We designed a new marking clip forr the esophagus and performed esophageal marking using the clip under the observation with the fiberscope. After we ascertained the safety, utility and durability of the apparatus in animal experiments, we applied the clip mainly to the patient with esophageal cancer. The preoperative irradiation field of the patient with esophageal cancer is decided by the basis of the supine projection of the esophagus; however, in the infiltrative or intracanaricular spreading cases, there are at times difficulties in deciding the irradiation field. The investigation revealed that 40% of patients were given inadequate fields. Presently we can obtain sufficient irradiation field by using the clip attached to the circumference of the cancer. We performed clipping again immediately before the operation and this clip is of help to decide the resection line since the clip is palpable during the operation. Furthermore, the clip plays the role of an indicator while performing mediastinoscopy and angiography, and it has an advantage of judging the lesion in three dimensions. We performed the clipping in a total of 52 times, using 70 clips. Neither complaints nor complications were observed. The clip remained on the esophageal wall for about 2 weeks. The characteristics of our clip are as follows: 1. Technically, the clip can be applied by as simple as a biopsy technique. 2. It is possible to make clear markings and is easy to identity. 3. The duration of the retainment of the clip is about 2 weeks and is long enough to observe the lesion. 4. No patient complained and complications were observed. 5. The clip may fall off into the internal cavity but it is not absorbed. Our clip method compensates for the weak point of the marking method which was designed by Palmar and Endo.

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In our clinic, the early or urgent endoscopy had been performed safely and effectively in 420 cases of upper G-I bleeding. In 25 pediatric patients with hematemesis and/or melena, the age ranged from 3 months to 15 years. They were examined without complications by the various kinds of fiberscopes as GIF-P, GIF-P2, JF-B2 or GIF-K SIF-B (Olympus Optical Co). In 21 of 25 patients, pediatric upper G-I endoscopy was carried out by preparation of both pharyngeal anesthesia and intramuscular injection of antispasmodic agent. Two patients were examined with general anesthesia and other 2 patients were done without anesthesia. In 20 patients, upper G-I barium radiography had been obtained prior to endoscopy which was done within 7 days after hematemesis and/or melena. In 14 of 20 patients, the bleeding lesions were identified radiologically and endoscopically, In 6 patients, the bleeding lesions were not identified radiologically but were detected endoscopically. In the remaining 5 patients, only endoscopy was performed and the bleeding lesions were identified in each patient. On infants and children with upper G-I bleeding, the ordinary endoscopy for adult patients could be done easily and safely in children older than 10 years, and pediatric endoscopy for infants and children under 5 year-old must be performed carefully with the use of general anesthesia and small caliber fiberscopes.

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Depth of gastric cancer invasion is closely related to its prognosis. Details of this relationship was first reported in 1937 by juji Saeki, to whom we pay a deep respect. Exact depth diagnosis, however, is a difficult task. In our previous reports, we dealt with endoscopic diagnosis of advanced cancer simulating a superficial one. This paper is to report our study on the diagnosis of cancer infiltrating down to the muscularis propria (pm). For the past 6 years a total of 703 gastric cancers were resected in our clinics, consisting of 536 advanced and 167 superficial cancers. Of advanced cancers, pm cancers were 43 lesions accounting 8%. Twenty one cases with slight infiltration into the subserosa (ss) were added and a total of 64 lesions were analysed in this study. Spread in each layer of the gastric wall was divided into 5 degrees and the pattern of infiltration was classified into types A, B, C, and D depending on the ratio of the spread in each layer, whereas advanced cancers were divided into those simulating superficial ones and those of Borrmann's types. Type A was dominant (60%), in which ss and pm of superficial-simulating type were 30 lesions (70% of pm) and 13 lesions (60% of ss) respecively. Most of superficialsimultating type was IIc+III and Borrmann II was dominant among Borrmann's types. Endoscopic depth diagnosis was quite difficult in cases of superficial-simulating type. when the submucosal spread appeared wide, deeper infiltration was likely. On the other hand, Borrmann's type of cancer was rather easy to diagnose. It was intersting to note that pm and ss lesions were most frequently found at the 5th and 6th decades respectively. No lesions of pm and ss were found to be smaller than 1cm and 1.3cm, respectively, in maximum diameter. Some other endoscopic findings were discussed.

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There have been several kinds of pan-endoscopes suitable for the observation of upper G. I. tract in practice. Yet, the present report deals with a continuous progression in this field with our newly developed trial-built visual changeable fiberscope GIF type SK. The present fiberscope is equipped with two optical systems; i. e., 30° oblique view system and 90° side view system. These two systems can be easily switched on the operation panel using a simple mechanism. The visual angle of the scope covers 85° obilque and 64° aside; bending angle of the tip is 120° up and down as well as 90° right and left. The length of the metal tip is 21mm and the diameter, 12mm. The length of the soft tube is 1340mm with a diameter of 10mm. It is also equipped with inflation and water feeding device but without suction and biopsy mechanism. There have been more than 200 peformances by using this new scope in our clinic since November 10, 1975 until April 4, 1976 and a good result was obtained. Comparison of this new scope with a conventional GIF-K showed marked reducion of insertion discomfort from the patients, improvement on the controllability of the scope, and the diminished blind areas in the upper G.I. tract. It is concluded that the presented GIF-SK fiberscope is suitable for the routine upper G.I. endoscopy, especially for the purposes of screening and surveying.

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It is essential for the diagnosis of a functional disturbance in the papillary region to make minute observations on endoscopical features of the papilla and on pictures of the bile duct obtained by EPCG. In order to obtain a more objective estimation of pathological conditions in the papillary region, the authors devised a manometer. The manometer was placed on the tip of a canula and inserted into the terminal portion of the choledochus and the pancreatic duct. Manometry was performed in 10 cases, 8 out of which had undergone sphincteroplasty. The pressure of the choledochus in patients after sphincteroplasty is 50-100mmH₂O, the pressure of the pancreatic duct is 80mmH₂O, and the pressure of the choledochus in patients with papillary carcinoma is 190mmH₂O. On the contrary the pressure of the untreated patient (gastritis) is 90mmH₂O. Manometry by duodenofiberscopy is a very useful procedure to determine the indication for re-operation in patients with postoperative symptoms after cholecysfectomy and sphincteroplasty, and is also valuable in elucidating the functional disorders of the papillary region seen in chronic pathological state of the pancreas and liver.

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The patient is a 12-year-old boy. The family history revealed that there is a heredity of pigmentation on the father's side. When he was ten years old, he noticed pigmentation on his lips and complained of occasiomal abdominal pain. On November, 1974, he was admitted to the Hirosaki Uuiv. Hospital with a chief complaint of abdominal pain without any episode of nausea, vomiting nor melena. Gastrointestinal X-ray examinations indicated small round polyps in the stomach and small intestine. The barium enema examination showed polyps in the descending colon. The walnutsized polyp of the descending colon was polypectomized endoscopically. The polyps was diagnosed to be hamartoma after histopathological study. After one year, the barium enema examination showed five polys in the descending, sigmoid colon and rectum. They were polypectomized endoscopically and the largest polyp was 25×15×10mm. Histological examination revealed that all of them were hamartoma. There has been only one case report on Peutz-Jeghers syndrome followed up in Japan, but no reporst on such rapid growth as this case has been documented. It is suggested that the growth rate of the polyp has relation to the growth potency of the cell population consisting of the histopathology of Peutz-Jeghers syndrome.

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