الفهرس 
Gross anatomy of the Stomach
PATHOLOGY OF DIFFERENT DISEASES AFFECTING THE STOMACHAFFECTING THE STOMACHOnly 14 pages are availabe for public view
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Abstract
Conventional endoscopy is the established primary diagnostic investigation for patients suspected to have gastric lesions. Simplicity, availability, rapid evaluation, and relatively low cost are advantages offered by it. The ability to determine the exact location of the lesion, to appreciate its gross morphology and subtle color changes caused by inflammation, The ability to obtain biopsy specimens and to evaluate the stomach, the esophagus and the duodenum for synchronous lesions are added advantages. However, conventional endoscopy has limited value for accurate staging of the gastric cancer especially the determination of depth of infiltration and does not contribute to nodal staging. (Bhandari S, et al, 2004).
The rate of complications by upper gastrointestinal endoscopy(UGIE) was reported as 0.11% in the study by shamir and schuman, the complications may be related to premedications given as abnormal reaction to sedatives, or the instruments as perforation, aspiration or bleeding from biopsy.( Classan M, et al, 2002)
Recent advances in computed tomographic (CT) technology have made faster, simpler and more accurate gastric imaging available. 2D-MPR and CT gastrography including virtual gastroscopy and transparency rendering provide multiple cross-sectional imaging and gastroscopic viewing in the same data acquisition; they are also helpful in detection and evaluation of gastric malignancies and a variety of inflammatory conditions that affect the stomach. (Kim JH, et al, 2006)
Virtual gastroscopy is a non invasive imaging modality for evaluation of gastric lumen. Virtual gastroscopy may provide an alternative imaging technique for patients for whom gastroscopy and upper gastrointestinal series are not suitable (Ogata, 1999)
Absolute contraindications of (UGIE) include an un- cooperative patients and preexistent perforation, there are relative contraindications as high risk patients include proximal oesophageal or pharyngeal obstruction, acute corrosive injury, aortic aneurysm and massive gastrointestinal bleeding.( Classan M, et al, 2002)
Evaluation of gastric tumors and other abnormalities is possible with virtual endoscopic techniques using CT. accurate evaluation of endoluminal morphology requires conventional endoscopy. Although it is invasive and has a limited field of view. Virtual endoscopy using 3D CT data sets provides an overview of tumors within the lumen of the gastrointestinal tract. Furthermore, extraluminal information can be obtained with 3D CT data sets. (Ogata, 1999)
Virtual gastroscopy allows detection of subtle mucosal changes and differentiation of mucosal lesions from submucosal lesions in the same way as gastroscopy. It provides additional information for evaluation of mucosal detail in the stomach. (Kim JH, et al, 2006)
Virtual gastroscopy has several advantages over gastroscopy: It has a wider field of view than conventional gastroscopy, the angle of the virtual camera can be adjusted omnidirectionally and it has no blind points because retrospective reformation is available. (Kim JH, et al, 2006)
Virtual gastroscopy failed to detect benign gastric lesions including small polyps and superficial-elevated tubular adenomas which are premalignant lesions. Poor distension of the stomach in the cardia and antrum and depression of the tumor account for missing these lesions by Virtual gastroscopy. With Virtual gastroscopy there also was a tendency to misclassify flat lesions such as types IIb EGC especially those located in the cardia and gastric antrum. (Kim HJ, Kim AY. et al. 2005)
CT gastrography including virtual gastroscopy is a promising method for evaluating gastric lesions despite its limitations. 2D-MPR and CT gastrography including virtual gastroscopy and transparency rendering can provide the comprehensive information from a single data acquisition for various gastric diseases, which otherwise would be obtained only by performing four different examinations including gastroscopy, UGIS, endoscopic US, and CT; however, further studies are required to prove the accuracy, efficacy, and cost effectiveness of virtual gastroscopy. (Kim JH, et al, 2006)