There has been no report concerning endoscopic study of intestinal absorption in the world literature. No endoscopist has tried to perform endoscopic observation of intestinal absorption. We tried to observe the duodenal mucosa endoscopically after administration of triolein (50 ml) into the duodenal lumen. At the same time, we measured the serum triglyceride level immediately before and 1, 2, 4 and 6 hours after administration of triolein. We named this method "loading endoscopy". The duodenal mucosa of the normal persons (15 cases) turned to be white at 30 minutes and became deep white 1 hour after, administration of triolein. The normal control group (7 cases) had an average elevation of 35 mg/dl in serum triglyceride after triolein administration. Only a little change to white color was observed in duodenitis (3 cases) and at the circumference of the duodenal ulcer (4 cases) after administration of triolein. Atrophy of villi was recognized in these lesions. But serum triglyceride level was remarkably raised in these cases. Only slight change in color and a little elevation of serum triglyceride level were recognized in the patients with obstruction of main pancreatic duct or bili4ry tract (4 cases). The shape of duodenal villi and methylene blue absorption were normal in these cases. The shape of villi and absorbed fat onto the duodenalmucosa could be observed in detail in biopsy specimen, stained with Sudan 111, under the dissecting microscope. Moreover, the physiological, histochemical and fine structural changes of duodenal mucosa during the healing process of duodenal ulcer were investigated by means of endoscopic and dissecting microscopic techniques. Very poor absorption of methylene blue and low alkaline-phosphatase activity were recognized in the circumference of duodenal ulcer (57 cases). In most cases (11/12) of ulcer scar, mucosal absorption of methylene blue and alkalinephosphatase activity did not return to normal, even ulcer healed without remaining hyperemia. Villi in the scarring zone of duodenal ulcer were low in height and not normal shaped but convoluted or daughnut shaped. These findings suggest that complete recovery in morphology and function of the duodenal mucosa is rather rare in healing of duodenal ulcer. In conclusion, this new mtehod-loading endoscopy combined with dissecting microscopy of the target biopsy specimens stained with Sudan 111-gave us many informations about intestinal absorption.

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High frequency oscillators have been developed and utilized for endoscopic polypectomy. Animal experiments were performed before applying them clinical trials. The results obtained from animal experiments and the findings by clinical trials were reported.1. Among oscillators, a transistor type which can provide a regular wave seemed to be most suitable. One with a built-in timer as a safety device is preferable.2. Degree of changes in the mucous membranes caused by high frequency current were almost proportional to the intensity and time of flow of electric current, however they were inversely proportional to the size of the area of the mucous membrane where an electrode were attached.3. Pathological study showes that changes in the tissues induced by coagulating wave sometimes continued to proceed over 1-2 weeks. Therefore, while performing polypectomy it is desirable to try to leave a polyp root by 3-5 mm in length.4. The size of a postoperative ulceration and the days required for its healing were dependent upon the thickness of pedicle, the duration of current flowed, and the place where the snare was set.5. Postoperative bleeding sometimes occured in cases in which the polyp had been removed with incomplete coagulation.6. Endoscopic polypectomy could be a perfect biopsy method which can cover demerits of usual biopsy methods. Further histological studies on removed polyps could provide the in formation for the definitive treatment of malignant polyp.7. We believe that there would be no accidental complications with enough understandings of properties of cutting and coagulating wave.

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The normal function of gall bladder played a role of "buffer" which made it difficult to visualize the branches of the intrahepatic bile ducts satisfactorily during EPCG. To demonstrate the intrahepatic bile ducts during EPCG, we applied CCK-PZ or Caerulein injections in 21 instances including 11 cases without gall bladder diseases, each 4 cases of cholecystitis and cholelithiasis, and 2 cases with adhered gall bladder. All of the branches of the intrahepatic bille ducts were graded and numbered and their demonstration before and after injection of CCK-PZ or Caeruleinn was compared in patients with or without gall bladder diseases. If the function of the gall bladder was normal, apparently better visualization of the intrahepatic bile ducts was obtainable after injection. Therefore, any intrahepatic lesion could be demonstrated easily. But in the cases of cholecystitis and cholelithiasis, no significant increase of visuability of the intrahepatic bile ducts could be shown after injection.

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Rendeu-osler-Weber's disease (hereditary hemorrhagic teleangiectasia or Osler's disease) is commonly kwown by telangiectasia on the skin or mucous membrane, hemorrhage caused by it and familial incidence. We presented one case of this disease here. The patient, a 48-year-old man, had since one year of age frequent bout of gastrointestinal bleedings. Reddish telangiectatic flecks, about 2-4 mm in size, were present on the lip and tongue. No pathological changes were recognized in the X-Ray of Gastrointestinal series and Chest. When endoscopical examination examined, spotted or irregular-shaped reddish flecks were seen disseminated in the stomach. A study of this patient's family tree, ranging back to four generations totallying to 16 persons, disclosed in 5 persons including this case, telengiectasia and epistaxis.

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A 64 year-old male with leiomyoma of the fundus of the stomach had been followed up endoscopically for approximately three years. Although one upper G I series and five gastroscopies were performed within the first two years, no changes were noted in size and shape of the tumor. However, it was found that the tumor had grown in size and ulcerated on the top at the sixth gastroscopy which was performed two years and seven months after the first study. The seventh gastroscopy, two months after the previous study demonstrated the ulcer becoming larger and deeper. Gastroscopic biopsy done at the same time established the diagnosiss of leiomyoma, which was comfirmed histologically on the surgical specimen.

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Hemobilia is a term first used in 1948 by Sandblom to describe bleeding into the bile ducuts. Most of the causes of hemobilia were trauma, inflamation and neoplasma. Hemobilia secondaly to percutaneous needle biopsy of the liver is very rare, and only 8 cases have been reported previously. This complication, although rare, need to establish early diagnosis, because mortality rate is very high. As soon as hemobilia is suspected from patients history, endoscopic observation of papilla of Vater will be helpful to make early diagnosis. We reported two cases of hemobilia secondary to percutaneous liver biopsy. The clinical features of colicky pain, gastrointestinal bleeding following biopsy were seen in both of the two cases, . In each instances endoscopical observertion of papilla of Vater was helpful in deciding the localization of source of hemorrhage. The hemorrhage ceased spontaneously on each instances.

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Four cases of diarrhoea and/or anal bleeding during antibiotic therapy were described ; Case 1; A 77-year-old man diagnosed as pulmonary tuberculosis was given S.M., I. N. H, and R.F.P. Six months after the institution of therapy, copious diarrhoea with occasional fresh blood developed. Barium enema study and colonoscopy revealed typical pseudomembranous colitis, namely slight raised yellowish-white patches of varying size studding the mucosal surface of all parts of the colon. Case 2 ; A 71-year-old man sought medical aid for cough, fever and dyspnea. A diagnosis of acute bronchitis was established and intramuscular injection of Lincomycin (600mg, two times a day) was started. Fourteen days later, loose stools and abdominal discomfort developed. Endoscopic examination was carried out 10 hours after the onset of the complaints, and revealed multiple minute erosions in the rectum and sigmoid colon. Three days after the onset, typical pseudomembranes were seen endoscopically in the place where multiple erosions had been observed. Therefore, these minute erosions were considered a quite early phase of pseudomembranous colitis. Case 3 ; A 75-year-old man who was diagnosed as otitis media was given intramuscular injection of Lincomycin (600mg, two times a day). Seven days later, explosive diarrhoea (four to fifteen bowel movements per day) developed and endoscopical examination revealed edematous mucosal appearance and marked dilatation of the capillaries in the rectum and sigmoid colon, but no pseudomembranes were observed. Case 4 ; A 46-year-old female was affected by an upperrespiratory tract infection, and intramuscular injection of Lincomycin (600mg) was prescribed. Eight hours after, the injection, she complained of diarrhoea and urticaria. Immediately, endoscopical examination was carried out and multiple irregular shaped erosions were observed in the rectum and sigmoid colon. Twenty-one days later, typical pseudomembranes were seen extending in all parts of the colon. The etiology of pseudomembranous colitis has not been well known yet. In general the disease occurs as a complication of various conditions such as (1) following abdominal operations, (2) colonic obstruction, (3) generalized systemic disease, e.g., uremia, septicaemia, leukaemia, and (4) after or during administraction of antibiotics. In U.S.A., this complication especially following Lincom ycin therapy is increasing, however, in Japan, the incidence of antibiotics-associated colitis has been thought to ber are. Therefore, though this is apparently an uncommon occurrence following the use of Lincomycin, it would seem prudent to reserve Lincomycin for sepecific indications where other drugs were not adequated.

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For the purpose of relieving the patients of the anxiety, the fear and the pain on endoscopic examination, we tried to use the premixed gas made up of 50% nitrous oxide and 50% oxygen in 54 cases. We convinced that this method was effective in 70% of the cases and had little side effect. We conclude the practical application of this prexmied gas will be useful for doctors who have little knowledge of the anesthesia by the reasons of its saf etiness and covenience.

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