The importance of gastroscopy in surgical diagnosis

Abstract

G ASTROSCOPY is now a we11 recognized diagnostic procedure. It is safe, easy to perform, and gives information not obtainabIe by any other method. This discussion is based on a series of 456 gastroscopies performed at the Massachusetts Genera1 HospitaI, where the Wolf-Schindler AexibIe gastroscope1’2 has been in use since earIy in 1933. In this series there has been one minor compIication, but no major compIication. PreIiminary x-ray examination of the esophagus is aIways carried out before gastroscopy in order to ruIe out esophagea1 disease that wouId contraindicate the bIind passage of the gastroscope. PreIiminary esophagoscopy is unnecessary, however, for the A exibIe gastroscope aIways passes readiIy through an esophagus that appears normal to x-ray examination. Gastroscopy is conducted as an offIce or out-patient department procedure. As the patient must be fasting, earIy morning is the best time. PreIiminary gastric Iavage is usuaIIy unnecessary and inadvisabIe as it may iriitate the mucosa, but preIiminary drainage by lowering the patient’s head with a Iarge stomach tube in pIace wiI1 frequentIy yield from I to 2 ounces of retained secretions and resuIt in a more compIete and satisfactory view of the mucosa. For anesthesia of the throat a 2 per cent soIution of pantocaine, used as a gargIe, has been found suflicient. Codeine, I$ gr., may be used for sedation. During the examination the patient Iies on the left side with the head extended on piIIows or heId in the hands of a trained assistant. OnIy a very few minutes are necessary for complete gastroscopic study, and the patient may go home immediateIy afterwards. He may eat within an hour of the examination, or as soon as the IocaI anesthesia wears off. Except for sIight sore throat, there wiI1 be no unpIeasant aftermath. Gastroscopy permits a minute study of aImost a11 the gastric mucosa, but certain bIind areas shouId be mentioned. The duodenum cannot be seen. The pylorus is usuaIIy we11 visuaIized, but an uIcer Iying within the pyIoric cana wiI1 probabIy not be visibIe. In a J-shaped stomach it may be impossibIe to see the Iesser curvature of the antrum near the pyIorus. This gastroscopic bIind spot is due to anguIation and is not aIways present; during the passage of a peristaItic wave the whoIe lesser curvature may become visibIe even in a diff%uIt case. Owing to the fact that the objective Iens Iooks at right angIes to the axis of the instrument there is a bIind spot on the greater curvature where the tfp of the g&troscope impinges on the muscosa. Bv manipulation of the instrument this &ea beiomes very smaI1. The portion of the fundus above the cardiac orifice and adjacent to the esophagus is aIso invisibIe, but is a reIativeIy unimportant area. Except for these smaI1 areas, which are of varying visibiIity and importance in