Lugol's solution spraying method hss been applied in esophagoscopy for the purpose of the differential diagnosis of many esophageal diseases; that is, inflammatory disease, ulcer, and hiatus hernia etc. This paper aimed to resolve the mechanism of vital staining on in vivo and in vitro experimental studies. As demonstrated by histochemical and biochemical esti-mation of tissue glycogen, the content of glycogen within the esophageal cancer cells decreased compared with it in the normal esophageal epithelium by anthrone agents. The frozen section of the esophageal cancer tissue was stained with Lugol's solution as small, irregularshapedly and scat-teredly brown area. On the other hand, the frozen section of normal esophageal epithelium revealed the uniformly and intensely stained layer, which represented the uniform permeation of iodine in the squamous epithelium. Clinically, this method has been applied in endoscopic diagnosis of the cancer of the esophagus for the following purpose: (1) Diagnosis of esophageal cancer with intraepithelial invasion (2) Determination of the oral margin of the primary or secondary cancerous lesion (3) Diagnosis of the esophago-gastric junction (4) Observation of the morphological and functional changes on the esophageal epithelium surrounding the cancerous lesions (5) Diagnosis of the separate or satellite cancerous nodule

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I Revaluation of Endoscopic differentiation between benign and malignant gastric ulcers. We have classified ulcerative lesions of the stomach by fiberscopic diagnosis into following five categories : E-I : Benign Ulcer E-II : Benign ulcer but the possibiity of cancer cannot be completely ruled out E-III : Difficult to determine whether it is a benign or malignant ulcer E-IV : Strong suspicion of cancer E-V : Cancer For the determination of E-II to E-V, accurate diagnosis only by usual observation sometimes is difficult because ulcer and cancer may be present at the same time. Accordingly, by means of close up observation of the redness and other characteristics of mucosa of gastric ulcer margin surrounding mucosal folds through f iberscope, we investigated the possibility of definite diagnosis of gastric ulcer. For detailed observation, specimen taken during the operation was immediately observed and photographied by magnifying to two to four folds. After the specimen was fixed by 10% formalin, it was stained by alcian blue and haematoxylin and again observed and photographied by the same procedure. I noticed that there were coexistance of benign gastric ulcer and cancer in the cases of E-II, E-III and E-IV . Some are very difficult to differentiate. Study by close up done observation was then done for the purpose of differ-entiation. Ulcerative cancer which show "over-hanging" and ulcerative cancer which have been covered by regenerated epithium are considered to be the most difficult ones to diagnosis by surface observation. Close up observation by endoscopy is useful, in the diagnosis of gastric ulcer, however, it must be based on histological confirmation. In conclusion, differentiation of the ulcerative lesion of the stomach, can be accurately made by endoscopic & microscopic close up examination. II Endoscopic study of Regenerative Epithelium around gastric ulcer During 13 monthed, from October, 1971 to October, 1972, 81 patients under treatment at het Institute of Gastroent-erology, Tokyo Women's Medical College, had been studied through the close-up observation of gastric ulcer margin by using forward-viewing f iberscope, GIF-D, PFS-F and PFS-F2. I classified the patterns of regenerative epithelium of ulcer margin into four types: Thistle type, Golden Banded Lily type, Wild Comomile type and Mixture type. Studies of the differences in the patterns of redness of four types were done by direct shooting biopsies and analyzed. The adquate number of specimens had been taken, and the regenerative epithelium of 53 lesions were studied according to Fukumoto's classification. I found out that almost each type of lesion changed to mixed type as it healed. III Comparation study of Endoscopic and dissection microscopic observation of regenerative Epithelium around gastric ulcer A comparative investigation of magnified view of the close-up observation and stereo-microscopic pictures of eighteen operated cases was done. As a rule, close-up observation was done, within twenty four hours prior to operation. Within 30 minutes after gastrectomy, these fresh specimens were washed in normal saline solution and they were examined by stereo-microscope at two time, four time and eight time magnification. The stereo-microscopic findings of each type are, Thistle type: The continuous regenerative mucosa is the place where muscularis mucosae and tunica muscularis are conglutinated. Golden Banded Lily type: Scattered red spots and dots are identical to redness of area gastrica. Mixture type: This type is mostly covered by regenera-tive mucosa and redness of margin is same as redness of area gastrica of remaining uncompleated regenerative epithelium. Histological findings of each type are; Thistle type: Hemorrahage can not been seen. Inflammatory reaction, by peramia, comgestion, vessel expansion and intestinal metaplasia is observed. Golden Banded Lily type: Vessel expansion, inflammatory reacti

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Resected specimens of the ulcerative colitis were cut up continuously from the anal part to the oral. The serial blocks were dyed with alcian blue or hematoxylin, and examined dissecting-microscopically and histologically. Result: (1) Morphological characteristics of the following subjects were described: erosion, ulceration, villous protrusion, inflammatory polyp, colonic pseudoarea. (2) An erosion and small ulceration have become distinguished. In the surrounding mucosa of erosion or ulcer, namely the mucosa in active stage, blue spots which consisted of goblet cells stained with alcian blue were found decreased under the dissecting microscope. (3) Around the erosion or ulcer, finger-like or hemispherical protrusions were sometimes found. The author has named it the "villous protrusion". The protrusion appeared to be composed of the regenative epithelium covering the granuration. This form appeared in the comparatively early stage of regeneration. (4) The surface structure of the inflammatory polyp varied from the nearly normal to the distinctively deformed structure. But it was in most cases possible to distinguish the inflammatory polyp from the adenoma or the metaplastic polyp. (5) The mucosal surface was found that looked like the subdivided normal colonic area. The author has named it the "colonic pseudoarea". This colonic pseudoarea was accompanied by disarrangement of glands and changes of muscularis mucosa. If the surrounding mucosa of erosion or ulcer shows pseudo-area, it is suggested that the lesion is recurrent. (6) Ulcerative colitis can be said histologically and dissecting-microscopically to be an inflammatory process of the mucosa involving the rectum and a variable length of colon in continuity with the rectum. (7) This method is useful for the morphological study of ulcerative colitis with main lesion in the mucosa. Furthermore the results of dissecting microscopic study are applicable to interpreation of magnifying endoscopy in the ulcerative colitis.

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Relationship between the recurrence of gastric ulcer and fundal gastritis was examined by the endoscopic Congo red test. On the basis of the extent of f undal gastritis, healed gastric ulcers were classified into two groups, i.e., 1) those with little or no fundal gastritis, and 2) those with moderate or severe f undal gastritis. In each group, rate of recurrence, location of recurrent ulcer and acid secretion were studied, and obtained the following results.1. Among a total of 84 cases, 32 (38.1 %) showed recurrence once or twice during the 1-year follow-up period. Among 33 cases with little or no fundal gastritis, only 18.2 % of them showed recurrence, but recurrence was more common in cases with moderate or severe f undal gastritis.2. Location of recurrent ulcer was almost identical with initial ulcer. However, there could be found a correlation between the location of recerrent ulcer and the extent of fundal gastritis. In general, location of recur rent ulcer was more proximal when f undal gastritis was. more extersive.3. An inverse correlation was observed between the rate of recurrnce and acid secretion. It seems likely that factors causing decrease in the mucosal defensive barrier are more important for the recurrence of ulcer than agressive factors, such as HCl.4. Gefarnate, which restores or potentiates the anatomical and functional unity of the mucous barrier, was effectiv-for the prevention of recurrence.Gastroenterological Endoscopy 18: 122-126, 1976.

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A method is developped in this medical department to delineate the outline of the submucosal lesion. In this method, one to 3ml of contrast media, either 60% Conray or 64.9% Conraxin mixed with a small amount of 5 % patent Blue-V solution, is injected through specially made needle of 0.5mm in diameter into the submucosal space approximate to the oral and anal aspects of the root of the lesion using fibergastroscope designed for biopsy. This is followed by direct X-ray examination and simple lateral and P-Apictures were taken. These pictures are analyzed and divided into two groups. The diffuse type shows diffusely dispersed contrast media and the defect type demonstrates clearly delineated outline of the tumescent lesion. The defect type picture is the characteristic finding of the submucosal tumor. So far until the time of the present report, 100 clinical experiences were accumulated without any complications. Iodine sensitive cases should not be subjected to this method and injection of contrast material to the cancerous area should alone be avoided. The method can be performed without much hazards and each illustrative cases will be demonstrated. The method is combine with the thorny needle biopsy technique and some promising results in the differential diagnosis of the submucosal tumor are obtained.

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An endoscopy of the stomach with concomitant use of arterial infusion of dye was designed and clinically tried. After arterial infusion of a dye, excavated carcinoma of the stomach was detected as a relatively irregularly stained area with longer retention of the dye as compared with normal area of the stomach. However, the area where carcinoma invaded deeper layers of the gastric wall was not stained. Accordingly, this method is considered useful for estimation of extensiveness and depth of carcinomatous invasion in the gastric wall. Staining of the gastric wall affected by diffuse carcinoma after arterial infusion of dye was poor and irregular. In the case of reticulum cell sarcoma of the stomach, the lesion was not stained at all. Resected stomach with leiomyoma was found to be homogeneously and deeply stained in the tumorous area. This method may be also used for differential diagnosis of nonepitheliar tumor of the stomach and for judgment of intractability of benign gastric ulcer.

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Using the new examination of endoscopic transduodenal pancreatocholangigraphy to diagnose of the diseases of pancreas and Biliary duct, we have made a new approach to the problem by direct endoscopic study of outer and inner fiberscope to observe the pancreatic duct and biliary duct. We used this method to insert the inner fiberscope from the ostium of papilloplastic surgery (2cases) to the common bile duct, and one case from the ostium of choledochoduo-denal fistula to the common bile duct. The other case was succeeded to insert to the pancreatic duct from the ostium of papilla Vateri. Because the instrument is still in improving, the observation of biliary duct and pancreatic duct is not sufficient, but if we continue to improve this kind of instrument, we can sure it will be the useful clinical examination.

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The complications associated with endoscopic retrograde cholangiopancreatography (ERCP) have recently been evaluated during a survey conducted by the research committee of the American Society for Gastrointestinal Endoscopy. Data was obtained on 3884 examinations with a total complication rate of 21.6/1000. Complications incl-uded pancreatitis (51 cases), cholangitis (25 cases), cardio-pulmonary (4 cases), perforation (3 cases), bleeding (2 cases), and miscellaneous (9 cases). Five fatal complications were associated with endoscopic retrograde cholangiopancr-eatography. Two cases of pancreatic sepsis following endo-scopic pancreatogram and two cases of cholangitis following endoscopic cholangiogram contributed to patient mortality. One cardiac arrest in a patient with documented atheroscl-erotic heart disease was also reported. Analysis of the individual complications indicated that patients with obstr-ucted ducts demonstrated by ERCP should be treated with early surgical relief of the obstruction because of the high incidence of sepsis. ERCP has proven to be a valuable new addition in the clinical evaluation of a variety of pancreatic and biliary tract diseases. It is a procedure that is associ-ated with significant complications which must be carefully monitored and vigorously treated.

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The diagnosis and treatment of intrahepatic stone was considered difficult previously. We report the result of fibercholangioscope on diagnosis and treatment of intrahepatic stone and discuss the possibilitys of its clinical uses. In a period of 5 years, we carried out operative f iberch-olangioscopic examinations on 214 patients (Table 1) Almost all cases were cholelithiasis and 42 of them, (20%) were intrahepatic stones. Most of the patients with intrahepatic stone were refered for operation by the first time, but 16 cases, (38%) were for reoperation. We classified "intrahepatic stone" with 5 types according to the site of narrowing of the biliary tract; It is convenient for selecting the operative methods, and studying of the cause and its prognosis. (Table 2) We have succeeded in removing the residual stone in most cases of type I (no narrowing) or type II (narrowing at duodenal papilla and lower portion of choledochus) of intrahepatic stones. However it is difficult the remove the stone in type III, IV and V. (narrowing at hepatic hilus and intrahepatic duct) (Table 3) The treatment of intrahepatic stone is not only to remove the stone completly but also to ream the narrowing of the biliary duct to decrease pressure and to drain the biliary system. Restenosis occured at the anastomotic portion of choledochojejunostomy in some cases for example. We tried to incise the narrowing by electric snare under fiber cholangioscope. Moreover, we gained good result by carry-ing out PTC-drainage and "endoscopic choledochal catheterization for drainage". The development of f ibercholangioscope makes it possible not only to remove stone easily bt also the diagnosis and to treatment of intrahepatic stone hitherto it is considered difficult.

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A new type of forward-viewing upper gastrointestinal fiberscope "GIF type D3" was made by Olympus Optical Company. This new fiberscope has the strong upward angulation of the apical portion with the intention to make easy observation of the lesser curvature side of the stomach mainly the gastric angulus, and is equipped with the mec-hanism by which it is possible to change the direction of the biopsy forceps about 20° aiming at easier and more precise biopsy. Diameter and effective length of the scope, length of the apical rigid portion, image of optics and structure of the control part are almost the same as the previous GIF type D2. The upward angulation of the tip gains about 180° and 200° if combined with the lateral angulation, however the downward angulation is only 80°. By this strong upward angulation, it becomes very easy to observe the cardia. But it is not sufficient for complete observation of the gastric angulus because the apical rigidd part is not short enough even having strong upward angulation. Biopsy forceps comes out in the left lower side of the visual field, which can be turned toward the right upper direction by the direction changing mechanism of the biopsy forceps. Thus, the tip of biopsy forceps turns to the center of the visual field easily, and it becomes possible to take precise biopsies from the right side of the wall. But, it is difficult or even impossible to take biopsy from the left side, because the biopsy forceps is apt to run parallel to this side of the wall.

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