A NEW METHOD FOR VISUALIZATION OF THE GASTRIC WALL: A PRELIMINARY REPORT.

Abstract

Over the past six years, celiac arteriography has been increasingly employed as an adjunct to the usual clinical and radiographic methods for evaluating lesions of the stomach (1). In conjunction with plain film examination and the routine gastrointestinal series, selective celiac arteriography as currently performed does not satisfactorily delineate the entire gastric wall or its various subdivisions (2). With this fact in mind we have recently used a new method for the simultaneous visualization of the overall thickness and arterial supply of the stomach. Method and Procedure The entire gastric wall is initially outlined by a combination of endo- and perigastric gas. This is carried out according to the Frimann-Dahl technic with 1,500–2,000 cc of oxygen for the pneumoperitoneum together with an orally administered gas-producing solution; e.g., Seidlitz powder (3). Selective celiac arteriography is then performed, using 20–30 cc (0.3 cc/kg) diatrizoate methylglucamine, 75–100 lb. per square inch injection pressure, and filming rates of 2 per second for four seconds, and 1.5 per second for the remainder of the examination for a total of 30 films (4). A second arteriogram, preceded by an augmented histamine test according to the method of Kay and Ward (25–50 mg diphenhydramine hydrochloride intramuscularly followed in half an hour by subcutaneous histamine phosphate or histalog 0.04 mg per kilogram body weight), is then obtained (5, 6). The filming is done thirty minutes after the histamine injection (assumed time of maximum gastric secretory response and mucosal blood flow). Results Four normal patients were examined with this new technic. The first patient so studied (Fig. 1) received no drugs to augment gastric secretion or blood flow. Figures 2, 3, and 4 represent examples of our results when pharmacologic agents were used to stimulate gastric secretion and blood flow. The age range of our patients was forty-six to sixty-eight years. All were normotensive except for one who had a blood pressure of 180/110 which reached normal levels on bedrest. No morbidity or mortality was encountered. All patients tolerated the procedure well. Discussion It has been our experience and that of others that conventional celiac arteriography as routinely performed (selective celiac injection of contrast agent with simultaneous employment of intragastric gas) for the evaluation of stomach pathology has two major shortcomings: (a) The ability to distinguish between the vascular patterns of the gastric mucosa, submucosa, and muscularis is poor, the arteriogram often giving nonuniform and inadequate staining of the stomach wall. This is of utmost importance since the earliest manifestations of gastric pathology usually occur in the mucosal layer.