A Comparison of Gastroscopic and Roentgen Findings

Abstract

THE flexible gastroscope has opened a new field in gastric diagnoses. In most cases it is safely and easily introduced and allows excellent visualization of the gastric mucosa in the living person. We have had three gastric perforations, all occurring during the use of instruments equipped with the spherical sponge tip devised by Henning. Experimental evidence indicates that the friction of this tip was responsible for these non-fatal accidents (9). No accidents have occurred when the long-finger guide was used. Lesions obstructing the esophagus and cardiac end of the stomach, aortic aneurysm, and suspected esophageal varices are contraindications to gastroscopy. Although most gastroscopists check their findings with roentgen findings, few radiologists check with the gastroscopist. Schatzki (8), Ansprenger (1), and Jutras (6) have made such comparisons. From 1926 to 1934 Sielman and Schindler made roentgenographic relief studies of the stomach in more than 4,000 cases. Of these cases, several hundred were gastroscoped. Since September, 1934, over 800 gastroscopies have been performed at the University of Chicago Clinics, most of these cases having been examined by Dr. Templeton by roentgen relief methods either before or after he had seen them gastroscopically. Gastroscopic and roentgenologic examinations should be considered as cooperative rather than competitive examinations. Either method may visualize lesions that the other cannot. Shape, contour, motor function, and gross lesions are better seen roentgenologically, while mucosal changes and smaller lesions are better seen gastroscopically. In some cases the roentgenologic examination is sufficient for accurate diagnosis. Gastroscopic Appearance of the Normal Stomach In the normal stomach, differences between the gastroscopic and the roentgenographic appearance are quite striking. Before the introduction of air the gastroscopist sees rather prominent, irregular, parallel folds which apparently do not correspond with the rugæ. This appearance of the collapsed mucosa presumably has nothing to do with its thickness and may or may not be of clinical significance. On distention with air these folds flatten easily and there appear in the body from 10 to 14 parallel folds, many of which are irregular, bifurcated, and traversed by cross rugæ (Fig. 1). Rugæ are rarely seen in the antrum, but a high-twisted cord-like structure separates the antrum from the body of the stomach. This fold, the musculus sphincter antri (Fig. 2), usually cannot be identified with certainty at roentgenologic examination. Roentgen-Ray Appearance of the Normal Stomach (A). After a single swallow of barium. — variety of patterns may be seen (Figs. 3–6). Not uncommonly there are from four to six roughly parallel folds in the body and the antrum, and occasionally the antrum contains in addition one or more oblique folds. (B). After filling the stomach with barium and then compressing it.