Abstract
With the improvement of the exciting filter clear fluorescence and delicate difference of the amout of fluorescence could be observed. In this paper, it was proven that fluorescence endoscopy reflected gastroduodenal mucosal blood flow. Further, intractability of ulcer was investigated on the basis of fluorescence findings in clinical cases. Materials and Methods1. Experimental study Histamine and norepinephrine were applied to the canine gastric mucosa of a certain area through a gastrofiberscope to alter the local mucosal blood flow. Then fluorescence endoscopy was performed. In addition, the technique was also performed on the canine gastric ulcers produced by acetic acid. 2. Clinical study Twenty cases of gastric ulcer and 39 of duodenal ulcer were examined and analysis was made on the time of the appearance of fluorescence and its distribution in the marginal mucosa of the ulcer.Results 1. Fluorescence appeared more rapidly in the hyperemic area where histamine was applied, than in the adjacent normal area. Whereas the appearance of fluorescence was delayed in the ischemic area where norepinephrine was applied (Figure 2). In the ulcers produced by acetic acid, fluorescence appeared more rapidly and was distributed evenly in the marginal mucosa of ulcer (Figure 1). 2, In the cases of which ulcer healed within 3 months, both retardation of the appearance of fluorescence and uneven distribution were not observed except 1 cese of duodenal ulcer. On the contrary, in over half of the cases of intractable ulcer, both findings were recognized (Figure 3, Figure 4, Table 4). From these results, it may be said that there is a favorable healing tendency in the cases where fluorescence apears rapidly and is distributed evenly, while in the intractable cases, fluorescence often appears later and is distributed unevenly. These findings recognized in the intractable cases are supposed to be based on the circulatory disturbance in the marginal mucosa of ulcer.
