Generally a gastrocamera is better than a f iberscope in tesms of quality of photographs because the former hous-es a small camera in the distal portion (lens-prism system) and the camera of the latter is mounted at the proximal end (fiber optic system). With a new gastrocamera, G T F type B₂, 105 cases were examined clinical results of which were evaluated. This gastrocamera has several merits as follow : 1. single-lens reflex system 2. lens cleaning device 3. shortness of hard distal portion 4. thick and tough biopsy forceps Observation and recording were improved because the lens cleaning device warranted always a sharp image and photographs, because a single-lens reflex system dissolved parallax and because shortness of hard distal portion all-owed examiners to approach lesions. All the phtographs of 105 cases were satisfactory, even after biopsy or/and dye spraying. Moreover, biopsy specimens easily taken with tough forceps under a clear close-up image. This new gastrocamera made it possible that good pho-tographs of every part of gastric mucosa were taken under any conditions and at the same time, whenever necessary, biopsy was carried out.

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Endoscopy has been the primary diagnostic test in the investigation of patients with suspected gastric malignancy. Among patients undergoing endoscopy of the stomach the number of elderly people has been increasing and cardio-vascular complications have been reported more frequently. This is the report of a study to determine cardiodynamic effects of endoscopy in patients with cardiovascular disor-ders. Changes in the heart rate, blood pressure, ECG, occur-ing at the time of endoscopy of the stomach were studied in a group of 59 cases of cardiovascular disease and in a control group of 27 cases. With regard to arrhythmias appearing at the time of endoscopy of the stomach, ventricular and atrial premature beats were the most numerous. Atrial fibrillation, as well as ventricular bigeminy were encountered. Two cases of atrial fibrillation continued even after the end of the examination. STT changes during endoscopy were found most freq-uently in the ischemic heart disease group and in the valvular heart disease group. There were 3 cases in which severe ST depression made it necessary to stop the exam-ination. The cardiovascular changes generally occured at the begining of the endoscopy examination. Two mg of pro-pranolol IV. seemed to be effective in preventing chang-es of heart rate. The data clearly permit the conclusion that upper G I endoscopy may be frequently comlicated by cardiovascular aberration. With sufficient care and some precautionary measures, however, these complications appear not to be of serious nature.

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This study was carried out with the aim of clarifying the relation between arteriosclerosis and atrophy of the f undic glands. Histopathological, clinical and endoscopic studies were performed on 70 cases who were operated on in our hospital during the past ten years. Based on various clinical tests, we graded the severity of general arteriosclerosis according to a definite standa-rd, and determined the degree of atrophy of f undic glands and arteriosclerosis of the gastric wall from the histolog-ical findings.The results were as follows.1) There was no significant relation between general arteriosclerosis and atrophy of the f undic glands.2) The degree of arteriosclerosis of the gastric wall was closely related to the degree of f undic gland atrophy. This correlation suggests that gastric wall arteriosclerosis might promote f undic gland atrophy.3) No remarkable relationship could be found between general arteriosclerosis and gastric wall arteriosclerosis.4) The preoperative endoscopic findings of atrophic pa-ttern were compared with the histological findings of glandular atrophy in the resected stomachs. The visuali-zation of the submucosal vessels coincided well with the histological glandular atrophy in the fundic area. The frequency of the endoscopic appearance of submucosal vessels is higher in the cases of gastric wall arterioscler-osis than in the non-sclerotic group. From these results, we consider that the arteriosclerosis of the gastric wall elicits a deficiency of blood supply to the gastric wall causing a thinning of the mucus membr-ane and eventual glandular atrophy. As this phenomenon progresses the transparency of the mucosa increases and the vessels beneath the mucosa can be visualized.

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Mucosal surface pH study was done for 58 cases having upper gastro-intestinal complaints. We got f ollwing results from surface pH study : 1. The mucosal surface pH of the stomach was chiefly affected by gastric mucosal atr-ophy ; 2. the surface pH of the case of endoscopic normal gastric mucosa were 5.5 for distal esophagus, 2.4 for ga-stric corpus, 2.2 for angle 4.9 for antrum and 6.5 for duodenal bulb. Determination of gastric atrophic border was carried out for 2 cases of duodenal ulcer, 1 case of gastric ulcer and 1 case of II a type early gastric cancer. The gastric mucosa showed from pH 0 to pH 3 could be diagnosed as f undic mucosa from bioptic histological basis. On the other hand, the gastric mucosa showed more than pH 6 could be diagnosed as pyloric mucosa. The area showed from pH 3 to pH 6 were diagnostic invalid for the dete-rmination of the gastric atrophic border. So, we recommend intravenous administration of tetra-gastrin in case of endoscopic determination of gastric atrophic border with microglass pH-electrode.

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A total of 89 polyps in 71 cases were polypectomied by endoscopic diathermy method during the period of 2 years and 4 months from September. 1972 to December, 1974 and the following result was obtained.(1) Endoscopic polypectomy is safely indicated for pedu-nculated or sub-pedunculated polyps with the largest dia-meter of smaller than 2. 0cm.(2) It is very important to determine endoscopically wh-ether a polypoid lesion is pedunculated or sessile. Polyp-ectomy is not indicated for sessile polyps which is larger than 1. 0cm in the largest diameter, because most of them are malignant, infiltrating to the submucosa extensively and colectomy is always required.(3) Carbon-ink marking would be advisable for accurate identification of a polypectomied site and subsequent foll-ow up examination.(4) Double contrast barium enema examination which is performed a few months after the polypectomy rarely con-firms a site of it as an ulcer scar.

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Extraction of common duct stone was successfully accom-plished in one out of five cases so far tried. Catheters used in conjunction with duodenal fiberscope included elastic wire basket catheter, modified Dormia catheter, modified Fogarty balloon catheter and newly designed so-called "Stork head" catheter. Elastic wire basket and "Stork head" catheters were found to be most useful for the purpose. The reason for the high failure rate four out of five cases is attributable to the size of choledochal orifice vs size of the stones present, i. e. stone extraction is only possible when wide opening is present between common duct and duodenum such as after choledochoduod-enostomy and sphincteroplasty or in the presence of incompetent sphincter or parapapillary choledochoduodenal fistula. Therefore, endoscopic sphincterotomy to provide good access to the common duct stone is mandatory for the successful removal.

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The dyeing of the colonic mucosa with indigocarmine or methylene blue solution was performed in 80 patients during colonofiberscopy.1. The superficial changes of the normal colonic mucosa on dyeing showed a regular, fine foldlike or granularappearance.2. In the early stage or in the stage of remission of chronic ulcerative colitis, the mucosal changes were classified into the following 3 patterns;1) the spotted appearance2) the hazy appearance3) the cobblestone appearanceThe classification was useful to indicate the degree of regeneration of the colonic mucosa.3. The dyeing gave much information on finding the border area between the normal and the abnormal.4. The mucosal changes of the colon were demonstrated characteristically in the case with tuberculosis or non-specific ulcer of the intestine.5. In polyp or polyposis of the colon, the superficial min-ute changes were observed. The dyeing was useful to determine the indication for endoscopic polypectomy, to identify the location of the polyp accurately although the differentiation benign polyp and polypoid carcinoma was not always possible.6. Inflammatory pseudopolyposis and lymph follicles which were not dyed were better observed with the surrounding mucosa completely dyed. The dye spray method was highly effective in the de-monstration of the superficial minute changes of the colon in both the ulcerous and the protruded lesions.

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During the past four years, 36 cases of ulcerative colitis were examined using dye scattering method in colonof ib-erscopy. Abnormal minute findings of the mucosal surface in this disease were classified into four categories; Grade II ; there are course and asymmetrical features accompa-nied with multiple erosions or ulcerations, Grade II ; there are irregular and asymmetrical features on the mucosal surface, but erosions and/or ulcerations are not, apparent, Grade I ; almost normally arranged spindle or oval fine structures but sporadic small depression in the mucosa, and Grade 0 ; normal findings. And this classification of the minute mucosal appeara-nce was correlated with the histological process of this disease. And the stainability of methylene blue solution was also corresponding to the healing process of this les-ion. As above mentioned, this method was useful for recog-nizing the healing process and the expantion of this dis-ease.

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Eedoscopic pancreatocholangiography is extremely useful for the diagnosis of the diseases of the pancreas and bili-ary aduct, and it is one of the essential means for their examination. At present, however, diagnostics of pancre-atogram has not been well established, and necessity for endoscopic examination of this region is being emphasized. We have therefore attempted the examination of pancreatic duct and biliary duct by inserting a fiberscope instead of a cannula into the doudenal papilla. The instrument used was a retrograde panceratocholangioscope (RPCS ), with a front-view fiberscope of 2 mm in diameter and 200 cm in length, with a field angle of 25 and 35. The Pan-view Fiberscope (PFS-BL) was used for the outer fiber-scope. For the examination, PFS-BL is first inserted into the duodenum, with the visual field in front-view, and RPCS is inserted from the biopsy forceps inlet to about 3 cm outside the tip of PFS-BL. Then the visual field of PFS-BL is changed from front to lateral view, RPCS is bent gradually into the visual field of PFS-BL and inse-rted into the papilla. This retrograde pancreatocholangioscopy has been carr-ied out on 8 cases to date, and successful observations were made on the inside of main pancreatic duct in one case and of the biliary duct in two casis after papilloplasty.

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Endoscopic Pancreato-Cholangiography (E. P. C.G.) has already become popular as an essential diagnostic method of pancreatic and choledochal diseases. And recently they try not only to analyze the pancreatocholangiograph, but the cytology by collecting the pancreatic juice and pan-creas function test under duodenoscopy, and pancreato-cholangioscopy by introduction of a small fiberscope through the duodenoscope into the choledochus and pan-creatic duct directly. However, there still remains a lot of problem on the reading of E.P.C.G. radiograph as well as on the technique and diagnostic evaluation of direct pancreatic juice collection test. In order to supply dificiencies in those diagnostic method and to utilize the technique, we have been studying the endoscopic continuous pancreato-choledoch catheter rema-ining method. This method is performed as follows: 1. Insert the long catheter into the choledochus or pancreatic duct under observation with duodenos- cope. 2. Extract the duodenoscope only while remaining the catheter in the same position. 3. Through the catheter remained various examina- tion and diagnostic procedure can be performed at any time needed. We have succeeded in remaining the catheter for 55% in the cases of pancreatic duct and 90% of choledochus. With the help of this method, selective cytology and pancreatic secretion test have become facilitated, and the other morphological examination such as low-tentional duodenography and selective angiography, and also simul-taneous pancreatography have become possible. And during our study we found in a few case there were rise in amylase consistency and the increase of pancreatic in the midnight when we performed the continuous pancreatic juice collection. From these results it can be said this method can be expected useful for the further diagnosis. Also this endoscopic continuous choledocho catheter remaining method was useful for the removal of choledo-chal stones, quick doreinage to prevent the acute choledo-chitis, and for the utilization as a guiding catheter. In its complication we found a proclem of rise of blood amylase, and felt there still remains a room for the impr-ovement of examination technique and the sellection of the cases.

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The incidence and clinical features of esophagitis in 159 Patients examined at the National Cancer Center Hospital are reviewed. The severity of esophagitis was classified into 4 grades by esophagoscopic apperances. One hundred fifty nine patients include 118 grade I esophagitis, 27 grade II, 7 grade Ill, and 7 grade N ·Slight eaophagitis (grade I and II) is found in any age group, but severe esophagitis (grade ID and N) is more frequent in groups of elderly people. Slight esophagitis predominates in males, while there is no sexal difference in patients with severe eso-phagitis. No definite tendency is observed in gastric a-cidity of patients with slight esophagitis, but acidity is high in the patients with severe esophagitis. The combi-nation of gastro-duodenal ulcer is more frequent in slight esophagitis.

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