There seem to be some confusions concerning the criteria for endoscopic diagnosis of gastritis in postoperative stomach. Some authors claim that reddening of the stoma suggests the presence of acute inflammation, and discrepancy between endoscopic diagnosis of atrophic gastritis and histological findings is claimed in some reports, which mostly employed blind suction biopsy for histological assessment. For the study of the gastric remnant with poorly distensible areas and a narrow lumen, a prudent choice of areas for assessment and an accurate locational correspondence between endoscopic and histological findings are indispensable. To solve those diagnostic problems, a correlative study was undertaken between endoscopic and direct vision biopsy findings. The materials consist of 81 subjects, in total, who underwent partial gastrectomy ; the operative procedures are Billroth I in 34 and Billroth II in 47 cases. The gastrocamera with fibrescope GTF was used to visualise and photograph the lumen of gastric remnant. The gastrofibrescope for biopsy GFB was then used to obtain tissue specimens under direct vision from 1) the stoma itself, 2) anterior wall of mid-segment of gastric remnant and 3) anterior wall in the vicinity of the stoma. Three or more specimens, within 1 to 2 cros apart from one another, were taken from each area. Endoscopic evaluation was made on reddening of the stoma, as well as on the degree of atrophy in the anterior wall of the mid-segment of gastric remnant and in the anterior wall near the stoma. Using the same criteria as in the non-operative stomach based on visible vessels and mucosal discolouration, the degree of atrophy was graded as (-) for normal mucosa, (+) for mild and (++) for marked atrophic gastritis. With the biopsy specimens from the stoma, atrophy, polymorphonuclear leukocyte infiltration and capillary dilatation were evaluated. As for the other areas, the histological findings of atrophy were studied. The histological degree of atrophy was judged from multiple specimens obtained from the same area and graded as atrophy (-) for normal mucosa, atrophy (+) for mild decrease in gastric glands and atrophy (+) in the case of glands less . than half of normal amount including complete disappearance. Inflammation of the Stoma : Reddening was compared with the infiltration of polymorphonuclear leukocytes, which revealed no significant relation between the two. A correlation between reddening and capillary dilatation was then tested. Capillary dilatation was more frequent in reddening cases (28/43) than in those without reddening (6/15), but this was not statistically significant. The stomal reddening, therefore, is not suggestive of acute gastritis, but may reflect an artificially induced local circulatory disturbance, when compared with our experiences that the reddening becomes prominent with air insufflation at the time of endoscopy, and, in particular, following repeated vomiting. Endoscopic Diagnosis of Atrophy and Histology : Comparison was made between endoscopic and histological assessments of atrophy in the anterior wall of midsegment of gastric remnant, to find a highly significant correlation between them (p<0.005) . Similarly, endoscopic assessment of atrophy was compared with the histological findings in the anterior wall near the stoma and a statistically significant correlation (p<0.025) was found. However, 10 of 19 endoscopically normal cases had mild degree of atrophy histologically, and 17 of 30 endoscopically mild cases had histologically marked atrophy, thus our endoscopic criteria of atrophic gastritis, as far as the vicinity of the stoma is concerned, seemed to have a less sensitivity than required. Furthermore, the biopsy specimens from the stoma almost always revealed marked atrophy, but its endoscopic diagnosis was difficult ; it may correspond to mucosal granularity occasionally seen in a close-up view of the stoma. The present study confirmed the validity of endo-sc
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