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Endoscopic ultrasonography in the assessment of the depth of gastric ulcer



Endoscopic ultrasonography in the assessment of the depth of gastric ulcer



Stomach & Intestine (Tokyo) 23(5): 495-501



The depth of a gastric ulcer is usually classified according to Murakami's classification, which is based on the histological relation between the depth of the ulcer and the structure of the gastric wall, such as mucosal layer, submucosal layer and muscle layer. Endoscopic ultrasonography can clearly visualize the structure of the gastric wall and the ulcer lesion. Therefore endoscopic ultrasonography is an excellent procedure for the judgement of the depth of a gastric ulcer. In case of Ul-II ulcer where the depth is limited to the submucosa, the sonographical changes of the gastric wall's structure are limited to the central high-echo layer, which corresponds to the submucosa. When the depth of ulcer reaches the proper muscle layer, that is Ul-III, the central high-echo layer is interrupted and the outermost high-echo layer, corresponding to the serosa, is intact ultrasonographically. If the outermost high-echo layer is interrupted, it indicates that the depth of the ulcer has reached the serosa, that is Ul-IV. Endoscopic ultrasonography for the determination of the depth of an ulcer has proved very useful, especially for the choice of the treatments of peptic ulcer.

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