Evaluation of roentgenologic study of the stomach

In order to achieve more correct diagnosis of gastric lesion, further progress in the technique of diagnosis is much desired. And so, in pursuing the more ideal study, about 7,500 cases of U. G. I. studies taken in Severance Hospital in the past 29 months from May 1969 to September 1971, have been reviewed to evaluate how the following factors will affect the demonstrability of gastric lesion in upper G. I. series. (1) Introduction of air into the stomach by nasogastric tube. (2) Kinds and concentration of barium. (3) Demonstrability according to the position of the patient. (4) Use of antispasmodics. The results may be briefly summarized as follows: 1. The intubation of nasogastric tube gives discomfort temporarily to the patient: however, it has an advantage that the amount of air required for ideal insufflation of the stomach can be controlled under the fluoroscopy. 2. About concentration and type of barium. a) Mikabarium in 90% seems to give the best result in filling study, mucosal relief study and double contrast study. b) Mikabarium in higher concentration adheres to the mucosa better, thus resulting in good double 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 given prior to barium ingestion, the anterior wall of stomach is better demonstrated with mucosal relief study. e) To get better result in contrast study, the selection of barium is important as well as rapid and proper positioning of the patient and abdominal respiratory movement. 3. Demonstrability of the stomach lesion according to the position. a) The small lesion either in pylorus or in antrum can be best demonstrated by compression technique of double contrast method in supine position. b) The mucosal relief study in prone by adequate air insufflation was proper to demonstrate the lesion of anterior wall. c) In the lesion of the angle, double contrast study and compression study were effective. The compression study was most effective in the elevated lesion. d) For upper stomach study, double contrast study was effective. The anterior wall lesion is better outline, and the posterior wall lesion in supline. 4. Antispasmodic agent gave better demonstrability of mucosa on poor distensible area or localized spastic area, difficult to evaluate