Total of 254 cases of biliary tract disease have been subjected to endoscopic cholangiography. In total of 146 cases of cholelithiasis endoscopic cholangiography was successfully accomplished in 120 cases i. e. success rate of 82 per cent. Choledochal and intrahepatic stones were visualized in 84 and 100 per cent respectively. In the course of the investigation 25 cases of parapapillary choledochoduodenal fistula were diagnosed which have hitherto been missed by the routine examination. The fistulas were classified into two groups i. e. Type I small fistula originating from intramural bile duct and Type II larger fistula originating from the distal portion of extramural common bile duct. Type I fistula is probably produced by the smaller stone which was lodged into the intram-ural portion of common bile duct while Type II fistula is the result of the larger stone which can not be passed into intramural portion of the duct and hence impacted into the distal portion of the extra-mural common bile duct.

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The newly modified esphagoscope with its top movable up to 2000, has been used for the observation of the esophagus and the gastric cardia. The length of the bending portion was 5.8cm. It was longer than that of the usual type of EF, but shorter than that of GIF-D. Manipulation of the instrument was same as the usual EF-B. II. There was no blind portion in the whole esophagus. The gastric cardia was seen from oral side for the first time, then inserting fiberscope into the stomach, observed from the stomach with 200° angle mechanism. The esophagogastric junctional area and the fornix was seen in the nearer distance and in the front of view. The examination was carried out in 88 cases of cardiac tumor, ulcer, achalasia and varices. The damage of the image glass fiber of the fiberscope was not increased in this mechanism.

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A name of gastritis verrucosa was proposed by Sano, after his careful microscopic investigations, to designate a group of gastric pathologies which is called as ‘takoibo’ or suckers-of-octopus-like gastritis, gastritis erosiva, gastritis varioliform, polyp of type II and so on. As the histologic feature of this disease he pointed out hyperplasia of the pyloric glands in the antrum and that of foveolar epithelium in the body. One hundred typical cases of gastritis verrucosa were selected among those who underwent gastroscopy or gastrectomy at the National Cancer Center Hospital during ten years from its opening in 1961. Average age of the cases was 44.5 years for gastritis verrucosa in the pre-pyloric area, 50.2 for the antrum, 58.8 for the angular area and 58.8 for the body. Shifting the age towards older with the location of its lesion became the more proximal is the same tendency as the proximal expansion of gastric atrophy by age. Sex ratio was 2.45 to 1. Two thirds of cases complained only vague epigastric discomfort or were discovered by mass-survey for stomach cancer. In the pre-pylorus and antrum gross type of the lesions was mainly ‘takoibo’ or ‘hebitama’ (snake-which-swallowed-eggs-like), and in the angulus and body it was 'takoibo' or polyplike. The lesions chiefly lined up on the longitudinal or circular folds in the pre-pylorus and antrum, and along the borderline between the pyloric and fundic glands area in the angulus. The gastric mucosa evaluated by gastroscopy was less atrophic in the cases of gastritis verrucosa than that in control cases. Complication of gastric ulcer was observed in 14%, duodenal ulcer in 12%, pedunculated polyp in 11%, borderline atypical epithelium in 2%. Endoscopic follow-up over 2 to 9 years was performed in 3lcases. The lesions were remained without change in 22 cases and regressed in 9 cases. Complication of gastric cancer was disclosed in 2 cases during the period. Gastritis verrucosa was considered to be originated from gastric erosions. However by what causes gastric erosions, which usually heal very rapidly, develop to this special type of gastritis in some cases is remained for further investigations.

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This is a report of observation of methylene blue, fat and iron absorbed into the human duodenal mucosa. Method: 0.5% methylene blue, iron (ferrous sulfate of saccharated ferric oxide combined with 0.1 N HCl and physiological sodium) or fat (salad oil and milk which were mixed and homogenized) was sprinkled on the duodenal mucosa through the fiberscope (GIF-D II, Olympus). Removal of these substances was done with water for washing several minutes later (0.5% methylene blue) or 20 minutes later (iron and fat) of their introduction. Biopsy specimens were stained with hematoxylin, prussian blue or Sudan 111 after formalin-fixation. Observation of biopsy specimens with and without staining was performed under the dissecting microscope. Histological study was also performed. Results: 1. Methylene blue. The normal mucosa was changed its odor into dark blue. Methylene blue solution within the villus tissue was detected under the dissecting microscope. Cryostat preparation of biopsy specimen revealed that methylene blue was taken into the cytoplasm of epithelial cells. Uptake of methylene blue was less effective in the circumference of duodenal ulcer, at erosive changes, island of gastric mucosa, some cases of white colored villi and small elevation due to protruberant lymph follicle. Hematoxylin staining made clearer the form of specimen's villi. Low, bounch or convoluted formed villi or gastric mucosal pattern was recognized under the dissecting microscope in the circumference of duodenal ulcer or at erosive changes. The shape of villi over the lymph follicle was flat or fused.2. Iron. Color of the upper part of normal shaped villi was changed from original white to light blue by prussian blue staining on iron introduction. Histological examination confirmed up take of iron into the duodenal epitelium.3. Fat Color of normal shaped villi was changed from original light orange to dark one by Sudan 111staining on fat introduction. Histological examination revealed that the quantity of fatty particles in the epithelial cytoplasm had increased after introduction of fat. 4. Decrease of iron and fat absorption was recognized in the circumference of duodenal ulcer. Conclusion: Absorbed substances into the duodenal mucosa were observed from mucosal surface. Methylene blue absorbed was recognized by endoscope. Absorbed iron and fat were detected under the dissecting microscopic observation of biopsy specimens with staining. The quantity of methylene blue, iron or fat uptake was diminished in some duodenal lesions accompanied by deformities of villi.

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This report is concerned with an adult symptomatic case of annular pancreas which was diagnosed by an endoscopic retrograde pancreatography. Review of English and Japanese literatures on the subject was also attempted. Our patient is a male of fifty three year of age with chief comhlaints of a longstanding postprandial abdominal fullness Believed by vomiting and recurrent episores of recent onset of fever, jaundice, and upper abdominal pain. Upper gastrointedtinal roentogen examination revealed a ssymmetric dilatation of the duodenal bulb and eccentric smooth annular defect of the outer margin at the junction of the first and second portion of the duodenum. These findings were noted constantly on repeated examinatiosn and were accentuated in the right anterior oblique position. Duodenofiberscopy revealed a major papilla just below the stenotic portion at the medial aspect of the second portion of the duodenum. Swelling of the longitudinal fold of the major papilla was noted. An endoscopic retrograde pancreatography showed a peculiar abnormality of the pancreatic duct system: Not only the 'duct of the annular portion but also the main pancreatic duct which passed through the tail and body of the pancreas in a usual way run to the right across the anterior surface of the duodenum, around the right side and again to the left across the posterior surface finally to open into the major papilla. Our preoperative diagnosis was as follows.(1) Annular pancreas with a peculiar pancreatic duct system as revealed by an endoscopic pan- creatography.(2) Recurrent episodes of cholangitis either due to choledochal stenosis induced by inflammation of the annular portion of the pancreas or due to formation fo stones in the biliary tract. Cholecystectomy, duodenojejunostomy, and choledo-chojejunostomy were performed. The gall bladder contained five stones and the choledochus a large stone of 12mm in diameter.Postoperative diagnosis are as follows.(1) A complete annular pancreas.(2) Duodenal stenosis.(3) Choledocholithiasis and cholelithiasis. Biopsy specimens taken from the annular portion and the body of the pancreas showed normal histology.

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Peritoneoscopy is a very important technique for diagnosis of intraabdominal diseases. However, until recently conventional peritoneoscopy required hospi-talization and use of the operating room. A new peritoneoscope has been deviced by the Olympus Optical Company of Japan which incoropor-ates a fiber conduit of 1.5mm diameter, composed of 20, 000 fibrils. The effective lenghth of the instrument is 109mm with an overall diameter of 3.0mm. The outside diameter of the trocar used is 3.4mm, inside diameter 3.2mm. Cold light is supplied by a xenon letup. The objective consists of a Mini-Lens with a view field of 65° and forward oblique view angle of 16°. One ocular lens is supplied for observation (30X) and one for photo-graphy (10X). Photography is performed by Olympus Pen F Camera with shutter speeds between 1/15 and 1/30 sec.. With the new small diameter peritoneoscope we have been able consistent lyto carry out peritone-oscopy at the patient's bedside, avoiding also need for incision and suture. Several examinations were performed in the outpatient department and patients allowed to return home after a period of observation (3-4 hrs.). Our case series is still limited but no complications were observed so far. In our opinion this new instrument will make peritoneoscopy an easier and. safer procedure and will be very useful to gastroenterologists and hepatologists.

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The present paper reports at first case of bleeding from digestive tract caused supposedly by an extremely large polyp in the duodenal cap. The only probable sourse of bleeding was the large duodenal polyp and no other changes were detected on various examina-tions. The endoscopic appearance of the polyp was large pedunculated one with erosion-like hyperemic depression on the summit. Surgical polypectomy was carried out later on.The removed polyp was 6.1 cm in length.Histological examination of the polyp mostly showed the normal structure of the duodenal mucosa, Though the adenomatous or cystic changes were revealed in a part of the polyp. The histological picture of the polyp was therefore thought to be compatible to mixoma. On the surface of the specimen, there was an erosion similar to the ordinary one on the duodenal mucosa. Two other similar cases were also reported briefly in addition.

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Retrograde jejunogastric intussusception is a rare condition in Japan. This report deals with a case of acute retrograde jeunogastric intussusception preo-peratively confirmed by gastrofiberscopy. The relevant literature has been reviewed. Case A 60-year-old Japanese male in fair general condition was admitted to the medical ward of the Kawasaki Medical College Hospital with complaints of sudden onset of moderate epigastric pain, vomiting of coffee -grounds material. 11 years ago, the patient was diagnosed “Duodenal ulcer”, and gastric resection (Billroth II) was per-formed. After operation, there was no significant symptom in upper G-I tract. Physical examination revealed left upper abdominal tenderness without palpable mass. An upper gastroint-estinal X-ray series showed a semicircular filling defect within a distended remnant stomach. Across the defect, there were parallel lines, simulating “coiled spring” (Fig. 1). A gastrof iberscopic examination revealed a marked invagination of the jejunum through the stoma, forming mountain range like tumors with dark violet-brown colored banana-like appearance. Coffee grounds liquid was noted, in the remnant stomach (Fig. 2, 3, 4, ). A diagnosis of acute retrograde jejunogastric intussusception was made. An emergency eperation was perf omed. The efferent loop of jejunum was inv aginated through the gastro-enterostomy into the gastric remnant. The jejunogastric intussusception was successfully treated by excision of the intussuscept of jejunum. The postoperative course was uneventful, and since discharge no further abdominal complaints have been registered.

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