The increasing incidence of colonic diseases has been reported lately in Japan and the early diagnosis and treatment is expected. The pilot model of Olympus CF-MS which has advantages of handiness as short as 630 mm in effective lengh and four dimentional flexibility with which biopsy is also possible was applied to mass screening examination and clinical examination with simplified preparation tecnique. The materials were 231 cases, of which 98 were employee of one campany (occupational mass screening) and 133 were persons living in N and K village (local mass screening). The modified Brown preparation tecnique were used on 213 clinical cases to compare the degree of residual stool with the simplified preparation. The comparative investigation of the visuality of Barium enema with endoscopic findings were performed. 1. Successful insertion to 60 cm and clear observations were obtained in 226 cases (97.8%) of mass exam. and 190 cases (89.2%) of outpatients. 2. Overall examination time were 12 min. for each case, of which 6 min. were spent for observation and the other 6 min. for sterilization. 3. The incidence of colonic diseases in mass screening were 20.8%. One colon cancer (0.4%), 39 polyps (16.9%) and 8 cases of colitis (3.5%). 4. 26 polyps were distributed in sigmoid and 24 in rectal region and most of them were sessile. 5. Local mass screening revealed higher incidence of colonic diseases (27.80) than the occupational screening study. 6. No complications were encoutered during on this examination. 7. Nine out of 48 colonic lesions remained asymptomatic. 8. The false negative Barium enema studies were identified by CF-MS at 53.2% in mass screenings and 33.3% in clinics. The colonic diseases are not so rare as we expected. the significance of mass screenings especially endoscopic observations were stressed in this study.

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In this paper, we defined a linear ulcer as one located in parallel with the lesser curvature of the stomach, excluding another type of linear ulcer crossing the lesser curvature, and investigated this linear ulcer by the endoscopical follow-up study. Observing 386 cases of round ulcers of the stomach, endoscopically followed up more than 3 months, we classified them into four types of healing courses. Chronic longitudinal linear ulcer, that is, δ-course ulcer was located mainly on the corpus, and healed up easily and recurred most rarely among four courses. However, these characteristics were considered as the ones of ulcer on the corpus rather than the shape of ulcer. Furthermore, ten cases of acute longitudinal linear ulcer with 3 cases of Mallory-Weiss syndrome were investigated. Seven cases except Mallory-Weiss syndrome were located mainly on the fundic gland area, and showed the severe clinical symptoms (nausea, vomiting, hematoemtesis. etc.). They healed up faster than 8-course linear ulcer. On the site and shape, these acute ulcers might be differed from some previously reported cases of acute ulcer on the corpus of the stomach. For the future, we would like to investigate more cases of acute longitudainal linear ulcer, to clarify the pathophysiological features including the experimental procedures.

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Endoscopic methylene blue staining method was done in 34 cases with the gastric cancer and 22 cases with other lesions. A gelatine capsule, which contains 100 mg of the methylene blue, was orally administered with protease (Pronase 20, 000 u), sodium bicarbonate (1g) and Gascon. After a couple of hours, endoscopic examination was done. Eighteen out of thirty four cases with the gastric cancer were markedly stained by methylene blue, while 6 cases were well stained and 6 cases were equivocal. But, 4 in all cases with cancer were not stained. Histologically, both well and poorly differentiated adenocarcinoma were well stained than signet-ring cell carcinoma. The staining form was not related to the size and location of the cancer, tonicity of the stomach, gastric juice secretion and gastric empting time. Methylene blue, which stained the cancer, is not incorporated into the mucous membrane, but just coats the mucus on the superficial membrane. It might be considered that the mucus secreted from the gastric cancer can easily bounds to the methylene blue in comparison with the conditions except the gastric cancer. About 25 % of the methylene blne is excreted into the urine within a few days. The side effect of the methylene blue was never observed, except one case who showed the slight increase of GPT and GOT.

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Recently, The various type of pan-endoscope are made for several purposes. About pan-endoscope which can observe from the esophagus to the bulbular portion, visual changeable type seems to be sufficient for particularly the Japanese people than the frontal viewing instrument. PFS-B₁₂₀₀ type, convertible lens system, and biopsy channel equipped pan-endoscope with effective length of 1270 mm (Machida, Tokyo) was improved newly as PFS-B_1200II type. Main improvements are automatic inflation and water feeding system, increased optical angle, and close-up and magnifying system. We applied this new apparatus for 70 cases in comparison with 146 cases examined by PFS-B1200 type. As a conclusion, this new PFS-B1200I type pan-endoscope is almost sufficient for our aims, except the application of this equipment for ERCP examination.

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With the use of colonof iberscopy after giving a enema of methylene blue solutions, stainability of methylene blue to the mucosa in various conditions were studied. The best stainability of methylene blue was, of tained, when 300 to 400 ml of 0.1% methylene blue was kept in the colon for 15 to 20 minutes and the endoscopic observation was done at 10 to 20 minutes after evacuation of the enema. By this method, the fine colonic area pattern can be seen in the intact colon, while it was not demonstrated in ulcerative colitis because of poor stainability. Each adenomatous polyp in all 4 cases was stained with tubular or sulcar pattern on its surface. However, the hyperplastic polyp was not stained. The cancer of the colon was usually poorly stained in our cases.

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Three cases of spontaneous choledochoduodenal fistula diagnosed by endoscopy were reported. The fistula of case 1 was detected by endoscopy after injection of CCK-PZ intravenously, because bile flowed out from the fistula orifice . The purpose of injection of CCK-PZ, however, was for cytology of distal bile duct because markedly swollen papilla of Vater, especially longitudinal fold, could'nt be ruled out malignancy, and the result of cytology was negative for cancer cells . And this patient had two common bile duct stones diagnosed by retrograde cholangiogram. The fistula of case 2 was detected by the cannula which was passed throgh the papilla orifice and came out from the fistula orifice. Retrograde cholangiography showed only dilatation of common bile duct and no stones were detected at any part of biliary system. The fistula of case 3 was much more easily detected endoscopically compared with former 2 cases, because erosive lesion flowing out bile at the longitudinal fold was seen only by usual observation of papilla of Vater. Therefore it is concluded that detection rate of choledochoduodenal fistula will be increased by careful endoscopic observation of papilla of Vater and the neighboring area. If the fistula can't be detected endoscopically in the patient who has the high possibility of fistula, intravenous injection of bile excretory agent (CCK-PZ etc.) is the one of the effective method of detection of fistula. At present, the detection of choledochoduodenal fistula is an important problem according to the progression of endoscopic papillotomy, because the fistula is one of the landmarks while deciding the length of incision of papilla of Vater.

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