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ATTEMPT IN GASTROSCOPY TO EXPOSE NARROW FURROWS BETWEEN PACKED FOLDS OF THE GREATER CURVATURE: SIMPLE TECHNIQUE TO AVOID A BLIND SPOT
Author(s) -
Ukawa Shiro,
Ukawa Kunio
Publication year - 2004
Publication title -
digestive endoscopy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.5
H-Index - 56
eISSN - 1443-1661
pISSN - 0915-5635
DOI - 10.1111/j.1443-1661.2004.00408.x
Subject(s) - curvatures of the stomach , medicine , curvature , stomach , premedication , anatomy , surgery , mathematics , geometry
Background: Occasionally, there are patients in whom the folds of the greater curvature of the stomach are closely packed, resulting in difficulty with endoscopic visualization of the intervening furrows. Methods: A simple technique was attempted to avoid such blind spots. This was to slide the scope tip along the furrow or furrows between the folds to attain smoothing in the greater curvature. In the present study, 424 patients required this unfolding maneuver for complete observation. This accounted for 12.5% of 3404 patients examined during the study period. It was found that sliding the scope tip across the folds or applying gentle pressure at a point of the greater curvature also was effective. Possible modification by atropine, given as premedication, is also discussed. Results: A marked smoothing effect was achieved in 263 patients accounting for 62.0%, a moderate effect in 125 patients accounting for 29.5%, and a poor effect in 36 patients, which is 8.5%. The background mucosa of the stomach seemed to be related to the degree of effectiveness. Specifically, the cases with widely spread chronic gastritis showed less response to the maneuver. Conclusions: Gentle contact with the greater curvature, cleaving the furrows between folds, mild touching in random directions, or applying pressure on a point, resulted in the unexpected flattening of the folds and widening of the narrow furrows in many cases. This phenomenon cannot be explained by mechanical factors alone, and a physiological response, such as an accommodation reflex, is suspected to be playing a role.