Mucosal Relief Technic Correlated with Gastroscopy in 150 Cases

Abstract

Two basic studies were fundamental to Berg's (3, 4) x-ray relief investigation of the gastro-intestinal tract. They were (1) the work of Forssell (13, 14) on the anatomy of the stomach and the movement of the gastric mucous membrane, and (2) Akerlund's (1) complete papers on the duodenal ulcer. Berg's work has been well known to roentgenologists for some time. His original monogram on this subject is classical. It seems superfluous to discuss the merit of his studies or those of his able contemporaries Cole et at. (10), Gutzeit (19), Holmes and Schatzki (20). Such discussions will be found in an increasing literature on x-ray relief technic. These workers had one aim in view—the anatomic demonstration of gastro-intestinal lesions. This does not connote that motor studies are less important: they are of definite value. However, if a lesion is present, the roentgenologist wants to demonstrate it on the film. If he is successful, much explanation will be unnecessary. Since August, 1937, over 400 patients have been examined by the relief method. Many have been re-examined. A large majority of these patients were from the gastro-intestinal clinic of the Out-patient Department of Provident Hospital. Of this number, 150 have been gastroscoped. We shall discuss only the cases gastroscoped and x-rayed by the relief technic. The reason for the limitation is obvious. Some standard of comparison was necessary to test the accuracy of our x-ray relief findings. Nearly all cases were x-rayed before gastroscopy. By careful observation and analysis, we endeavored to record significant findings at fluoroscopy. To do this it was necessary to begin the examination with no preconceived ideas—a frequent cause of errors. If there were discrepancies between the gastroscopic data and relief findings, the relief examination was repeated. It is not necessary to have elaborate machinery to do a good grade of x-ray relief technic. Some years ago Haudek remarked that “the equipment is more in the radiologist than in the machinery.” It is possible to adapt this technic to one's gastro-intestinal equipment and obtain a film of good diagnostic quality. In our series the time factor in the average case varied between one-eighth and one-fifth second. It is exceedingly important to be able to switch quickly from fluoroscopy to roentgenography; if not, one will not see on the film the finding depicted at fluoroscopy. Forssell's (13, 14) publications stress the movement of the gastric mucous membrane. Preparation of the patient is the same as that required for routine x-ray examination of the stomach. In some cases lavage of the stomach is necessary to make sure it is empty. The examination is made with the patient in the vertical and horizontal positions and also from many angles. Films are made in the position best illustrating the lesion. Transparent cotton wadding was used for pressure pads. We found barium and water an adequate contrast substance.