Visualization Of Mucosa Research Articles

Addition of enemas to oral lavage preparation for colonoscopy is not necessary

To evaluate whether the addition of enemas to oral electrolyte lavage is helpful for colonoscopic preparation, we conducted a prospective, randomized, observer-blinded trial to compare oral lavage plus enemas with oral lavage alone. The quality of preparation, mucosal visualization, and the volume of retained colonic fluid did not differ between the two groups. Twenty-two percent of the patients in the group who received oral lavage plus enemas compared with 12% of the patients in the group that only received oral lavage stated that they would refuse to repeat the preparation for future colonoscopic examination. Seventeen percent of the patients in the group that received oral lavage plus enemas demonstrated anorectal trauma or inflammation compared with only 5% in the group that received oral lavage alone (p = 0.09). These results indicate that the addition of enemas to oral lavage preparation for colonoscopic evaluation cannot be routinely recommended. However, enemas may be considered on an individual basis in the occasional patient unable to consume the complete oral lavage or in whom residual stool is found during colonoscopic evaluation after oral lavage preparation.

Computed Tomography of the Abdomen with Fat Density Oral Contrast Medium

A 12.5% corn oil-emulsion (COE) was tested as an oral contrast agent for abdominal computed tomography (CT) examinations in 100 patients. The results were compared with those obtained from another group of patients who received a conventional, high-density, oral contrast agent (2-3% iodinated solution). There was no statistically significant difference in the subjects' tolerance to the two agents (P greater than 0.05). There was, however, a significant improvement in image quality with COE (P less than 0.05). Gastrointestinal tract discrimination, and mucosal and mural visualisation was of higher quality with fat density oral contrast medium than with the high-density contrast agent. These data suggest that COE should be considered for routine use as an alternative to conventional high density oral contrast agents in upper abdominal CT.

Colonoscopy after Golytely preparation in acute rectal bleeding.

Thirty-five consecutive patients with acute hematochezia, negative gastric aspirates, and negative sigmoidoscopy underwent urgent colonoscopy after Golytely purgation. Mucosal visualization was excellent. Colonic bleeding lesions were identified in 24 of 35 patients, and hemorrhage originating proximal to the ileoceal valve was documented in three of these 35 patients. Therapeutic endoscopic electrocautery, employed in 12 of 35 patients, was effective in 11. The peroral preparation was well tolerated, and there were no complications of the preparation or of colonoscopy. The data suggest that urgent colonoscopy following Golytely purgation is a safe, sensitive, and specific diagnostic procedure that provides an opportunity for early nonoperative treatment of acute colonic hemorrhage.

Today's Esophagologist, Autocastrated

DIRECT inspection of diseased tissues is the most generally helpful of diagnostic efforts. Years ago, the clinician found that proper management of many gastrointestinal problems requires direct inspection of the appropriate mucosal and serosal surfaces via endoscopy. After many years of serious effort to achieve effective mucosal visualization throughout the whole gastrointestinal tract, from top to bottom, the goal has now almost been reached. Anybody who reads a journal or goes to a meeting knows that these days the mucosal panorama from lips to Treitz' arch is open to view in almost any adult patient, whenever the clinician feels a need for the diagnostic information it can give. The question of whether the patient with gastrointestinal disease fares better these days, now that pangastrointestinal fiberoptic endoscopy has become so popular, cannot be answered as yet. Advances in medical instrumentation have never automatically meant advances in therapeutic effectiveness, but if eventually

Agglomeration of barium sulfate and roentgen visualization of the gastric mucosa.

In previous investigations of the factors influencing visualization of the gastric mucosa (1–3), we have considered the nature of the opaque medium and the constitution of the subject. After developing a procedure for evaluation of the results of attempted visualization in which we had some confidence, we studied the influence of particle size in barium sulfate, the use of organic compounds of iodine rather than barium, and the role of constitutional factors in the subject, including gastric function. It was found that, with barium sulfate, increase of particle size beyond a certain point gave poorer results, but that reduction of particle size below this value conferred no advantage. Great variation occurred from person to person, the constitutional factors showing the best correlation with mucosal demonstration being the volume of the gastric juice and its mucin content. The greater these values the poorer was the visualization. Barium sulfate was found to be more influenced in this way than were the organic iodine compounds, which could be used safely and effectively in the alimentary tract. Secretions of the alimentary tract have been shown by Frazer et al. (4) to interfere with roentgen visualization of the small intestine by barium sulfate, and to cause its flocculation both in vitro and in vivo. We have investigated this phenomenon, have attempted to associate it with the composition of the gastric juice, have evaluated its importance in influencing mucosal visualization, and have sought means of its prevention. Since the phenomenon is one of flocculation or agglomeration of BaSO4 into large particles which sediment rapidly, we have used for its quantitative evaluation a method derived from that given in the U. S. Pharmacopeia (5) for testing particle size. In a 50-ml. glass-stoppered cylinder with 0- and 50-ml. marks close to 115 mm. apart is placed 5 gm. of BaSO4 U.S.P. that has been passed through a No. 60 sieve. Water and other materials are added to bring the volume to 50 ml. The contents are mixed by inversion every two seconds for one minute and the cylinder is put on the table. The times at which the boundary of the descending BaSO4 passes each 5-ml. mark are noted. These are plotted on co-ordinate paper and the maximum rate of sedimentation is estimated graphically. From the measurement of the cylinder, this result is converted to millimeters per second. The results of this test can be striking, in that addition of gastric juice to give a 1:10 dilution may accelerate the sedimentation more than ten times. The phenomenon is believed to be one of adsorption of a constituent of the gastric juice by the particles of barium sulfate, since increasing the amount of added gastric juice increases the agglomeration until a maximum is reached, after which further additions have no effect.

Roentgenologic study of the lower esophagus and the esophagogastric junction.

At times the detection of early organic lesions and physiological disturbances involving the lower end of the esophagus still offers some difficulty. Part of this difficulty lies in the lack of accurate knowledge of the anatomy and physiology of this region. The roentgenologist must await clarification from the anatomists and physiologists who, up to now, cannot fully agree as to the relative importance of the various structures participating in the closing mechanism at the esophagogastric junction. A great contribution, however, can be found in Lerche's book on The Esophagus and Pharynx in Action (1). This, coupled with a simple oil-contrast technic (2) which improves the visualization of the mucosal pattern of the lower esophagus, has made the present study possible. The use of mineral oil as a double-contrast medium for mucosal pattern visualization was first reported by Gianturco (3) in his studies on the stomach. In order to verify Lerche's concepts and to give the oil-contrast technic a more extensive trial as a screening process in detecting abnormalities of the lower esophageal region, a survey was initiated in the Department of Radiology at Bellevue Hospital Center. Five hundred unselected ward and outpatients were used. Technic: After fluoroscopy, and before the taking of conventional gastrointestinal films, the patient was given 2 heaping tea-spoonfuls of thick barium cream, followed immediately by 2 ounces of extra heavy mineral oil. In about one-third of the patients a polygraph (four exposures) of the lower esophagus was obtained before the conventional film study, and in the remaining two-thirds the polygraph was taken after the films. The polygraphs, obtained with the patient prone, with the xiphoid process on the center of the film, included two views in the posteroanterior position, in deep inspiration and expiration respectively, and two views in the right anterior oblique, also in deep inspiration and expiration (Fig. 1). The chief advantage of this technic is that a single administration of thick barium and mineral oil suffices for a prolonged examination of the esophagus. The polygraphs taken after the conventional films gave a better mucosal pattern than those taken before. The rate of retention of the medium, however, varies considerably and is probably an individual factor dependent on the amount of secretion present. Normal polygraphs were studied for anatomical and physiological variations. Positive cases were checked with the conventional films and the findings were compared. A clinical summary of the gastrointestinal symptoms and findings was obtained from the patient's chart and analyzed. The results appear later. Lerche has demonstrated the anatomical presence of an inferior esophageal sphincter and has described a gastroesophageal segment of expulsion, the component structures of which are diagrammatically shown in Figure 2. Our roentgenologic study seems to confirm his findings.

Fictitious Polyps as Seen in Double-Contrast Studies of the Colon

The first recorded use of air studies of the colon was in 1896, when Becher made roentgenograms of the stomach and isolated loops of the large intestine after filling them with lead acetate solution as well as inflating the bowel with air (11). Following this, various phases of the technic were described. In 1909 Groedel recommended the bismuth clysma. About the same time Haenisch developed the trochoscope, forerunner of the present day horizontal fluoroscope (2). Barium solution replaced bismuth salts as an opaque material about 1911. Growing appreciation of mucosal pattern visualization, stimulated by the work of Forssell and others, led to the technic of combining the simple opaque enema with injection of air. Between 1911 and 1923 such names as Rieder, Haenisch, Schwarz, Stierlin, Groedel, Case, George, Carman, and Sampson are associated with the methods then at hand (11). In 1925 Fischer described his combined method of barium enema and injection of air (3). This method has been used and modified by ...