Acute Gastric Mucosal Lesion (AGML) Following Endoscopy: Its Frequency and Measures against It Sachico Takasu 1 , Haruhito Tsuchiya 1 , Yukihiro Sakurai 1 , Masayoshi Ito 1 , Yoshinobu Hinoue 1 1Department of Gastroenterology, Kanto-Teishin Hospital pp.653-660
Published Date 1989/6/25
DOI https://doi.org/10.11477/mf.1403106479
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 With the increasing use of panendoscopy as the first line examination of the upper gastrointestinal tract, occurrences of AGML following panendoscopy begun to be reported from some institutions in our country. In our hospital the first case was indentified in 1984 and 17 cases in total were experienced by the end of 1987 (Fig.1). Frequency is calculated as 0.73 per 1,000 examinations after 1984 or 0.39 per 43,499 examinations which were carried out in the past 12 years. It occurred more frequently in male (0.48 per 1,000) than in female (0.21 per 1,000) as shown in Table 1.

 These patients ranged in age 23 to 59 years, most frequent in 40s (Fig.2). AGML developed after the first examination of panendoscopy in 8 cases and after the second examination in 4 cases. The frequency of AGML, however, was unrelated to the number of examination performed (Table 2). No seasonal change was noted. The frequency of AGML was 0.37 for the examination without biopsy and 0.43 for that with biop-sy. Among endoscopists who performed over 3,000 examinations, the frequency of AGML ranged from 0 to 0.9 (Table 4).

 In nationwide study using questionnaire in 1988, 129 hospitals or clinics answered that they never experienced such a case but 50 institutions reported 420 cases with the frequency, 0.7 cases per 1,000 panendoscopic examinations. It was experienced more often in small hospitals and clinics with highest, 7.59 cases per 1,000 examinations (Tables 5 and 6). This phenomenon may reflect in part the difficulty to repeat examination in larger institutions when a patient complains abdominal pain after panendoscopy.

 Patients in most cases start to feel severe pain 3 to 8 days after panendoscopy. Urgent repeat examination reveals island-like or linear erosions covered by black or white coat mostly in the antrum (Figs.3 and 4). Conventional anti-ulcer treatment is effective in rapidly relieving the symptoms with the lesions healing within several days. Almost invariable clinical course and distribution of the lesions suggest a cause-and-effect relationship between panendoscopy and the AGML.

 At the endoscopy in which AGML occurred afterwards, no abnormality was the most frequent finding followed by mild erosive change (Table 3). The frequency of AGML after panendoscopy was lower in cases with gastroduodenal ulcer and gastric malignancy than expected, and higher in cases with anisakiasis, esophageal varices, gastric erosion and no abnormal findings (Table 7).

 The antral wall which lacks oblique muscle layer is distended markedly during endoscopy by insufflation. Furthermore, peristaltic contraction tends to be strong in the antrum. Ischemia of the antrum caused by these factors during endoscopy is likely to lead to the development of AGML especially when it is accompanied by low mucosal resistance or hypersecretion of acid. Low frequency of AGML following panendoscopy in patients with peptic ulcer may be explained by the use of anti-ulcer agents which are usually prescribed when ulcer is detected. Although the stomach is often overinflated at polypectomy, no AGML is reported afterward. This may also be explained by the use of anti-ulcer drugs.

 AGML after panendoscopy occurs rarely but the most important obstacle for the popularization of panendoscopy. The measures against the development of AGML may be to avoid over-insufflation of the stomach and to administer H2-blocker for several days after panendoscopic examination.

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