Brushing Cytology with Fibergastroscope under direct Vision

The cell collection methods for gastric cytology have been developed from the simple aspiration method of gastric juice, lavage with physiological saline, lavage with α-chymotrypsin solution, abrasive balloon, and gastroscopic cell biopsy to cytology with fibergastroscope under direct vision.Authors reported already in many papers the result of cytology for gastric malignancies by various technics described above, and emphasized the effectiveness of cytology for the diagnosis of early gastric carcinoma.Since last 1971, authors deviced the instrument for brushing cytology, constituted from thin vinyl tube and small nylon brush with wire. The thin vinyl tube putting small brush in it is inserted into the fibergastroscope.When examiner finds the lesion in the stomach, the vinyl tube is pushed out from the distal part of the scope at first, then the small brush is pushed out from the covering vinyl tube under direct vision. By the manipulation of the handle at the proximal part of the scope, the brush is abrassed the surface of the lesion. After these manipulations have finalized, the brush is pulled into the vinyl tube, and then the latter is pulled out from the scope. Smear preparations are made by touching this brush on slide glasses.This brushing cytology with fibergastroscope was performed for 112 cases of various gastric diseases including 31 of gastric cancer. The positive result by this technique was 90.3% cytologically. 5 cases of early gastric cancer were positive in all. This technique is significant with many merits as described below.1) The procedure is very simple and the examination is carried out with biopsy technique at the same time.2) The cell collection from the wider area and from the lesion of the difficult biopsy examination is possible.3) The damage for the lesion is a little.4) The technique of smear preparation is very easy and it is not necessary to make many smears. Usually 2 or 3 smears are enough to perform the cytological examination.5) Cells taken by this technique are rather fresh and easy to make correct diagnosis.In conclusion, the brushing cytology with fibe rgastroscope is very useful for the diagnosis of early gastric cancer, especially small cancers.