We devised an esophagofiberscope with a magnifying apparatus (FES-MB, by Machida Co. Ltd.), for the purpose of getting better visions in differentiation on esophageal lesions. This apparatus, attached to the ordinary esophag-ofiberscope, gives the maximum magnification up to 1.7 by 15 times by operating the handle. This was designed to have a hole for the markerof the sport in the magnifiedGastroenterological Endoscopy area. It gavean great improvement on the result of shooting biopsy. In this way this apparatus can be used for the routine esophagoscopy. Various esophageal lesions were shown in the recordings with ordinary esophagof iberscope and with the magnifying apparatus. This apparatus was useful for observing esop-hageal mucosa, especially on reddening, erosion, small vessels around ulceration and magnified mucosal surface after dying mucosa. Detailed observations with magnifica-tion on elevated lesions was also very useful for getting better differential diagnosis. Cancerous surface was shown with characteristic mucosal form. This detailed observation with magnifying endoscope willl become more common in all on the digestive system, and may, in the future, change the course of development of the endoscopy itself.

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One hundred and twenty one cases had been followed up for more than two years as benign gastric lesions because of negative biopsy. Seven out of 121 cases were revealed to be carcinoma by follow-up biopsy. And six out of them were early cancers and one was a advanced cancer, which resembled closely benign gastric lesions endoscopically, Initial endospic diagnoses of these cases were 2 cases of pedunculated polyp, 3 cases of active ulcer, 1 case of mu-ltiple ulcers and 1 case of verrucous gastritis. And initial biopsy results showed no malignancy in all cases, further-more histological findings of these cases were compatible with the endoscopic appearances except one case. We discussed the possibility of the factors which might bring false negative results at the initial biopsy and compared the initial biopsied specimens with operated materials his-topathologically, in all cases. After these analyses, we found that two regenerative polys changed to malignancy, and these corresponded to 5.4% of 37 cases which had been followed up as a benign polyp in the same way. In the other cases, however, we could not prove malignant change from gastric ulcer or verrucous gastritis, as the possibility that initial biopsy might be false negative could not be denied. But one case out of three ulcer cases was suspected for malignant change at the margin of the ulcer because repeated biopsies from there had been consistently negative over three years. We concluded that benign gastric lesions, such as pedu-nculated polyp, ulcer and verrucous gastritis, were not independent of gastric cancer. And if endoscopical appea-rrances suggest for benign nature, possibility of existence of cancer cannot be excluded, even when biopsy was negative. Benign gastric lesions should be followed up endoscopically, including biopsy as far as possible.

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We have been performed endoscopic polypectomy for polypoid lesions of the stomach and the duodenum, as treatment and complete biopsy. Here, we deal with significance of endoscopic polypectomy for the atypical epithe-lium of the stomach and the duodeum. From Jan. 1973 to Jul. 1975, 134 cases and 226 lesions had been polypectom-ied in our hospital. Out of them, atypical epitheliums were 15 lesions and 14 cases. 8 lesions located at the pyloric antrum, 5 at the body and 2 at the duodenum. 8 lesions were sessile type, and 7 were subpedunculated or peduncu hated type. The maximum sizes of all gastric lesions did not exceed over 20mm. and the maximum sizes of 2 duo-denal lesions were 25mm. and 40mm. respectively. Accord-ing to histological study of biopsied specimens from these lesions, 14 lesions were classified as group III of atypism, 2 were as duodenal adenoma and 1 was as group IV. Ac-cording to histological study of polypectomied lesion, that is, complete biopsy, their degrees of the classification were corrected in some cases, as follows: 2 lesions out of 14 lesions as group III with biopsy were corrected to be eos-inophilic granuloma and grade I to II, each, 2 duodenal lesions changed form grade I to II (Westheus) and one lesion of group IV with biopsy was proven to be a papillo-tubular adenocarcimonatous tissue. As conclusions, by endoscopic polypectomy, 5 lesions out of 17 lesions (29.4%) were corrected their histological findings by biopsy. Therefore, endoscopic polypectomy can be evaluated as both complete biopsy and treatment. No accidents nor complications had been experienced, follow ing polypectomy. According to follow-up study after polypectomy, no recurrence had been experienced.

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On 3 cases of gall stones in the common bile duct and/ or bile flow stasis, the electromyograms of duodenal pap-illa were recorded before and after the endoscopic sphin-cterotomy of the ampulla of Vater by endoscopic direct induction method. The electromyograms of duodenal papilla after endoscopic sphincterotomy showed almost similar patterns and rhythms to those before endoscopic sphincterotomy. The bile flow mechanism was not destroyed functionally by endoscopic sphincterotomy. On the view of the topographical anatomy and the physiology of duodenal papilla, the endoscopic sphincterotomy of the ampulla of Vater should be performed for the pur-pose of the removal of stones at the common bile duct and the temporary elimination of bile stasis was emphas. ized.

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During the last 9 months in Fukuchiyama National Hos-pital, the colonoscopy using CF-MB (Olympus) was performed to 135 subjects, as a screening examination, without fluoroscopy accordance with our "simplified preparetion method" which had been reported to be useful for observing the left colon. Out of them, 71 had no complaint but following signs considered to originate from the disturbance of the left colon were complained in 64, that is melena, abdominal pain, abdominal tumor or abnormal bowel movement. As a result of it, various diseases could be detected in 38 cases (25. 9 %) ; carcinoma, 3, polyp or polyposis, 20, diverticulum, 2, proctitis or colitis, 5 and malanosis coli, 5. Especially, 13 of 35 cases had no complaint and the frequency of these diseases correlate to the age distribution; the older the subjects were growing, the more frequently diseases were found. Therefore, the old people must be examined regardless to their complaints. Furthermore, 13 cases with anal bleeding were examined as an emergency colonoscopy within 7 days of its onset. In 7 cases, the bleeding source could be diagnosed endos-copically, but 2 were diagnosed only suspiciously and 4 could not be comf irmed in their bleeding source. Namely, at the time of anal bleeding, emergency and/or screening colonoscopy was proved to be also useful in order to establish its source, as in the upper gastrointestinal tract.

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The two cases of the gastric lymphoid hyperplasia who-se diagnosis was initially made by biopsy were followed up. The first case was a 62-year old woman. On the first endoscopic examination mucous membrane showed uneven surface with erosions all over the stomach. In the cardia a large round tumor was observed. The histologic findings of lymphoid hyperplasia were obtained in all of the biopsy specimens taken from those lesions. But after three and half years, the findings of lymphoid hyperplasia disappe-ared at the lower half of the stomach, and there was only fibrosis. During the course, there were no suggestive findi-ngs shifting to sarcoma or to carcinoma. The second case was a 65-year old woman. A relatively shallow ulcer surrounded with widespread uneven mucous membrane was found from posterior wall to greater curv-ature of pyloric antrum. After three months, the ulcer healed to scar, and the biopsy specimens from the lesions did not show any findings of the lymphoid hyperplasia.

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A case of Bowen's disease with malignant lymphoma was presented. The relationship between Bowen's disease and other malignant tumors, with the exception of skin cancer, was discussed. Reviewing the recent 232 cases of Bowen's disease, the sex ratio, male to female, was found to be 1.6 :1. The average age of male and female was 64.3 years and 62. 7, respectively. In Japan, 319 cases of Bowen's disease have been reported to date. Among these, 31 cases (9.1%) of Bowen's disease developed malignant neoplasmas. This figure, 9.1 %, showed twice as much indence as that of earlier reports in Japan, and nearly equal to that of Andersen's. However, this figure was lower than that of American reports. The difference was statistically significant at the 1 % level, evaluating on the bases of Chi-square distribution. As for the complicated group of Bowen's disease with other malignant tumors, the ratio of Bowen's disease on unexposed area to that on exposed area was found to be 5.4:1, whereas for all Bowen's disease, it was 3.8:1. However, no significant difference was found between the former and the latter. The average age of former complicated group and of the latter was 63 years and 64 years, respectively. No significant difference was found between them. On the other hand, the sex ratio was statistically significant, namely, it was suspected that female patients of Bowen's disease were more susceptible to other malignant tumors than male. Comparing the incidence of malignant tumors in autopsy materials with that of malignant tumors complicated with Bowen's disease, it is suspected that carcinoma of uterus is highly associated with Bowen's disease. However, a hasty conclusion that there is a certain correlation between them must not be made, since five out of thirteen cases of uterus carcinoma went ahead of the Bowen's disease. The incidence of complication of each malignant tumor with other malignant tumors, in autopsy cases, was also showed. This incidence was compared with that of complicated Bowen's disease. Among the cases of carcinoma of uterus and rectum, no significant difference was found between them. If there is no correlation between carcinomaa of uterus and other malignant tumors, it can be concluded that Bowen's disease is not correlated with other malignant tumors.

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A case of the small intestinal carcinoma which is rare in the alimentary tract was reported in this paper. A 35-year-old man was admitted to our institute May 19th 1975, complaining of vomitting and weight loss. Radiologic examination of upper G-I tract revealed a tubelike stenosis with marked dilatation of the third portion of the duodenum. Roentgenological impression was a malignant tumor of the small intestine, but differentiation from a localized ulcerative disease was necessary. Endoscopic examination by small intestinal f iberscope (SIF-B, Olympus) also showed annular constriction with epithelial irregularity of its margin, which strongly impressed malignancy. Histologic diagnosis of biopsy specimen was reported as signet ring cell carcinoma. Cytodignosis by aspiration under direct vision was signet ring cell carcinoma too. The patient underwent operation on June 5th 1975 Histological studies of the resected material exactly coinsided with preoperative diagnosis.

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