Abstract
The chromoendoscopic features of healed gastric ulcers and the accuracy of diagnosis of histological repair of gastric ulcers were investigated by the endoscopic Congo redmethylene blue test. Histological repair of gastric ulcers was graded by Murakami and Koide's scale, as follows: Ul1, Ul2, Ul3 and Ul4. Endoscopically, Ul4 scar is observed as a flat granular area without any depression, sometimes associated with redness. Ul3 scar is observed as a distinct depression in the surrounding normal mucosal surface, usually associated with homogenous redness. In contrast, Ul3+1 or Ul3+2 scar are seen as a distinct depression with irregulary-patchy redness. A correct diagnosis of histological repair of gastric ulcer was made in 82.6% of the lesions by chromoendoscopy. Histological repair of gastric ulcers located in normal oxyntic gland mucosa could also be accuratly diagnosed by chromoendoscopic examination. Ul4 scar are observed as discolored areas, but Ul3 scar are seen as nondiscolored areas surrounded by discolored areas. Follow-up studies of patients with Ul4, Ul3 and Ul3+1 or Ul3+2 lesions showed that recurrence was significantly rare in patients with Ul4 lesion than in patients with Ul3 and Ul3+1 or Ul3+2 lesions. Therefore, we conclude that1) chromoendoscopic examination is useful for diagnosing the histological repair of gastric ulcer and 2) healing of gastric ulcer should be defined clinically as disappearance of ulcer fur.
