Abstract
The dyeing of the duodenal mucosa with methylene blue solution was performed during duodenoscopy for evaluation of the duodenal lesions. The instrument used was GIF-D (Olympus). 10 ml of 0.5% methylene blue solution was sprinkled on the duodenal mucosa through the duodenoscope under visual control: Several minutes later, washing with 40 ml of water was carried out and then the fluid in the duodenum was aspirated. The duodenoscopically normal mucosa was stained well into dark' blue when methylene blue was introduced. A finger, leaf or ridge shaped villi were recognized remarkably on dvein in this area. The dyeing was less effective in the circumference of duodenal ulcer or at the erosive changes, island of gastric mucosa, small elevation due to hyperplasia of the lymph follicle and white colored villi. This phenomenon made it easier to recognize the range of erosive changes and to find the small lesions like gastric mucosal island. Biopsy was then undertaken, and the specimens were observed under the dissecting microsiope before fixation and were made into cryostat preparations. This examination revealed that methylene blue was taken into the cytoplasm of epithelial cells.Dissecting microsopic observation with hematoxylin staining of biopsy specimens and histological examination showed abnormalities in the areas of the uptake diminution. The mucosal villi around the duodenal ulcer were observed to be low in hight and were changed into a bunch, doughnut or gyrus form. Histological examination revealed these.deformed villi to be regenerated epithelium. Low villi were also observed in the cases of erosive changes. The surface of gastric mucosal island showed the sulcioral or f oveoral pattern and became red by PAS staining. In the case of white colored villi, histological examination showed the leaf shaped epithelium, swollen lamina propria and hyperplasia of glandular crypts. The epithelial cells over the hyperplastic lymph follicle were swollen. In conclusion, fiberduodenoscopy with introduction of methylene blue makes it easier to recognize the regenerated mucosal area around duodenal ulcer, the range of the erosive changes and the small lesions like gastric mucosal island. Dissecting microscopic observation of biopsy specimens teaches us not only accuracy or inaccuracy of biopsy but also gives much information about the shapes ;of villi at j normal and abnormal mucosa.
