Robert E. Paul

Endoscopic Pancreatography: An Analysis of the Radiologic Findings in Pancreatitis

The endoscopic pancreaticographic findings in 46 proved cases of pancreatitis are analyzed. Pathologic ductograms were demonstrated in approximately 60%. Significant information was obtained in many cases, allowing both proper diagnosis of the primary disease process and complications thereof. Because of the latter, the procedure has proved to be quite helpful in isolating those patients who could benefit from surgery.

Chronic erosive gastritis—A recently recognized disorder

We have reviewed the clinical manifestations, endoscopic findings, pathology, and upper gastrointestinal x-rays in 10 patients with chronic erosive gastritis, a disorder that was rarely recognized before the use of double-contrast upper gastrointestinal radiology and endoscopy. The characteristic x-ray appearance is that of a series of 3 to 11-mm nodules, some with central collections of barium, that are distributed along rugal folds and usually extend into the antrum. The endoscopic appearance is similar: small erythematous nodules with shallow central erosions. The pathology differs from that seen in peptic ulcer disease. There are few polymorphonuclear leukocytes and a predominance of plasma cells in the inflammatory infiltrate. Seven of our patients presented with epigastric pain similar to that of peptic ulcer disease; four of these also had anorexia and weight loss. In two other patients anorexia and weight loss were the only symptoms. One patient was asymptomatic. All nine symptomatic patients responded to antacid treatment. However, repeat x-rays demonstrated persistence of the nodules, although the central erosions usually disappeared. The etiology is unknown. Chronic erosive gastritis appears to be a distinct entity different from peptic ulcer disease.

Pancreatographic abnormalities due to pancreatic cancer

The endoscopic cannulation records of two medical centers (Niigata, Japan and NEMCH, Boston, Mass.) were studied for evidence of pancreatic cancer. Of a total group of 483 pancreatic ductograms, 33 were characteristically abnormal and fell into 4 patterns: stenotic, tapering, obstructed, or unclassified. Three causes of false-positive patterns emerged: idiopathic chronic pancreatitis, surgical mobilization of the head of the pancreas, and traumatic pancreatitis. No false-negative results have been found in this brief followup period. The endoscopic method remains valid for preoperative diagnosis of pancreatic cancer, keeping in mind these sources of false-positive results.

Demonstration of Erosive Gastritis by the Double-Contrast Technique

The value of the routine pharmacologically-aided double-contrast examination of the upper gastrointestinal tract in demonstrating superficial gastric erosions was assessed. Ten cases of erosive gastritis were diagnosed during a six-month period. It appears that erosive gastritis is more common than generally believed. Diagnosis requires relaxation of the stomach and demonstration of fine mucosal relief by the double-contrast technique.

Malabsorption in Marfan (Ehlers-Danlos) syndrome.

A patient with somatic features of both Marfan and Ehlers-Danlos syndromes presented with severe intestinal malabsorption. Functional intestinal abnormalities were thought to be due to bacterial overgrowth associated with small intestinal hypomotility and giant jejunal diverticula. The structural intestinal defects are presumed to be the result of defective collagen synthesis in these hereditary connective tissue disorders.

Roentgen Diagnosis of Linear Ulcers

Linear peptic ulcerations are not uncommon lesions of the stomach and duodenum and can be demonstrated by upper gastrointestinal series. This is facilitated by the double contrast technique, but they may also be appreciated via compression methods. The criteria found helpful to establish the presence of a linear ulcer include: (a) contour deformity; (b) niche projection; (c) fuzzy line; and (d) folds radiating to a line (crater). Routine use of these criteria with the double-contrast method enabled the authors to diagnose 42 linear ulcers.

Linear and Rod-Shaped Peptic Ulcers

Experience with the routine use of the pharmacologically aided, double-contrast examination to demonstrate various primary and healing ulcers over a six month period is assessed. Thirteen linear or rod-shaped ulcerations were diagnosed. It appears that gastric relaxation and the demonstration of fine mucosal relief are necessary to detect ulcers of linear or rod form.

Chronic erosive gastritis resulting in cachexia

Nine patients are reported who presented with severe weight loss of up to 13.6 kg (30 lb) as a result of chronic erosive gastritis. In many the cachexia was sufficient to prompt a search for malignancy but no other lesion was found. The importance of the radiological pursuit of this diagnosis is emphasised. Illustrative case histories are presented.