Peptic ulcer and gastric carcinoma: diagnosis with biphasic radiography compared with fiberoptic endoscopy.

Abstract

The diagnostic value of biphasic radiographic examination of the stomach and duodenum was compared with that of fiberoptic endoscopy in a prospective, blinded study of 385 patients with dyspepsia. This investigation was directed at gastric malignancies and peptic ulcers. Methodologically there is no absolute standard for a study of this kind because histologic examination is useful for detection of cancer but inadequate for ulcers. As an alternative, kappa indexes and the sensitivity and specificity, as derived by Hui and Walter, were calculated and compared. For the detection of gastric carcinoma, radiographic and endoscopic findings had almost perfect agreement beyond chance. For gastric ulcers, radiography and endoscopy had substantial agreement, which became perfect if small ulcers (less than 5 mm) were excluded. For duodenal ulcers, radiography had a lower sensitivity than endoscopy; this disagreement disappeared if small ulcers were excluded. Both methods have equal merit; choice of the initial diagnostic procedure will therefore depend on cost, discomfort to the patient, and risk of complications.

An early gastric carcinoma treatment strategy based on analysis of lymph node metastasis

“…Precise preoperative evaluation of the depth and size of early gastric carcinoma should be performed by radiology, endoscopy with biopsy, and EUS. In a prospective, blind comparison, Shaw et al15 found that double‐contrast radiography and endoscopy were equally capable of detecting early gastric carcinoma. Tumor depth (mucosa or submucosa) was diagnosed accurately by EUS in 55% of our patients and in 72% of patients reported by Sano et al16 Overdiagnosis of tumor depth may be related to submucosal fibrosis and disorganized muscularis mucosae caused by the ulceration of the tumor per se or a previous endoscopic biopsy,17 the distinction of which occasionally may be difficult.…”

Systematic Approach toward the Clinical Diagnosis of Functional Dyspepsia

“…However, this resource is not available to the same extent in all geographic areas and consequently, primary care physicians often use upper gastrointestinal series, which are less expensive and easily accessible. However, radiography has consistently been shown to provide inferior diagnostic accuracy in detecting structural causes of dyspepsia (66,67). In order to decrease the risk of wrong diagnosis with upper gastrointestinal series, a process of matching a carefully established clinical diagnosis and a radiographic report should lead the physician to pursue the investigation with endoscopy each time that there is discordance.…”

Comparative Organ Imaging: The Gastrointestinal Tract

“…Double contrast gastrography has comparable sensitivity to endoscopy for the detection of gastric ulcers in man. 66 Nuclear scintigraphy is particularly applicable to the evaluation of gastric motility, since quantitative assessments of gastroesophageal reflux and gastric emptying rate can be made. The principal disadvantage of gastric scintigraphy is the poor anatomic detail of the images.…”