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Video Endoscopic Sequence 1 of 3.
Gastric Ulcer.
This 76 year-old male, smoker, presented nausea vomiting
and non-specific abdominal pain at endoscopy displays a
well circumscribed smooth, regular, rounded edge with a
flat smooth base and surrounding mucosa.
For more endoscopic details download the video clips by
clicking on the endoscopic images, wait to be downloaded
complete then press Alt and Enter; thus you can observe
the video in full screen.
All endoscopic images shown in this Atlas contain
video clips.
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Video Endoscopic Sequence 2 of 3.
Multiple biopsies were taken to ruled out malignancy.
A gastric ulcer is a break in the normal tissue that lines the
stomach.
Ulcers develop when the normal defense and repair
mechanisms of the lining of the stomach or duodenum are
weakened, making the lining more likely to be damaged by
stomach acid.
By far, the two most common causes of peptic ulcer are
infection of the stomach with Helicobacter pylori bacteria
and use of certain drugs.
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Video Endoscopic Sequence 3 of 3.
Ulcer in red Scar
A follow up endoscopy was performed after six week of
treatment with PPI.
Smoking
Studies show smoking increases the chances of getting an ulcer, slows the healing process of existing ulcers, and contributes to ulcer recurrence.
Four stages of gastric ulcer healing have been established by correlating endoscopic findings with those obtained from stereoscopic microscopy and histologic observations: I. initial healing stage; II. proliferative healing stage; III. palisade scar stage; IV. cobblestone scar stage. The palisade scar and cobblestone scar stages roughly correspond to Sakita's red and white scar stages, respectively. It is suggested that healing is not complete until the cobblestone stage with attendant micropit formation is achieved.
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Video Endoscopic Sequence 1 of 10.
Case of Multiple Ulcers.
A 76 year-old, female, presented with a three day history
of melena without any abdominal pain. She had one episode
of hematemesis (about 100 ml blood) in the emergency
room, patient has a strong alcoholic drink abuse.
An upper endoscopy with magnification was performed.
multiple ulcers was detected across of the gastric camera,
esophageal varices was also detected.
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Video Endoscopic Sequence 2 of 10.
The image displays a high magnification endoscopy
displaying one of the ulcers.
Symptoms of peptic ulcer disease include epigastric
discomfort (specifically, pain relieved by food intake or
antacids and pain that causes awakening at night or that
occurs between meals), loss of appetite, and weight loss.
Older patients and patients with alarm symptoms indicating
a complication or malignancy should have prompt
endoscopy.
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Video Endoscopic Sequence 3 of 10.
The image and the video clip display several ulcers
across of the entire stomach.
For younger patients with no alarm symptoms, a
test-and-treat strategy based on the results of H. pylori
testing is recommended. If H. pylori infection is diagnosed,
the infection should be eradicated and antisecretory
therapy (preferably with a proton pump inhibitor) given for
four weeks.
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Video Endoscopic Sequence 4 of 10.
Retroflexed image shows multiple ulcers.
Surgery is indicated if complications develop.
Administration of proton pump inhibitors and endoscopic
therapy control most bleeds. Perforation and gastric outlet
obstruction are rare but serious complications. Peritonitis
is a surgical emergency.
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Video Endoscopic Sequence 5 of 10.
A panoramic view of the gastric body, retroflexed image.
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Video Endoscopic Sequence 6 of 10.
Chromoendoscopy using indigo carmine.
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Video Endoscopic Sequence 7 of 10.
A close up of generative epithelium at the border of the
ulcer, magnifying image.
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Video Endoscopic Sequence 8 of 10.
More images and video clips of multiple ulcers with indigo
carmin stain.
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Video Endoscopic Sequence 9 of 10.
Chromoendoscopy using lugolīs solution.
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Video Endoscopic Sequence 10 of 10.
In addition of multiple ulcers, patient shows esophageal
varices.
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Video Endoscopic Sequence 1 of 9.
Pre-Pyloric ulcer surrounding with regenerative epithelium.
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Video Endoscopic Sequence 2 of 9.
More evident the regenerative epithelium is observed,
surrounding the ulcer using a magnifying endoscope.
Recently, magnifying endoscope has been used clinically
for its developments in amplifying power, definition and
operational capability.
Magnifying endoscopy is helpful for more correctly
distinguishing hyperplastic lesions from adenomatous and
cancerous lesions, and for improving detection of early flat
and depressed cancer.
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Video Endoscopic Sequence 3 of 9.
A magnifying close up.
Magnifying endoscopy may have an obvious value in
diagnosing chronic atrophic gastritis, intestinal metaplasia
and H pylori infection.
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Video Endoscopic Sequence 4 of 9.
Magnification chromoendoscopy dye-methylene blue.
The new detailed images seen with magnifying
chromoendoscopy are unequivocally the beginning of a new
era where new optical developments will allow a unique
look on cellular structures.
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Video Endoscopic Sequence 5 of 9.
High-resolution chromoendoscopy.
Chromoendoscopy, the intravital staining of gastrointestinal
epithelia, provides additional diagnostic information with
respect to the epithelial morphology and pathophysiology.
Based on experience gathered, chromoendoscopy is now in
more widespread use, in particular to identify preneoplastic
and neoplastic lesions.
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Video Endoscopic Sequence 6 of 9.
Another image and video clip, Chromoendoscopy with
methylene blue. Tissue staining during endoscopy
(chromoendoscopy) is a technique used to study the fine
details of the mucosa throughout the gastrointestinal tract.
Chromoendoscopy combines high resolution endoscopy with
various methods of vital staining of epithelial structures. In
these methods, during endoscopy, tissues are coloured by a
stain introduced through a spray catheter. The staining
techniques are technically simple, economical and easy to
perform.
Various stains produce different optical effects. Contrast
staining with indigo carmine fills folds, villi and other
uneven areas and hence emphasises the structure. A
different image is obtained by using absorptive stains such
as methylene blue or Lugols solution which are directly
taken up by the cells, thus staining them.
An even more differentiated investigation is possible using
zoom or magnification endoscopy. This uses special
endoscopes capable of enlarging the endoscopic images up
to 150 times. It does not take much imagination to predict a
dynamic development of chromo- and zoom endoscopy.
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Video Endoscopic Sequence 7 of 9.
For more endoscopic features download the video clip.
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Video Endoscopic Sequence 8 of 9.
Multiple erosions are observed
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Video Endoscopic Sequence 9 of 9.
Dye-Scattered picture (Methylene blue) multiple erosions
are appreciated.
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Video Endoscopic Sequence 1 of 5.
Giant Gastric Ulcer.
91 year old female presented epigastric pain, nauseas and
vomiting for 3 months.
The biopsies were benign.
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Video Endoscopic Sequence 2 of 5.
Retroflexed Image.
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Video Endoscopic Sequence 3 of 5.
Posterior wall of the gastric corpus.
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Video Endoscopic Sequence 4 of 5.
Adenomatous polyp near of the giant ulcer.
See the video sequence of this polyps after six week of
treatment, of that ulcer is appreciated with magnifying
endoscopy with chromoscopy.
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Video Endoscopic Sequence 5 of 5.
A follow up endoscopy was performed after six week of
treatment, a scar was found.
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