Diagnostic aspects of peptic ulcer. 3. Endoscopy in diagnosis of peptic ulcer.

Abstract

1. Peptic ulceration of the esophagus is probably best diagnosed and evaluated by means of endoscopy. The more widespread use of the “flexible” esophagoscope has led to improved appreciation of pathology of the esophagus. Biopsy under direct vision is relatively simple and rewarding, since good specimens are obtained, and the nature of ulcerations determined accurately. 2. A new, completely flexible endoscope, the “Fiberscope,” composed of bundles of glass fibers, may in the future allow the visualization of the interior of the duodenum. The diagnosis of duodenal ulcer should be greatly enhanced by this instrument, when perfected, since many of such lesions are still missed on x-ray examination. 3. Gastroscopy with the flexible gastroscope is of special value in the diagnosis of ulcers not seen on x-ray examination and in confirmation and evaluation of those visualized by x-ray. In both cases the ulcer should be followed to complete healing by gastroscopy. Gastroscopic biopsy of ulcers under direct vision is so far unsatisfactory but may in the future be improved by the use of better instruments. 4. Gastroscopic photography is now feasible and is useful in evaluation of ulcerations as well as in teaching. Several cases have been described and illustrated to demonstrate characteristics of gastric ulcerations.