Microangiography was performed to study the chronic gastritis. Radiopaque medium, solution of barium sulfate crystal or colloidal solution of silver iodine was injected into the blood vessels of resected stomach. 1) In superficial gastritis, the marked dilatation of superficial vessels of gastric mucosa was only found withoutremarkable changes of the vascular architecture. The characteristic signs in endoscopic findings are reddend mucora with adhered mucous, so called "diffuse reddish pattern". 2) In hypertrophic gastritis, remarkably elongated, increased f oveolar vessels were seen in a bundle. Endoscopic findings are characterized by a uniform gastric area with a narrow avascular boader. 3) In atrophic hyperplastic gastritis, there is remarkable protrusion of area gastricae due to the hyperplastic change of f oveolar epithelium. The vascular pattern of hyperplastic gastritis resembles to the hypertrophic gastritis as seen in fig. 19. Endoscopic findings are also granular, however, the gastric areae are not uniform in size and they are rated by wider avascular zone. 4) In atrophic gastritis, mucosal vessels are shortened, sparse and shows dentriform pattern . Endoscopic findings are charactarized by discoloration, and loss of avascular zone which makes gastric area indistinguishable. 5) In specific gastritis, such as Menetrier's disease, gastritis polyposa are singular to atrophic hyperplastic gastritis in vascular patterns. In erosive gastritis, histopa. thological study revealed onion-like structure of gastric areae. 6) The mucosal vessels around enlarged lymph follicles are oppresed and erosion of the mucous membrane just above those vessels are seen. These erosions might be due to the disturbance of microcirculation because of the compression of vessels by hypertrophied lymph follicle. This is observed in follicular gastritis.

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The purpose of the investigation is to ascertain the feasability of the endoscopic cure of the gastric polyp or polyposis without surgical operation using high frequency current and to study the relationship between the hyperplastic polyp and cancer of the stomach. 230 patients with gastric polyp or polyposis were examined and in 281 instances, polypectomy was done using high frequency current (spark-gap type apparatus) and Machida type 2-channel fibergastroscope PFS-F type. In 64 instances, small sized poylps, the polyps were cauterized by the same method. There were 345 polyps thus treated. These polyps included sessile type 173 polyps and pedunculated 171 polyps. Results: Polypectomy was done for 281 polyps and 274 samples were obtained (97.5%); 7 samples were lost after polypectomy. There were 211 polyps diagnosed as the hyperplastic polyp by direct biopsy. In these polyps, the histological examination of the removed polyps revealed that 193 to be hyperplastic polyp (90.6%), 3 to be polyp cancer and 14 to be gastritis polyposa. There were 55 samples which was diagnosed as gastritis by gastric biopsy. In these, 27 were gastritis polyposa (49.1 %), 20 were hyperplastic polyp, one was atypical epitherium, one fibroid, one fibroid polyp and one aberration tissues by the examination of the removed polyp. There were 5 atypical epitherium group III diagnosed by biopsy. Examination of the removed polyps however revealed one adenocarcinoma tubulare. One atypical epitherium group IV diagnosed by biopsy was so confirmed by the histological examination of the removed polyp lesion. Conclusion: It was concluded that the endoscopic polypectomy for polyps of the stomach can be done safely using high frequency current. It was felt that the method can substitute the surgical operation in this particuler lesion. The removal of the polyp as a whole offered unique opportunity to compare the biopsy findings with the histological whole tissue examination, showing the importance of the removal of the whole polyp as evidenced by the presence of polyp cancer in 1.4 % of hyperplastic polyps.

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Gastric endoscopy is regarded as a valuable method in the diagnosis of gastric carcinoma. If the surface of gastric mucosa is covered with carcinoma tissue, the extent of carcinoma lesion wil be easily diagnosed by the endoscope. However, carcinoma tissue often infiltrates directly beneath the benign superficial epithelium, so endoscopic diagnosis for such subsuperficial carcinoma infiltration is sometimes difficult. The authors intend to clarify the macroscopic characteristics of subsuperficial carcinoma infiltration. Fifty lesions of 34 cases were revealed to have subsuperficial carcinoma infiltration over 1cm in diameter. The histologic types of these cases were only mucinous adenocarcinoma and signet ring cell carcinoma. Using the endoscopic pictures and the pictures of fresh surgical specimens, the surface color and superficial characteristics were studied. Subsuperf icial carcinoma infiltration locarized within the mucosa or from the proper muscle to the serosa did not change endoscopically the surface color of the gastric mucosa. While, the surface color of nearly half of the lesions which had severe grade of subsuperficial carcinoma infiltration turned to red as compared with the surface color of neighboring non-carcinomatous area. The study of surface color using fresh surgical specimen gave the almost same result as that of endoscopy. The surface of the gastric mucosa of almost all lesions with subsuperficial carcinoma infiltration endoscopically showed an irregular or elevated nature, but the surface of a few lesions was the same as that of the mucosa without carcinoma infiltration. The study of the superficial characteristics using fresh surgical specimens gave a little different results as compared with the endoscopic study. This result was the same as that mentioned in the previous report.

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Retrograde pancreatocholangiography was first reported in 1968 by McCune based mainly on surgical cases; which in Japan, Takagi, Oi et al. developed and brought into practice a peroral method (endoscopic retrograde cholangiopancreatography or ERCP), which currently constitutes one of the most effective diagnostic procedures for the lesions in the pancreas and biliary duct. In this paper we would like to report on the clinical evaluation of ERCP carried out on 208 cases.Objects ERCP was carried out from July of 1972 to September of 1975 on 208 cases admitted in the 1st Department of Internal Medicine, Gunma University and affiliated hospitals suffering from and suspected of hepatic, biliary duct and pancreaic diseases. The ages ranged from 15 to 82 years.Results1. Successful cannulation into the papilla of Vater accounted for 182 of 208 cases or 87.5 %. The rate of successf of radiography indicated 92.5 % with selective bile duct radiography and 86.3% with selective pancreatic duct radiography.2. This method makes one of the effective examinations in differential diagnosis of obstructive jaundice.3. Significant correlation was recognized between the maximum diameter of the pancreatic duct and the patient's age.4. Significant corelation was recognized between the maximum diameter of the pancreatic duct and that of common bile duct.5. As characteristic radiographic appearances of the pancreatic duct with chronic pancreatitis, dilatation suggestive of a string of beads, snaking, cyst formation, etc. were demonstrated. For the definitive diagnosis of chronic pancreatitis through ERCP, however, further studies are required.6. By cytology of pancreatic juice following ERCP, discovery of early-stage pancreatic cancer can be expected.

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We assumed that the vascular pattern of the mucosa in ulcerative colitis would be capable of reflecting the blood flow in the mucosa of the colon.The biopsy specimens of the mucosa which were taken with the colono-fibersco a were examined immediately under the view of dissecting microscope (Olympus type X-Tr, Nikon multiphoto).The microvasculra pattern around the papilla in the normal mucosa of the colon revealed that the appearance of each capillary was regular, smooth and not interrupted. In active stage, the papilla was disappeared completely but the capillary was observed, including scattered bleeding. In inactive stage, the papilla was reappeared and hyperemic capillary was observed. In contrast to active and inactive stage, the microvascular pattern around the papilla was almost normal except for scattered hyperemic lesion during the process of remission.According to the characteristic microscopic findings of the mucosa obtained in various stages of ulcerative colitis, we emphasize that the above mentioned method is very simple and highly valuable in determining whether the clinical course of ulcerative colitis is in - remission state or not.

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Endoscopic papillotomy is one of the great advances in recent years in the fields of endoscopy. We have performed 12 cases of endoscopic papillotomy to remove the common duct stones, to cure the choledochoduodenal fistula and to perform the biopsy of the tumor of the common bile duct. We have experienced 2 cases of complications of endoscopic papillotomy. One was acute pancreatitis because of the electrical damage of pancreatic duct. The other was massive bleeding from the incized papilla. The detal was mentioned here. Af etr papillotomy, it was attempted to insert a biopsy forceps f ram the incized papilla into the common bile duct in order to take specimens in the stenotic portion of the common bile duct. But the biopsy forceps couldn't insert into the common bile duct, because it was hard and didn't bend upwards enough as like the cannula. So, we developed a newly designed biopsy forceps. This instrument is easier to insert into common bile duct from the incized papilla because of its softness. With the advent of this improved soft biopsy forceps, it will become possible to perform the endoscopic transduodenal biopsy of the common bile duct without papillotomy. This method will serve the progress of the endoscopic diagnosis for such diseases as cancer of the common bile duct, the cholangitis and etc.

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The results of the 1974 A/S/G/E survey of complications relating to colonoscopy and polypectomy are analyzed. Members reported 25, 298 diagnostic colonoscopies with a morbidity of 0.32% and a mortality of 0.008%. The most common complication of diagnostic colonoscopy was perforation (55 cases or 0.22%). The only fatalities (2) were associated with perforation. There were 6, 214 colonoscopic polypectomies reported with a morbidity of 2.3 % and no mortality. The most common complication of polypectomy was hemorrhage (115 casesor 1.9%).

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A 61-years-old man was admitted to our hospital because of pain with epigastrium and weight loss. The abdomen was tender on palpation in the left upper quadrant, but no masses were palpable. Labalatory date revealed moderate hypochromic anemia. Result of glucose tolerance test showed diabetic carve. X-ray photographs and endoscopic pictures of the stomach revealed a ulcer on the lesser cuverture of the lower body. Scintigram of the liver with 198Au colloid and Pyelogram was not significance. The resected stomach showed mucosl elevation, measuring about 19 by 15cm, on the posterior wall of the corpus. Histologically, many spindel-schaped celles and some malignant lesion diveloped under the muscularis mucosa of the stomach. It was diagnosed maignant Schwannom of the stomach.

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The patient (A 6960), a 37-year old man, was admitted on August 26, 1974, with a episode of rectal bleeding. He had felt epigastric dull pain and general fatigue for two weeks prior to admission. At the evening of August 23, he had a sudden onset of profuse rectal bleeding after severe vomiting. Since this episode, he had noted sense of distension in the left lower abdomen gradually. There was no previous history of abdominal surgery. On the day of admission, he had experienced of a little amount of rectal bleeding again but had no more those episodes during hospitalization. The WBC count was 11000 and ESR was 30mm in one hour. The first barium enema examination (Fig. 1) showed localized area of narrowing with irregularity of the mucosal pattern in the lower portion of the descending colon, and the 2nd examination (Fig.2) showed persistent 3 linear ulcer scars and several deverticula-like deformities at the same area. Colonofiberscopic examination (Fig.3) revealed the ulcer scar, uneveness and bleeding of the mucosa and narrowing of the lumen immediately proximal to the ulcer scar. A minimal resection of the descending colon with end-to-end anastomosis was done with clinical diagnosis of benign ulcers of the colon. On opening the specimen 4 linear ulcer scars were seen side by side, each measuring 4.4cm, 4.1cm, 3.2cm and 2.2cm in length, separated by intact mucosa (Fig.4). Microscopically, the ulcer remained superficial or submucosal layer and there was a very marked fibrotic tissue beneath it with a mild chronic inflammaroty reaction (Fig.5). The diagnosis was simple nonspecific ulcers of unknown cause. There has been no recurrence of bleeding in more than 17 months of follow-up. Clinical symptoms and pathological findings in the literature were reviewed and some discussions were made.

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In recent years, endoscopic retrograde cholangiopancreatography (ERCP) has become the most effective diagnostic method for diseases of the pancreas and bile duct. However, the successful ERCP in children has been very scares. This report presents the ERCP performed in children. One was 6-year-old boy weighing 19kg. ERCP was sucessefully performed using JF-B2(Olympus Co.)under general anesthesia and both biliary and pancreatic ducts were clearly visualized. The diagnosis of congenital choledochal cyst was established. The other was 8-year-old girl weighing 22kg. k RCY was also performed using JF-B2 under general anesthesia and the established diagnesis of congenital choledochal cyst was made. It is considered that ERCP is the most valuable method for the diagnosis of congenital choledochal cyst. The abnormal confluence of the bile and the pancreatic ducts associated with this disease is clarifies by this method. The study of the abnormal connection of both ducts will be useful to solve the pathogenesis of congenital choledochal cyst and to determine the method of operation. An improvement of f iberendoscopy will make it possible to perform ERCP in the newborn infant. By this method, the differential diagnosis of congenital biliary atresia and hepatitis in infant, etc will be established endoscopically.

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