In 1964 Takemoto et al. came across a case in which grayish-white protrusions were seen scattered about in the gastric antrum endoscopically. It was further found after gastrectomy that they were caused by intestinal metaplasia. Convinced that such a case could be not infrequently encountered on careful observation, author have since then set about to tackle with the possibility of endoscopic diagnosis of intestinal metaplasia in the gastric mucosa. "Definition of specific type of intestinal metaplasia" Endoscopically, grayish-white protrusions of varying size are seen here and there in the antrum. They mimic "Stepping Stone" in the Japanese garden, in the resected stomach. Elevated parts correspond to hyperplasia of mucosa associated with marked intestinal metaplasia, while depressed parts between them show severe atrophic gastritis with no trace of intestinalization. Auther defined the word of "specific type of intestinal metaplasia" the only type which has endoscopical and histological characteristics as above. "Roof slate type of intestinal metaplasia" Areas clearly discolored in milky-white as seen by endoscopy extend over relatively flat mucosal surface, and intestinal metaplasia is to be seen almost over their whole extent. "Scattered rice grain type of intestinal metaplasia" From the antrum up to the level of the gastric angle lied grayish-white protrusions scattered about on the mucosa as if rice grains had been pasted on its surface. "Snow fleck type of intestinal metaplasia" From gastric angle toward corpus several streaks of "Kammrötung" were seen, with white small granulas like snow fleck on them. "Classification of the histological findings of intestinal metaplasia diagnosed endoscopically" Resected stomachs of 19 cases which were diagnosed endoscopically examined histologically. Author classified them 4 types, I type (specific type of intestinal metaplasia), II type, III type, IV type (roof slate type of intestinal metaplasia). "Factors which influence endoscopic diagnosis of intestinal metaplasia" Endoscopic appearance may vary, depending upon such factors as the quality of the source of light, distensibility of gastric wall and the presence of as-sociated superficial gastritis. "Incidence of intestinal metaplasia diagnosed endoscopically and confirmed by biopsy" It may be too early as yet to refer to its frequency from the view point of endoscopy. But at least in the author's estimation, out of 5, 687 cases including both out and inpatients examined by FGS-C and FGS-CL 126 cases (2.2%) with endoscopically diagnosed intestinal metaplasia were later confirmed as such by biopsy. Up to this time intestinal metaplasia was diagnosedd only by histological examination. Owing to the excellent development of endoscopy, recently endoscopic observation become finer and more acurate. Author made it possible to diagnose some types of intestinal metaplasia by usual endoscopical examination.

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The forward viewing f iberscope GIF type D has been widely used as an indispensable tool for the examination of the upper G. I. tract, since it was developed in 1971 by Olympus Optical Co. Recently the fore-oblique viewing f iberscope GIF type K has been introduced, representing further modifications of the GIF type D. Compared with the GIF-D, two main improvements are seen in the GIF-K: 1) The objective lens is placed 30° obliquely against the longitudinal direction of the (iberscope, 2) The distal end of this new f iberscope is metaltipped. We have used the new fiberscope on 93 cases between June and December 1974, whose classifica-tion is: 2 cases of esophagitis, 4 cases of esophageal cancer, 2 cases of esophageal varices, 22 cases of gastritis, 22 cases of gastric ulcer, 7 cases of gastric cancer, 2 cases of gastric submucosal tumor, 8 cases of gastric polyp, 5 cases of operated stomach, 11 cases of duodenal ulcer and 11 normal cases. From observations of the above cases examined with GIF-K, the following two points should be considered as advantages of this new type of the instrument: 1) It makes easier for us to pass the tip of the f iberscope through the esophageal entrance. 2) We can easily observe the side of the lesser carvature at the gastric angle and the pyroric antrum which are regarded as relatively blind spots using forward-viewing type endoscopes.

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Heretofore, it has been regarded to carry out endoscopic examinations on the patients bleeding from the digestive tracts. However, recent improvement in endoscopic apparatus and the diagnostic techniques in Japan have made it possible to carry out an urgent endoscopy within a short time after the bleeding; so that we are able to locate the bleeding sites very soon, make a correct diagnosis and given necessary first aid and treatment accordingly. On behalf of this purpose we have been studying stanch methods for the treatment by endoscopy and we made two types of stanch clips for the bleeding from digestive tracts and for the bleeding after polypectomy by f iberscope. The type "A" clips is for small lesions like de-veloped vessel end from bottom of the ulcer and type "B" is bigger than type "A", for larger lesions like bleeding after polypectomy. These clips are used from forceps-canal of f iberscope same as forceps for biopsy, also used not only for the urgent cases but for followings; to recognize the border between oesophagus and cardial mucous, to obtain knowing anterial and posterial walls of duodenum by X-ray examinations and marking of the lesions in the case of surgioal operations, etc. The type "A" clips was made so small, its length is 5.0mm, width is 1.5mm and 0.05 grams in its weight.

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Endoscopic studies of 440 active duodenal ulcer patients (male 405, female 35) were carried out by using duodenofiberscope (Type JF-B). Multiple duodenal ulcer (58.9%) was found more frequently than single ulcer (40.7%), and two rare cases of duodenal retrobulbal ulcer were also ob served. The location of single ulcer in 179 cases was hold more frequently in the anterior wall of duodenal bold, and in order of lesser curvature, posterior wall and greater curvature. Multiple ulcer was mainly found in the anterior wall, and relieved the order of lesser curvature to posterior wall compared with single ulcer. Single ulcer assumed most frequently the form of linear ulcer, and multiple ulcer was mainly round form. Salami ulcer was observed in 109 cases (17.1%). Most of them was accompanied with duodenal open ulcer or ulcer scar, and it was discussed that the histological findings of salami ulcer was considered to be the erosive changes associated with duodenal ulcer. In this report, linear ulcer was more frequent compared with another authors. It might be related that the healing of linear ulcer was detected by dye-scattering method. The healing time of linear ulcer prolonged than another forms of duodenal ulcer, and the recurrence was occasionally noted. Peptic ulcer was sometimes coexisted in the sto-mach and duodenum (9.1%), gastric ulcer was found most frequently as the form of round ulcer in the gastric angle, and dundenal ulcer was round or linear form in the anterior wall. The healing time of duodenal single ulcer was not differed from multiple ulcer by means of the endoscopic observation. Many of duodenal ulcer patients with severe initial symptoms or with linear ulcer showed prolonged healing period. Anticholinergic drugs used alone paraenterally was not so much effective to heal duodenal ulcer within 3 months observation period, and the use of antacid or another antiulcerative drugs with anticholinergica was more effective.

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Eighteen patients who were to undergo radiation tharapy to the pelvis for carcinoma of the uterine were studied. All patients were treated by means of ¹³⁷Cs and telecobalt treatmant or 10 million volt linear accelerator. Almost all cases recieved 4000 to 6000 rads of total dosage. The changes noted in the bowel are classified into 6 grades based on their appearance at proctosig-moidoscopy. The commonest changes consist of local edema, hyperemia, and teleangiectatic areas. Such changes are classified as an actve slight lesion (6 cases). Friable mucosa that bleeds easily and has erosion is classified as an active moderate lesion (5 cases). If condition progresses, the changes are fol-lowed by the appearance of ulceration. This is an active severe lesion (3 cases). Atrophic mucosa is an inactive slight lesion (2 cases). Granular mucosa is classified as an inactive moderate (0 case). If bowel stricture or fistulas occurs, this is an inactive severe lesion (0 case). Endoscopic changes are most frequently found in rectum and rectosigmoid junction, The changes are always localized at anterior wall of the rectum and only 6 in 16 cases with endoscopical abnomalities have a lesion at one side of the wall. It seems that there is no relation to effective radiation doses and endoscopical findings. Symptoms of radiation injury to the lower bowel frequently appear from one to two years after radiation therapy. Onset and term of symptoms are no relation to endoscopical grades. The mucosa in biopsy specimens are abnormal in every case. In a majority of patients the biopsy specimens reveals increased Paneth cells, eosinophilic infiltration containing eosinophilic crypt abscess, edema in stroma, appearance of hyaline like substance and dilated blood vessels. Compared with ulcerative colitis, irradiation proctitis has more lymphcytes and plasma cells infiltration than neut rophils. These findings are useful in diagnosis of irradiation proctitis and increased Paneth cells are noteworthy and has been previously described.

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