抄録
There has been no report concerning endoscopic study of intestinal absorption in the world literature. No endoscopist has tried to perform endoscopic observation of intestinal absorption. We tried to observe the duodenal mucosa endoscopically after administration of triolein (50 ml) into the duodenal lumen. At the same time, we measured the serum triglyceride level immediately before and 1, 2, 4 and 6 hours after administration of triolein. We named this method "loading endoscopy". The duodenal mucosa of the normal persons (15 cases) turned to be white at 30 minutes and became deep white 1 hour after, administration of triolein. The normal control group (7 cases) had an average elevation of 35 mg/dl in serum triglyceride after triolein administration. Only a little change to white color was observed in duodenitis (3 cases) and at the circumference of the duodenal ulcer (4 cases) after administration of triolein. Atrophy of villi was recognized in these lesions. But serum triglyceride level was remarkably raised in these cases. Only slight change in color and a little elevation of serum triglyceride level were recognized in the patients with obstruction of main pancreatic duct or bili4ry tract (4 cases). The shape of duodenal villi and methylene blue absorption were normal in these cases. The shape of villi and absorbed fat onto the duodenalmucosa could be observed in detail in biopsy specimen, stained with Sudan 111, under the dissecting microscope. Moreover, the physiological, histochemical and fine structural changes of duodenal mucosa during the healing process of duodenal ulcer were investigated by means of endoscopic and dissecting microscopic techniques. Very poor absorption of methylene blue and low alkaline-phosphatase activity were recognized in the circumference of duodenal ulcer (57 cases). In most cases (11/12) of ulcer scar, mucosal absorption of methylene blue and alkalinephosphatase activity did not return to normal, even ulcer healed without remaining hyperemia. Villi in the scarring zone of duodenal ulcer were low in height and not normal shaped but convoluted or daughnut shaped. These findings suggest that complete recovery in morphology and function of the duodenal mucosa is rather rare in healing of duodenal ulcer. In conclusion, this new mtehod-loading endoscopy combined with dissecting microscopy of the target biopsy specimens stained with Sudan 111-gave us many informations about intestinal absorption.
