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Diagnosis of intractable gastric ulcer by endoscopic ultrasonography

Diagnosis of intractable gastric ulcer by endoscopic ultrasonography

Stomach & Intestine 27(12): 1413-1421

We studied the findings of intractable gastric ulcer by endoscopic ultrasonography (EUS). It was possible to diagnose the depth of ulcer by EUS. The echo pattern in Ul-IV were subclassified into six types, that is Hn, Bsub n Bn, Hf, Bsub f, Bf. We measured the diameter of ulcer and ulcer area in EUS pictures by using a video processor, EXCEL. In this report, we observed the endoscopic cumulative healing rate in 140 patients with active gastric ulcer, and compared the healing rate of H-2 blocker with that of proton pump inhibitor. Ninety-four patients with gastric ulcer were treated with H-2 blockers. The endoscopic cumulative healing rates after 8 weeks of H-2 blocker treatment were 89% in Ul-II ulcer, 82% in Ul-III ulcer, and 64% in Ul-IV ulcer. In Ul-IV ulcer, the lowest cumulative healing rate among 6 echo patterns during the same periods was 33% in the Bf type under H-2 blocker treatment. The healing rate in an ulcer area larger than 400 mm-2 was below 50%. Likewise, the contraction rate of the ulcer area in the healed group was sigificantly lower than that in the non-healed group (p lt 0.001). Thus the EUS findings of intractable gastric ulcer were found to be Ul-IV, Bf type in the internal echo pattern, ulcer area larger than 400 mm-2, and poor contraction rate of the ulcer area. Histologically, this type of gastric ulcer had thick, wide, dense fibrosis, and fusion between the muscularis mucosae and the proper muscle layer. All 46 patients in the omeprazole treatment group had achieved endoscopic healing within 8 weeks. Between H-2 blocker and proton pump inhibitor treatment group, there was no difference in ulcer depth, echo pattern, and ulcer area. When endoscopic healing was verified in patients with intractable gastric ulcer by omeprazole, a comparatively large ulcer area in EUS picture remained and patients relapsed a short time after discontinuance of omeprazole. It was suggested that internal ulcer healing should be maintained duirng gastric ulcer treatment.

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Accession: 008460226

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