Abstract】：Objective：To investigate the examination method of gastroduodenal ultrasound diagnosis and its clinical value. METHODS: After filling the gastric cavity with an echogenic ultrasound aid orally, the follow-up analysis of 980 cases with positive gastroduodenal ultrasonography was performed to summarize the methodological and clinical values of gastroduodenal ultrasonography. RESULTS: There were 93 positive ultrasound diagnostic cases, including 25 cases of progressive gastric cancer, 18 cases of peptic ulcer, 5 cases of gastric polyp, 8 cases of cardia cancer of lower esophagus (fundus), 6 cases of gastric parenchymal tumor, 23 cases of gastric sinusitis, 3 cases of gastric mucosal cyst, and 8 cases of gastric prolapse, with a positive detection rate of 9.49%, a compliance rate of 93.9% with gastroscopic diagnosis, and a compliance rate of 86.6% with pathological diagnosis. Conclusion: The filling method of gastroduodenal ultrasonography has a high detection rate for common diseases and is an ideal method for gastroduodenal examination. 【Key words】: ultrasound; diagnosis; ultrasound co-developer; gastroduodenal disease Gastroduodenal is a common and multi-morbid organ of the digestive system, and traditional examination is based on gastroscopy and barium meal X-ray; Data and methods All cases were from 980 outpatients and inpatients of our hospital, aged 10-91 years old, with an average age of 54 years old, of which 93 cases were diagnosed positively by ultrasound, 54 males and 39 females, with There were 93 positive ultrasound cases, 54 males and 39 females, with varying degrees of epigastric pain, distension and discomfort. Gastroscopic, pathological and surgical findings were used as criteria for follow-up control. Instruments and materials: Aloka-4000 color ultrasound machine, Philips HD7 color ultrasound machine, Toshiba-530 ultrasound machine, etc., probe frequency 3.5-7.5MHz, using the “world brand” gastrointestinal ultrasound developed by Zhejiang Huzhou East Asia Ultrasound Institute. The patient was fasted with water and food. Method: Patients fasted from water and food for more than 8 hours; 1 packet of ultrasound aid was added to 500 ml of boiling water and washed into a thin paste. Manipulation: examine the lower end of the esophagus and cardia, take the right lateral recumbent position, place the probe under the saber process longitudinally and transversely, and sweep the acoustic beam to the left posteriorly; the gastric fundus is taken from the left lateral recumbent position at the midpoint of the left costal margin, and sweep the acoustic beam to the left posteriorly; the gastric body is taken from the standing position or right lateral recumbent position, and sweep from the saber process downward transversely and longitudinally; the gastric sinus and duodenum are taken from the right lateral recumbent position, and sweep from the right costal margin downward transversely and longitudinally, and the duodenum is located between the pancreatic head When examining the duodenum and the fundus, the subject was asked to inhale deeply and then hold his breath to make the diaphragm move downward in order to show clearly and eliminate the blind spot. Results: The examination results of 980 cases showed that the blind areas were eliminated by changing different positions and the cooperation of the examinees, and the lower part of the esophagus, various parts of the stomach body and duodenum could be clearly displayed. Ultrasound suggested 93 positive cases (9.49%), which were analyzed against gastroscopic and pathological diagnosis, including 25 cases of progressive gastric cancer, 18 cases of peptic ulcer, 8 cases of pancreatic cancer of lower esophagus (fundus), 5 cases of gastric polyp, 6 cases of gastric tumor, 23 cases of gastric sinusitis, 3 cases of gastric mucosal cyst, and 8 cases of gastric prolapse. The compliance rate between ultrasonic diagnosis and gastroscopy was 93.9% and 86.6% with pathological findings. Discussion: Gastroduodenum is a cavernous organ of the gastrointestinal tract. In early studies, gastroduodenal ultrasonography was performed by oral ultrasound imaging solution of traditional Chinese medicine and saline and other aqueous filling methods, which achieved certain clinical application value, but the aqueous agent had a short residence time in the stomach and emptied quickly, thus not ensuring sufficient observation time, and the aqueous agent was not conducive to the full unfolding of gastric mucosal folds and the exclusion of mucus and air in the stomach. The lack of good contrast effect between the hypoechoic area formed and the hypoechoic lesion of the gastric wall is not conducive to the differential diagnosis of the disease (2). After filling the gastric cavity with an echogenic ultrasound aid, the mucosal folds of the gastric wall were fully expanded, forming a uniform moderate echogenic region in the stomach, eliminating the interference of mucus and air, and forming a good contrast interface between the aid and the mucosa of the gastric wall, showing the structures of the lower esophagus, stomach and duodenum one by one; the lower esophagus was a tubular structure with a diameter of 5-6 mm, and the lumen was linear and strongly echogenic (Figure 1), and the cross-section was The mucosal layer, submucosal layer, muscular layer, and plasma layer of the gastric wall structure showed a four-layer structure with low and high echogenicity from inside to outside (Figure 2); while in the drinking water method examination, the gastric wall showed a five-layer structure due to the formation of an interface between the non-echoic aqueous medium and the mucosal surface. The duodenum is triangular when filled, and the regular opening and closing of the pylorus can be observed. The correct identification of the structural layers of the GI wall helps to improve the detection rate of upper GI lesions and determine the depth and extent of lesion infiltration; it also helps to review after treatment and observe the healing of the lesion area. The sonographic features of ulcerative lesions: under the background of echogenic ultrasound aids, the ulcerative lesions appear as limited thickening of the gastric wall, the submucosal tissue echogenicity is lower than the muscle layer echogenicity, the level is not clear, the perimeter of the mucosal surface depression is elevated in the shape of a “ring dike”, the echo in the concave surface is enhanced, and the local peristaltic stiffness. In the case of duodenal ulcer, the filling of duodenum is restricted and the time is significantly prolonged. In progressive gastric cancer, the echogenicity of the mucosal surface is similar to that of ulcer, but the lesion is often ≥3 cm in extent, the thickness of the local gastric wall is greater than 10 mm, the layers are unclear, and the mucosal surface is often depressed, showing a crater-like sonogram with a “small mouth and large base” and rigid peristalsis, which is more common on the side of the gastric lesser curvature, and some of them are accompanied by enlarged perigastric lymph nodes. In our group, there were 25 cases with lesions larger than 3 cm in diameter, 17 cases of adenocarcinoma of the gastric body, 5 cases of adenocarcinoma with invasive cell carcinoma, and 3 cases of invasive cell carcinoma, including 3 cases with perigastric lymph node enlargement. Gastric mucosal polyp: a hypoechoic mass with a tip in the gastric cavity that moves back and forth with gastric peristalsis; in larger polyps, the surface often forms a depressed ulcer. In this group, the diameter of polyps was 5~30mm by ultrasound, and in one case, a localized depressed echogenic ulcer was seen on the mucosa of the gastric lumen. The proposed polyps (less than 10 mm in diameter) were diagnosed during gastroscopy, and no obvious lesions were seen on the mucosal surface during ultrasonography, which might be pseudo-polyps. Gastric mucosal cysts: round echogenic areas with clear borders and elevation toward the gastric lumen were seen on the mucosal surface or submucosa of the stomach, which could occur in various parts of the stomach and were generally small in diameter, about 5 mm. In this group, round anechoic areas with clear borders on the mucosal surface and no obvious clinical symptoms were found. Substantial tumors of the gastric wall: one case of lymphosarcoma of the gastric antrum and five cases of subplasmic mesenchymal tumor of the gastric wall were diagnosed pathologically. The sonogram showed a substantial hypoechoic mass with irregular morphology and heterogeneous internal echogenicity, which was elevated toward the gastric lumen or plasma layer. Lower esophagus and pancreatic cancer at the bottom of stomach: the lower esophagus is obviously thickened and hypoechoic, with narrow lumen, increased cross-sectional diameter and eccentric lumen, which cannot effectively enter the gastric cavity through the esophagus during gastroscopy, while ultrasound can clearly show the narrowed part of the lower esophagus and make up for the deficiency of gastroscopy. Among the five cases in this group, there was one case of esophageal indolent cell carcinoma and four cases of esophageal squamous cell carcinoma. Chronic gastritis: patients had symptoms of epigastric distension and vague pain; ultrasound examination showed normal thickness of gastric wall, clear hierarchical structure, local gastric mucosal surface (especially obvious in the gastric sinus) was not shiny, and submucosal echogenicity was slightly reduced, among the 23 cases with ultrasound suggesting chronic gastritis, 20 cases were diagnosed as chronic superficial gastritis by gastroscopy, among which 18 cases were biopsied under the microscope, and pathological diagnosis: chronic inflammation of gastric body (sinus). Ultrasound diagnosis of chronic gastritis has a certain reference value for clinical diagnosis. Hypogastric prolapse: In the standing position, it was clearly shown that the gastric greater curvature side reached the pelvis, the gastric less curved side reached below the iliac spine line, and the gastric body surface projection was low tension type, and in one case, during fasting examination, a large amount of retained material in the stomach filled the gastric cavity to act as a contrast agent. The patient with hypogastric prolapse had a thin body type, and the small abdomen was significantly distended and distended after meals. Follow-up shows that frosty ulcers and superficial erosive gastritis are often seen on the mucosal surface of patients with hypogastric prolapse, which is related to the long-term irritation of the gastric mucosa due to the inability to empty the gastric cavity in a timely manner. Barium meal and gastroscopy are traditional GI examination methods that provide valuable diagnostic information for clinical workup, and the development of upper GI ultrasound diagnosis is a good complement to traditional gastrointestinal examination methods (gastroscopy, barium meal X-ray) (3), which can provide timely information on early asymptomatic phase lesions and is an ideal screening tool for upper GI diseases. The examination technique has not been described in detail in previous literature. Because of the irregular morphology of the stomach, the examination technique is relatively demanding, which is one of the reasons why gastric ultrasonography is not widely performed. The development of gastroduodenal ultrasonography, especially in primary hospitals, is expected to provide valuable information for the early diagnosis of gastroduodenal diseases and is worth promoting.