The results of 312 cases of gastric biopsy under the direct vision have been analysed. All of the 127 cases of early gastric cancers were accurately diagnosed by gastric biopsy, while out of 90 cases with advanced gastric cancers, 83 cases were positive (92.2%). Ninety eight cases of various gastric diseases except cancer were observed over 2 years with repeated biopsy procedures but no cancer was detected in this group. With regard to the false-positive cases, 2 cases of adenomatous polyp with atypical cells, 2 cases of ulcer, and 2 cases of erosion with regenerative epithelial cells were misdiagnosed as differentiated adenocarcinoma.

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The endoscopic findings of 41 patients who had been followed for more than 1 year and subsequently found to have a gastric cancer were analized retrospectively. Observation period of 1 year or longer was chosen because the once-a-year frequency of mass screening examination of the stomach for general population is common in Japan. The 41 cases consisted of 27 of early gastric cancer and 14 of advanced cancer. And the so-called malignant cycle was observed in 7 of early carcinoma and 4 of advanced carcinoma. Retrospective analyses of roentgenological, endoscopical and histological findings of the gastric cancer have revealed the following results: 1) Early gastric cancers do not change to advanced cancers in a short period of time. 2) It takes at least 6 months for one malignant cycle. 3) Cancer cells have a tendency to invade the deep layer rather than spread along the mucosa. 4) Attention should be paid not only to the ulceration, but also to the changes in the surroundings for accurate diagnosis.

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In 178 cases with upper G-I lesions, the endoscopy using the small caliber f iberscope GIF-P2 (Olympus Optical Co) was done easily and less painfully. This fiberscope has the following specifications: forward field view, outer diameter 9 mm, angle of view field 83°, working length 1, 100mm, bending angle up to 180° down to 60°, right and left 100°. So this fiberscope was useful not only for the routine examination of the upper G-I tract but also for the emergent and functional endoscopy.

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Evans Blue (or Indigocarmin) was injected through celiac artery catheterization under the gastrofiberscopic observation, resulting in clearly demarcated gastric lesion from surrounding mucosa. We observed 33 lesions in 31 patients by this method, : 27 cases of gastric cancer, two gastritis, an atypical epitherium and a gastric ulcer. Method: Angiography was done by Seldinger's method. The Olympus gastrof iberscope was employed, the type is GTF-S2 or GTF-S3 and their light source using no filter. Following to the celiac angiography, the lesion of the stomach was photographed by conventional endoscopic method and 10ml. of 0.1w/v% Evans Blue (or 0.2w/v% Indigocarmin) was infused into the celiac artery within one second by assistant's hand injection, the lesion and the surrounding mucosa were taken by gastrofiberscopic camera until the dye fade out from the gastric mucosa. Result: By this new method, blood circuration at the vascular mesh of the gastric mucosa was observed through the injected dye movement, and the lesion was become easier and more accurate than conventional endoscopic photographs, i.e. irregular ulcer margin, conversing folds with clubbing, discoloration or coating mucosa, redness or bleeding and so on. In the lesion of well differentiated adenocarcinoma, the injected dye was better infused than anaplastic one. Conclusion: We believe that gastroendoscopic diagnosis by I.A.D. will make more useful diagnosis for various kinds of gastric lesions, especially in the differentiation between malignant and benign. As a future problem, the more accurate observation of the intra- and submucosal vascular mesh is expected to be possible by this method, and we hope that the I.A.D. would serve in detection of the extent of cancer spread which is covered by regenerated epitherium. Furthermore, the I.A.D. may enlage the diagnostic approach for the organs in the abdominal cavity under the laparoscopy.

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Recently, remarkable advances in fiberoptics and vigorous efforts to observe the whole colon have increased the insertion rate into the ileocecal area and made it possible to observe almost all parts of the colonic mucosa. On the other hand, several new approaches to perform the colonoscopic examination with more ease, safety and exactitude have been discussed. A newly devised colonoscope, type CF-130 (Olympus), is really the instrument to be developed for these purposes. It has more flexibility and wider view field than those which are on the market now, but its effective length is only 130cm. During the last five months, 55 cases were examined in our clinic by using this colonoscope. Average time for the insertion was 6.4 minutes to the splenic flexure, 11.3 minutes to the hepatic flexure, 16.6 minutes to the cecum and 18.7 minutes to the terminal ileum, which was much shorter than those by means of CF-LB-2. The rate of success in introducing the scope to the terminal ileum was 93.3 % by CF-130, contrariwise, 86.7% by CF-LB-2. According to these clinical experiences, it is emphasized that CF-130 is much easier to handle than CF-LB-2. Up to this time, it is generally said that CF-MB-2 with only 111cm of effective length is easier to operate than CF-LB-2, the effective length of which is 187cm: however, it is difficult to introduce CF-MB-2 into the distal parts of the colon because of its short length. Therefore, distal parts of the colon have tended to be examined by CF-LB-2 and proximal parts of the colon, so-called left-sided colon, by CF-MB-2. By using newly devised CF-130, however, not only distal parts but also proximal parts of the colonic mucosa are able to be examined with more ease. Therefore, it is emphasized that CF-130 is useful as a pan-colonoscope to inspect the whole parts of the colonic mucosa at a time.

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Eight cases of gastric ulcer possibly associated with steroid therapy were observed with endoscopy. Gastroscopy revealed multiple ulcer of the antrum in 5 cases, simple ulcer of the antrum in one case, multiple ulcer of the corpus in one case and giant ulcer of the lower corpus with small multiple ulcer of the antrum in one case. The steroid therapy was done for nephrotic syndrome, chronic hepatitis, Harada's disease and unknown eruption of the skin. The kinds of the steroid used for therapy were Predonisolone, Bethamethasone and Dexamethasone. Three cases were treated only, by steroid and others weer given some analgesica with steroid. Their doses were not so great in amount. And, steroid therapy was continued from 20days to 1 year. In general the symptoms were not severe, such as slight epigastralgia and full sensation with nausea or vomiting except one case which had a shock-stage after hematemesis and tarry stool. These cases were treated with non or a little dose of steroid and healed about 2 months later, because of the necessary of it for the basic disease.

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One of the most important problems in colonoscopy is to differentiate carcinoma from benign polyp. It is, however, very difficult to diagnose the early carcinoma or focal carcinoma by endoscopical findings such as bleeding, erosion or rough surface appearance. Using magnifying colonoscope type CF-MB-M (Olympus) and dye spraying method, a case of rectal carcinoma was diagnosed endosco-pically by inspecting its minute surface appearance. With this method, irregular, distorted and nonstructural shape and arrangement of colonic superficial pits were clearly observed endoscopically, and these findings could easily differentiate from advanced carcinoma or benign polyp. from normel mucosa. Therefore, it is expected that magnifying colonoscopy will be one of the diagnostic technique to detect the early carcinoma as well as endoscopic polypectomy.

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A 55-years-old man was admitted to our hospital because of epigastralgia. The abdomen was tender on palpation in the epigastrium but no mass were palpable. Laboratory data were unremarkable. X-ray photographs and endoscopic pictures of the stomach revealed an ulcer on the lesser curvature of the angulus and multiple erosions and polypoid lesions on the antrum. The resected stomach showed polypoid lesions on the intermediate zone and hypertrophic folds of the corpus. Histologically sarcoid tubercles were revealed in the mucosa and the submucosa of the antrum and the corpus.

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