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Endoscopic Diagnosis of Gastric Remnants K. Takezoe 1 , S. Ukawa 2 1Department of Surgery, Aoyama Hospital For Tokyo Metropolitan Officials 2Department of Surgery, Hayashi Hospital pp.875-882
Published Date 1977/7/25
DOI https://doi.org/10.11477/mf.1403112614
  • Abstract
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 Gastric remnants show virtually unlimited morphological variations, depending on their size, method of resection or anastomosis, adhesions and pathological distortion if present. Additionally, distensibility is restricted at the areas adjacent to anastomosis or suture line and also there are various changes directly related to surgery. These factors make radiological as well as endoscopic diagnosis of post-operative stomach more difficult in comparison with the ordinary stomach examination. However, there are many problems inherent to postoperative stomach such as regurgitation esophagitis, disfiguration of anastomosis, granuloma along the suture line or anastomosis, stomal ulcer, cancer, ERCP in Billroth Ⅱ stomach, etc. Endoscopy is mandatory for dealing with these problems.

 In general, requirements for an upper G-I endoscope would include : (1) elimination of blind area without difficulty; (2) high visual acuity and recordability; (3) facility of inflation and washing of the lens, aspiration and washing of the G-I canal ; (4) channel for biopsy and cytology; (5) safety and minimal discomfort to the patient and (6) durability. So far, however, a single instrument cannot fulfil all these requirements.

 Preliminary X-ray study of the esophagus, gastric remnants and distal intestines is mandatory for proper selection of endoscopes. At the moment, a combination of forward and side-viewing fiberscopes is required for thorough examination. Our experience most favorably support the combination of GIF type P 2 (Olympus) and JF type B2 or similar one.

 The GIF type P 2, a newly developed slender forward viewing fiberscope with acutely angulatable tip, has proved to be quite satisfactory for examination of the upper G-I tract. Since the tip can be bent 180° with a radius of only 1.8 cm, it was found to be most suitable also for examination of gastric remnants. Even in a smaller gastric remnant, U-turn is easily possible, although J-turn may be unsuccessful in patients with subtotal gastrectomy. However, the front view of the upper portion of the lesser curvature near the cardia is frequently difficult to obtain and it may have to be supplemented by other side-viewing apparatus in occasional cases as mentioned previously.

 Special care should be paid to differentiation between “the normal variants” and diseases, particularly cancer. Biopsy or cytological study should be readily applied whenever indicated.


Copyright © 1977, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 1882-1219 印刷版ISSN 0536-2180 医学書院

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