction is on duodenal side of pyloric tube, and this portion is more anal from endoscopic pyloric ring. Also, observing the fixed specimen dyed from hematxilin macroscopically, the mucosal gastro-duode-nal junction of pyloric tube can be classified into 3 types as follows: the clear type (29 cases for 103 cases, 28.1%), the indistinct type (38 for 103, 36.9%), and the type that the gastric mucosa enter into duodenal side (36 for 103, 35.0%) . The last type is most f requantly observed in cases of duodenal ulcers. Now, the structure of muscle layer of the pyloric tube is very complicated and the pyloric sphincter is not indipendent. The histological study of pyloric tube by longitudinal and cross sections reveal that the muscle fibers of pyloric tube has characteristical structure. Occasionally, the bigining of circular muscle of duodenum thicken in some cases, as the structure of pyloric muscle must be recognized as the complication of gastric and duodenal muscle. We classified the muscle layer of pylorus macroscopically in fixed spe-cimen as follows: the hill-like type (69 cases for 133 cases, 51.9%), the peak-like type (51 for 133, 38.4 %), the protruded type (8 for 133, 6.0%), and the flat type (5 for 133, 3.7%). The longitudinal length of pyloric ring was measured at lesser curvature from the point that longitudinal muscle enter the circular muscle in 116 cases, and it is appeared that longitudinal leugth of pyloric tube is about 7mm. 444 cases diagnosed as peptic ulcer clinically were studied histologically, and it was revealed that the ulcer of pyloric tube was 10.6% of them and the erosion was 11.9 %. We investigated the diagnostic ability of each type of endoscope about the ulcer of pyloric tube under the consideration that the ulcer of pyloric tube is of within abaut 1cm anal side of mucosal gastro-duodenal junction, and the ulcers of in 1cm more anal side was named as the prepyloric ulcer. It can be recognized that the frontal viewing system including PFS has more merit. Namely, the qualitative diagnosis of nar-row pyloric tube can be made by using theses scopes, and it can be insert so earily into the stomach with deformity or stenosis under the direct vision that the more anal lesions can be observed comparatively. So, the gastric mucosa and the duodenal mucosa could be differentiated from observation using PFS or GIF-D. There is no remarkable difference between each type of endoscope about prepyloric ulcers, but being not influenced by anal lesions, PFS and GIF-D are ver

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