Detailed Diagnosis of Lesions on the Anterior Wall of the Stmach K. Kumakura 1 , M. Maruyama 1 , N. Sugiyama 1 , R. Takada 1 , H. Ochiai 1 1Dept. of Internal Medicine, Cancer Institute Hospital pp.1405-1418
Published Date 1971/10/25
DOI https://doi.org/10.11477/mf.1403111523
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 A series of 266 cases (296 lesions, excluding those less than 5mm in diameter discovered only by histology) of early cancer of the stomach have been experienced during the five-year period from January 1965 to December 1969 at Cancer Institute Hospital.

 Of these, 241 cases were of single early cancer, including 75 of protuberant type and 166 of depressed variety, with 47 of them located on the anterior wall (25 of them protuberant and 22 depressed). An analysis was made of these 47 cases as to what kind of detailed examinations was performed for lesions on the anterior wall.

 In 16 of 25 protruding lesions, compression revealed them most successfully (13 cases by compression in the upright and 8 likewise by it in the prone position).

 As for the remaining 9 cases, (1) 5 were demonstrated to the best advantage by the double contrast method (3 in the supine and 2 in the prone); (2) 2 were lesions smaller than 10 mm (one a type Ⅱa, 7 mm in diameter, demonstrated in the prone mucosal relief picture with compression applied, and the other, a type Ⅱa, measuring 5mm in width, observed with some difficulty by upright compression); (3) and in the last 2 cases, their size was both so large that they were visualized by every examination in a way -but not too satisfactorily. After all, compression is the method of choice in demonstrating those smaller lesions, even when located on the anterior wall. The prone double contrast method is not always necessary in visualizing a lesion on this wall. It should also be remembered that an appropriate amount of air plays an important role in applying compression with success to a large lesion of type Ⅱa or Ⅱa+Ⅱc.

 In 16 of 22 cases of depressed lesions, prone double contrast study proved best in demonstrating them. Of the remaining 6, (1) 2 of type Ⅲ+Ⅱc were best visualized by compression, (2) and in another 3, the whole aspects of the lesions were not seen to the best advantage by the prone double contrast method, but as such they were good enough for correct diagnosis; (3) and the last one was undetected in the same procedure, but was demonstrated by compression, although with difficulty. The prone double contrast method has, as it were, a blind spot.

 There were five cases most faithfully demonstrated by comression (2 cases of type Ⅲ+Ⅱc and 3 type Ⅱc, both 20 to 30111111 in the greatest diameter with sharply outlined margin). However, too large a Ⅱc or Ⅱb-like lesion can not be visualized well by compression. There was also a case demonstrated most faithfully by prone mucosal relief picture.

 The smallest lesion ever visualized faithfully by prone double contrast method measured only 6mm in diameter in a Ⅱc lesion and 15 mm in a Ⅱb-like lesion. After all, prone double contrast method, although technically complicated with afore-mentioned blind spot, is still the best procedure for the demonstration of the depressed lesion (especially Ⅱc) on the anterior wall.

Copyright © 1971, Igaku-Shoin Ltd. All rights reserved.


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