A fiberscope for the upper GI tract, GIF-P 2, is a forward-viewing scope featured with thin diameter and a strongly flexible short tip. After its completion following to our medical advice in November 1975, 2, 500 times of examination were carried out in our clinic. In 971 times it was performed without previous X-ray examination. We heve reviewed the files of endoscopy films and reports and studied about the usefulness of a GIF-P 2 in comparison to the other models. Its introduction was always smooth except in 2 cases of cervical esophageal stenosis. "U-turn" observation of the esophagus, cardia and duodenal cap was easy. Investigation of a focus from unusual angle of view is available with this "U-turn" technique. No complications were encountered except one massive bleeding after polypectomy of a big gastric polyp. Grade "A" quality photographs of each part were taken in 74 to 95 % respectively from the esophagus to duodenal cap. Distribution of 276 gastric ulcers in the stomach detected with a GIF-P 2 was same to that diagnosed by conventional method. This indicates absence of blind area in the stomach for a GIF-P 2. In 87 % of cases diagnosed as advanced stomach cancer and 59 % as early one, cancer was confirmed afterwards. On the other hand, malignant cases were detected by biopsy in 1.7% of the cases which were reported as benign with a GIF-P 2. These figures are in the same level to that obtained with side-viewing gastrofiberscopes. The ability for detailed observation is as excellent as ordinary f iberscopes. Biopsy with a GIF-P 2 hits the focus in 97 % of advanced cancer and 100 % of early ones in the stomach and esophagus. Its flexibility and nicely controlable tip contribute very much to establish these marbellous results. In conclusion a GIF-P 2 is the most suitable fiberscope for panendoscopy of the upper GI tract. The pain to patients is minimum. In order to fit the world-wide requirement for reduction of ionizing irradiation, panendo-scopy with a GIF-P 2 should be performed in the place of conventional upper GI series. In our clinic the latter was reduced less than half after the use of a GIF-P2.

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Ninety-two cases of liver diseases which had definite diagnosis and underwent EPCG examination or 'Pharma-cological EPCG' were studied. The diagnosis were made by laparoscopy and biopsy in majority of cases. In a few cases the diagnosis were made by operation biopsy or autopsy. Ductal calibers were investigated in 67 cases in which ducts beyond the fourth branches were demonstrated either in right and/or left lobe. Ductal configurations and branchings were also investigated in 64 cases which have shown ducts beyond the third branches either in right and/or left lobe. In addition, in all 92 cases, the abnormal findings of the caliber were analyzed by the branch number and were classified into serveral gronps according to the type of liver disease, as shown in the table. Some types of liver diseases have shown characteristic findings of the intrahepatic cholangiograms when they have had complete visualization. So EPCG can be contributory in diagnosing liver diseases when it demonstrates complete visualization of the intrahepatic bile ducts.

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Peroral cholangiopancreatoscopy (PCPS) and peroral direct cholangioscopy (PDCS) are discussed. PCPS using a mother and babyscope (Olympus Co.)was attempted on 8 cases. The duct systems were observed in 7 cases; cholangioscopy in 5, pancreatoscopy in 1 and cholangiopancreatoscopy in 1 case. Concerning to the babyscope, it is required to develop the bending system and the biopsy channel for further step. In order to supplement these weak point of the babyscope, we developed new technique without using the babyscope, that is, direct observation of the bile duct (peroral direct cholangioscopy, (PDCS)). PDCS with using forward-viewing fiberscope GIF-P2 was performed in 6 cases after endoscopic papillotomy. In 4 out of 6 cases the tip of the endoscope was inserted directly into the common bile duct through the incised papilla. The common bile duct could be observed clearly compared with the babyscope by this method. Furthermore, in one case a stone in the common bile duct was caught by a basket catheter under direct visual control and removed from the duct to the duodenum. At present time authors have considered a role of peroral cholangiopancreatoscopy as follows. PCPS is useful for endoscopic observation of the pancreatic and the bile duct with or without endoscopic papillotomy. PDCS is useful for endoscopic observation and treatment of the bile duct after endoscopic papillotomy.

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From Jan 1973 to Dec. 1976, 1880 cases of duodenal ulcer were diagnosed with duodenal fiber-scope in our clinic and two near-by hospitals. This report is focused on the features of duodenal ulcer in the high age-group over 60 years of age.1) 187 cases of duodenal ulcer in the high age-group ranged 9.8 per cent of all.2) As for the types and location of duodenal ulcers in high age group there were no difference in comparison with other generations.3) The scar of duodenal ulcers in the high age-group were found a half of all examined cases, and the active stage ranged 23 per cent of all.4) In ability of gastric acid secretion of each generation, there was no difference in MAC value, but some of BAO and MAO values decreased slightly in high age-group.5) In endoscopic examination, the gastric mucosa of high age-group showed mildly atrophic gastritis or normal mucosa. There was distinct difference from the mucosa of some other gastric diseases including gastric polyps and gastric ulcers.

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A 45 years old male with Granular cell tumor of the esophagus had been follwed up endoscopically for one year. This patient had no clinical feature, when this tumor was found incidentally. By X-ray studies, a clearly limited shadow defect was found at lower esophagus. Esophagoscopy revealed that there was a small sessile, white tumoroon the anterior wall at 35 cm. from the (incisor teeth) with somewhat depressed area at the top of the tumor, however no ulceration nor erosion was found on the surface of the tumor. Pathologic diagnosis of the endoscopic biopsy specimen was granular cell tumor. Although further upper GI series and esophagoscopy were performed after one year, no changes were noted in size and shape of this tumor. This may be the first clinical 'report of an esophgeal granular cell tumor in Japan.

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A 52 year-old man admitted to our hospital for further examination of his liver disease. In his clinical examination, serum AFP was positive and liver scintigram revealed shadow defect at the right hepatic lobe. By selective celiac angiography, the findings of tumor vessles, encasement, tortuosity and dilatation of the right hepatic artery were recognized. Peritoneoscopic finding revealed scar liver of the left lobe. And so, we diagnosed of subacute hepatitis. The findings of E. R. C. P. revealed intrahepatic cholelithiasis of the left intrahepatic bile duct. Comprehensively, he was diagnosed of primary hepato-cellular carcinoma with subacute hepatitis and intrahepatic cholelithiasis. Accordingly, when these diseases are suspicious, it is very important that these complemental diagnostic methods are to be done actively.

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