When endoscopic examination for UGI tract was indicated, esophago-gastro-duodenobulboscopy was routinely performed with a forward-viewing instrument (Olympus GIF-P₂ or GIF-K), regardless the site primarily necessitated endoscopic observation. When it indicated, biopsy specimens were always obtained during the same endoscopic procedure. Among 1323 cases so examined, various disorders, including 81 esophageal, 408 gastric and 184 duodenal diseases, were diagnosed. Endoscopic diagnosis was usually made depending on the findings of direct observation and those of endoscopic photographs were used as additional informations. Malignancy was encountered in 48 cases, consisted of 4 cases with carcinoma of the esophagus (including 2 early cases), 43 with carcinoma of the stomach (including 10 early cases) and one with carcinoma of the duodenum. In the majority of these cases, it was possible to make a diagnosis only by endoscopic observation . However, the diagnosis of two cases with early carcinoma of the esophagus and two cases with early carcinoma of the stmach were made by histopathologic study on biopsy materials. Almost every cases with gastric ulcer, benign epithelial and non-epithelial tumor and some inflammatory disorders were also biopsied so that their diagnosis would be highly accurate. Two cases with early esophageal carcinoma and some of other esophageal disorders such as esophagitis and esophageal varices were detected by endoscopy in otherwise unexpected cases. Duodenal ulcer was very common disorder and often complicated with other gastroesophageal disorders. Therefore endoscopic examination for UGI tract should be always esophago-gastro-duodenobulboscopy by a directviewing endoscope, especially when it is an initial endoscopic examination for the patient. Since histopathological study on biopsy specimen are essential in establishing diagnosis of not only malignancy but also other disorders, an endoscopic instrument eguiped with biopsy channel is indispensable. A panendoscope, which is designed to observe from the esophagus to the duodenum and has an endoscopic biopsy system, is a first choice endoscopic instrument for UGI tract among many other kinds of endoscopes.

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Ninety-five cases of liver cirrhosis with esophageal varices were experienced in our clinic and these were classified endoscopically into grade I, II, IIIa, and IIIb. We studied relationship between the endoscopical findings of esophageal varices and clinical findings, and the following results were obtained. 1) Parallel relationship between splenomegaly and grade of esophageal varices was seen. The larger splenomegaly was the higher grade of esophageal varices was present. The similar relationship was found, between venous dilatation of abdominal wall, and the varices. But no correlation was found between hepatomegaly and grade of esophageal varices. Splenomegaly and venous dilatation were more commonly seen in the bleeding cases, in comparison to the non-bleeding cases. 2) Gamma globulin and platelet count were closely related to the grade of esophageal varices, and some correlation was found between ICG level and grade of esophageal varices, similar correlation was seen in albumin. The value of gamma gulobulin was higher, and the value of platelet count was lower in the bleeding cases than in the non-bleeding cases.

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In 50 patients under local anesthesia we have investigated, electrocardiographic changes in peritoneal insufflation of room air during peritoneoscopy. 1) There is no significant variance in pulse rate during 3 phases (before insufflation, after insufflation, after deflation). However, there are occasional cases of vagotony after insufflation, which may easily lead to circulatory insufficiencies. 2) There is some variance in the QRS vector, the T vector, the cardiac position and the transitional zone due to cardiac oppression; this cardiac oppression is caused by elevation of the diaphragm due to peritoneal insufflation of room air. 3) We observed that the supraventricular premature beat or the ventricular premature beat in 6 of 7 cases diminised after peritoneal insufflation of room air. 4) ECG monitoring is very useful to find early circulatory insufficiency during peritoneoscopy.

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With the improvement of the exciting filter clear fluorescence and delicate difference of the amout of fluorescence could be observed. In this paper, it was proven that fluorescence endoscopy reflected gastroduodenal mucosal blood flow. Further, intractability of ulcer was investigated on the basis of fluorescence findings in clinical cases. Materials and Methods1. Experimental study Histamine and norepinephrine were applied to the canine gastric mucosa of a certain area through a gastrofiberscope to alter the local mucosal blood flow. Then fluorescence endoscopy was performed. In addition, the technique was also performed on the canine gastric ulcers produced by acetic acid. 2. Clinical study Twenty cases of gastric ulcer and 39 of duodenal ulcer were examined and analysis was made on the time of the appearance of fluorescence and its distribution in the marginal mucosa of the ulcer.Results 1. Fluorescence appeared more rapidly in the hyperemic area where histamine was applied, than in the adjacent normal area. Whereas the appearance of fluorescence was delayed in the ischemic area where norepinephrine was applied (Figure 2). In the ulcers produced by acetic acid, fluorescence appeared more rapidly and was distributed evenly in the marginal mucosa of ulcer (Figure 1). 2, In the cases of which ulcer healed within 3 months, both retardation of the appearance of fluorescence and uneven distribution were not observed except 1 cese of duodenal ulcer. On the contrary, in over half of the cases of intractable ulcer, both findings were recognized (Figure 3, Figure 4, Table 4). From these results, it may be said that there is a favorable healing tendency in the cases where fluorescence apears rapidly and is distributed evenly, while in the intractable cases, fluorescence often appears later and is distributed unevenly. These findings recognized in the intractable cases are supposed to be based on the circulatory disturbance in the marginal mucosa of ulcer.

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We experienced 2182 cases of duodenal ulcer which were surely diagnosed with the duodenal fiberscopy from Jan. 1973 to Mar. 1977 in our clinic and two near-by hospitals. This report is focussed on the clinical fetures of duodenal ulcer in the young less than 19 years of age. 1) Seventy cases of duodenal ulcer in the young ranged 3.20 of all. 2) Sex ratio, M : F=5.4: 1. 3) Statistical data Showed that environmentally, 67, 9 per cent of patients were urban dwellers, and as to occupation, 50% of patients were students, and 28, 1 percent of patients had abdominal pain as the chief complaints. 4) Endoscopically the stage of duodenal ulcer in the yound was no difference in comparison to other generations. 5) Sixty five per cent of duodenal ulcer located on the anterior wall in the duodenal bulb. 6) Linear duodenal ulcer in the young were less than in other generations. 7) In the gastric acid secretion, BAO and MAO values in the young age group took the highest level of all ages.

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