The endoscopic findings of 49 patients who had followed up for more than I year and subsequently found to have agastric cancer were analized retrospectively. In the 49 cases with 52 lesions, 32 lesions were early gastric cancer and the remainder were advanced cancer. The itemizing of the all lesions with early gastric cancer, were follows; IIa+IIc(11esion), IIc(13), II+IIa(2), II c+III(13) and III+IIc(3). On the other hand, in itemizing of the all lesions with advanced cancer, IIc+III like was 6, Borrmann I was 3, Borrmann III was 9 and Borrmann IV was 2. The so-called malignant cycle was observed in 7 of early cancer and 4 of advanced cancer. During observation period, the width of lesion did not expand appreciably, but the granular and nodular surface changes became more conspicuous and the color change was marked. And rapid progress occured in none of these patients. It is concluded from these observations that the progress from early to advanced carcinoma requires considerable time.

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The authors reported the actual incidence of upper gastrointestinal disease following CNS injuries was about 70 % by endoscopic observation. In the present study, natural history of acute upper gastrointestinal disease after CNS injuries was performed in 33 cases.1) None of hemorrhagic erosion developed into acute gastric ulcer. However, in two cases, an ulcer was observed to evolve from an duodenal erosion.2) Although the healing was protracted in some cases, acute gastric lesions usually healed in a few weeks.3) The course of gastroduodenal lesions did not parallel in the clinical status of the patients.4) The behavior of these upper gastrointestinal lesions was influenced by sepsis and hypotension.5) Administration of glucocorticoid had no relationship with the occurence and course of the stress ulcer.

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The possibility of the infection of viral hepatitis type B through endoscopec examination of the digestive tract was investigated, in the first place, by comparing three groups (A: endoscopically unexamined, B: endoscopically examined and C: bioptically examined) of patients about the percentage of antigen positive cases and that of antibody positive cases. As to the percentage of antigen positive cases, there was no significant difference among the groups while the percentage of antibody positive cases was 18.3, 25.4 and 28.0% in the group A. B. and C. rest, ectively, being significantly higher in the latter two groups, and the difference was especially remarkable in inpatients. In addition, saliva and gastric juice were clearly positive for HBsAg, which can be a medium of infection, in 7 cases among the 13 cases examined. In a washing test of endoscopes contaminated with HBsAg, washing with soapy water was effective for removing the antigenicity of HBsAg, and the use of a well-closed automatic washing apparatus was regarded as effective for the purpose.

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Our first experience with newly designed pediatric forward-viewing fiberscope G1F-P2 (Olympus Co.) showed that this instrument can easily pass the first and second portion of the duodenum and the papilla of Vater is visible tangentially in all cases. In our first trials we were able to manage the tip of the instrument in a position ready for cannulation. A new technique of ERCP using this instrument is described in detail. By this procedure the position of the maximal tended tip of the instrument provides a more selective cannulation into the common bile duct, preventing the risk of pancreatic duct filling. The method was performed to 15 cases. FRCP, using this technique, can be performed after normal esophago-gasro-duodenoscopy. Therefore, we wanted to test if this instrument can be used for ERCP and when possible, if a combined method of upper GI endoscope and visualization of the duct system will probably become the routine procedure. This method was performed to 15 cases and succeeded in 12. The bile duct was filled in 12 cases and the pancreatic duct in 4. Further experiences are nessssary to estimate the value of the new method. At present time, we only can maintain that cannulation of the papilla of Vater is possible and compared to normal ERCP using side-viewing fiberscope the visualizaition rate of the biliary system is higher than of the pancreatic duct. But present stage of experiences usual ERCP by duodenofiberscope is easier to perform and may be the first procedure of filling the duct systems. The new technique may be recommended when using a duodenofiberscope the visualization of the biliary system is missed or when combination of upper GI endoscope, based on the anatomic condition, intubation of the papilla is easy in a short time. From our experiences, the new method of ERCP is not a routine procedure. It is reserved for special indications. Acknowledgement The author is indebted to Prof. E. Seifert (West Germany) for his kind cooperation and generous supply of materials.

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Upper esophageal varices were created in 11 out of 35 dogs by ligation of azygous vein and partial constriction of superior vena cava. The varices were easily visible by fiberoptic endoscopy and confirmed by histologic examination. This is a simple effective one-stage means for establishing upper esophageal varices. The prominent superficial veins over the chest and abdomen provide an excellent site for manometry, venography and experimental hemostasis.

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With the recent development of endoscopic devices with increased instrumental efficiency, the application of endoscopy is no longer limited only to the field of diagnosis but has been extended to facilitate treatment of lesions inorgans or body cavities under direct vision. Meanwhile, the usefulness of cryosurgery has recently been widely propagated. However, this technique of surgery has at present rather limited clinical applications to the body surface and region close to it. We have devised two different procedures for the practice of cryosurgery within the gastrointestinal tract under direct vision via an endoscope. Procedure 1 Endoscopic cryo-contact method: The probe used in this technique consists of a pliable tube (9mm diam. x 900 mm length) with a foremost metal cooling device (9 mm diam. x 30 mm length) where the extreme cold is produced via adiabatic expansion of nitrous oxide gas cirulating in it. The metal cooling device with the same angular mechanism as fiberscope is passed into the digestive tract along with a GIF-P fiberscope and applied with pressure onto a lesion under direct f iberscopic vision. Procedure 2 Endoscopic cryo-spray method: An instrument consisting of a pressure-aspirtion interlocking device, a spray-nozzle and a baroceptive system, with the use of liquid nitrogen which is sprayed directly over a lesion through biopsy or manipulatory fiberscope. This presentation deals with the basic experimental findings and the results of clinical tests of these cryosurgical procedures.

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The recent development of the duodenoscope made the blind region smaller and more precise observation possible. However, the endoscopic observation of the pyloric ring from duodenal bulb side is still impossible. In order to observe this area, we have tried our new original technique, that is, intrabulbar inversion method using side viewing duodenoscope JFB and JFB 2. We have obtaind good result for observation of the pyloric ring and its neiboring areas from duodenal bulb side. The pyloric ring of 15 cases out of 22 were observed well. Among them, one case with duodenal ulcer, two with duodenal ulcer scar and one with polyp near the pyloric ring were diagnosed correctly. Moreover, it was possible to obtain the biopsied specimens from that polyp. With above mentioned inversion method, these follow-up cases were mainly studied in this report.

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A case of lymphangioma at the splenic flexure of the colon coexisted with early rectal cancer was reported. A 78-year-old man complaining of lower abdominal pain visited a hospital, where a rectal polyp was found. He was transferred to our department for endoscopic polypectomy. It was done successfully, and the retrieved specimen was diagnosed histologically to be an early rectal cancer. Nine months later the same patient complained of lower abdominal pain again, and he was admitted in our department. Physical examination on admission showed no abnormalities. Double-contrast barium enema demonstrated a thumb-tip sized, smoothly outlined and well circumscribed polypoidal lesion at the splenic flexure. Under colonof iberscopy, a tumor as big as a thumb-tip was found and its surface was smooth and not different from the surrounding mucosa. On the microscopic examination, the formation of numerous cavernous cavities lined with endothelium and the intact overlying mucosa were recognized; a diagnosis of lymphangioma cavernosum was made. The pathology and clinical aspects of lymphangioma of the colon in the literature including the 4 cases reported in Japan were discussed.

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A woman, 62 years of age, complaining of epigastric pain and hematemesis underwent gastric fluoroscopy and endoscopic examinations, by which ulcer was observed in the antrum. Approximately one month later, this lesion became a scar followed by an appearance of the gastric polyp atthe same site another one month later. Under the suspicion of malignant changes, gastrectomy was performed but histologically, it turned out to be a hyperplastic polyp with an ulcer scar, UL-II noted at the foot of the polyp. Throughout the course of the long term observation of gastric polyp, there hardly appeared morphological changes. On the other hand, these observations were proved in some reports by autoradiographic studies on mucous membrane. Furthermore, it is reiterated that polyp grows rapidly up to a certain size within extremely short period of time, however it shows no remarkable changes any more after such a rapid growth. The presented case seems to conform with these opinions because polyp appeared at the site of the ulcer scar within about one month. The authors think that our findings will play some suggestive roles in clarifying the causes of gastic poply.

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European experience of en.doscopic papillotomy (EPT) is reported in cooperation with Prof. M. Cremer (Brussels). EPT has been performed to 1304 cases in Europe until February, 1977. Successful rate of EPT, indications, complications and motality were discussed.

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