Evaluation of roentgenologic study of the stomach

In order to achieve more correct diagnosis of gastric lesions, further progress in the technique of diagnosisis much desired. And so, in pursuing the more ideal study, about 7500 cases of U.G.I. studies taken in SeveranceHospital in the past 29 months from May 1969 to Sep. 1971, have been reviewed to evaluate how the followingfactors will affect the demonstrability of gastric lesion in upper G.I. series. (1) Introduction of air into thestomach by nasogastric tube. (2) Kinds and concentration of barium. (3) Demonstrability according to the positionof the patient. (4) Use of antispasmodics. The results may be briefly summerized as follows; 1. The intubation ofnasogastric tube gives discomfort temporarily to the patient; however, it has an advantage that the amount of airrequired for ideal insufflation of the stomach can be controlled under the fluoroscopy. 2. About concentration andtype of barium. a) Mikabarium in 90% seems to give the best result in filling study, mucosal relief study anddouble contrast study. b) Mikabarium in higher concentration adheres to the mucosa better, thus resulting in gooddouble contrast; however, it tends to coagulate each other in the high concentration. c) Micropaque powder of 110%solution produces good double contrast, but it has the disadvantage of making air bubbles. d) When water is givenprior to barium ingestion, the anterior wall of stomach is better demonstrated with mucosal relief study. e) Toget better result in contrast study, the selection of barium is important as well as rapid and proper positioningof the patient and abdominal respiratory movement. 3. Demonstability of the stomach lesion according to theposition. a) The small lesion either in pylorus or in antrum can be best demonstrated by compression technique ofdouble contrast method in supine position. b) The mucosal relief study in prone by adequate air insufflation wasproper to demonstrate the lesion of anterior wall. c) In the lesion of the angle, double contrast study andcompression study were effective. The compression study was most effective in the elevated lesion. d) For upperstomach study, double contrast study was effective. The anterior wall lesion is better outlined, and the posteriorwall lesion in supine. 4. Antispasmodic agent gave better demonstrability of mucosa on poor distensible area orlocalized spastic area, difficult to evaluate.