The origin of endoscopy goes dack to Greek time. Hippocrates (BC 460-375) had written about the usage of a speculum for the diagnosis and treatment of hemorrhoids. The real speculum of Greek-Roman period are seen among the remains of Pompeij (AD 79). They have two to four lieves which are opened by gripes or a scew and applied for the observation of the rectum, vagina or uterus (fig.-1). The speculum was supposed to be used rather widely in that period. It was introduced into Europe and used without remarkable development until 17th centry(fig.-2). In 1807 P.B. Bozzini (1773-1809), a doctor of Frankfurt am Main, had published a booklet of 25 pages entitled by “Lichtleiter or a report on a simple device for the observation of the cavity or space of living animals and its application”. Bozzini had intended to use his instrument mainly for the clarification of the general rule of movement in 'Animalisation'. In his age, philosophic discussion about an animate things such as 'Animismus'or 'Vitalismus' was widespreding. His instrument (fig.-3, 4) doesn't like to be used virtually, and it was named by authorities as a magic lantern for the observation of hidden inside of the human body. His further investigation was forbidden. Bozzini's booklet is the first work on endoscopy but gave little influence to its following development. In early 19th century urology began to separate from surgery as a special department. In 1826, PS. Segalas (1792-1875), an urologist in Paris had demonstrated his method for the observation of interior of the urethra and urinary bladder. He used two candles and a concave mirror for illumination (fig.-6). His technique is a simple but practical one and he had succeeded in its clinical application. In 1856. A.J. Désormeaux (1815-1882), an urologist of Necker Hospital, had demonstrated a sophisticated instrument utilizing a gasogen lamp, lens and mirror (fig.-7, 8, 9). His instrument was given a fovorable reception, and in 1865 he published a book of 180 pages entitled as “Endoscope and its application for the diagnosis and treatment of urethral and bladder diseases” He is the first one who used the word ‘endoscope’. A. Kussmaul (1822-1903), a professor of medicine in Freiburg, was famous in that period by his treatment of pyloric stenosis by means of gastric lavage with alkaline solution. Of course his treatment was effective in limited cases and he was trying to make more exact diagnosis. His disciple was sent to Paris to learn Desormeux's endoscope. In 1968 he asked a sword-swallower to swallow a metal tube and succeeded to observe a part of his gastric mucosa with a Désormeaux's endoscope. An exact copy of the metal tube (47×1.3cm.) is preserved today in Kyushu university (fig.-15). This was approved as the first gastroscopy. No need to say that his gastroscope was unable to be used for practice and his interest had also moved to the other field. However his success is an important milestone in the history of gastroscopy as a testimony of the possibility of straight rigid tube insertion into the stomach. In 1970's, endoscopy was carried out for the observation and treatment of the nasal cavity, larynx and urethra. Endoscopy of the rectum wasn't performend widely because the traditional speculum was considered enough for clinical purpose. About esophagoscopy, several odd instruments were seen in literatures, but their clinical application must be impossible. In conclusion, endoscopy had originated in Greek. A remarkable development was made in 19th century and much interest was focused on it as a new technique for the observation of the human cavity. However development in the other fields such as electricity or optics was necessary before its wide clinical application. Furthermore little attention was payed on the position of patients, which is importand for endoscopy.

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The fine gastric mucosal patterns at the surface of the gastric mucosa were observed by using the magnifying fibergastroscope (FGS-ML) with about 30 magnifications. To simplify the fine gastric mucosal patterns, we made the magnifying endoscopic classification in the following ways; FP (foveolar pattern), FIP (foveolointermediate pattern), FSP (foveolosulciolar pattern), SP (sulciolar pattern) and MP(mesh pattern), which modified Yoshii's classification by means of dissecting microscope. The depressed parts (pastric pits) of the gastric mucosal surface, which showed FP, were consisted of circle. The depressed parts of SP and MP consist of sulcus, while the depressed parts of FSP were formed of tubule and sulcus. The term of FIP which was characterized by the circular and tubular depressed parts was adopted newly as our endoscopic classification. FIP is observed in more narrow space of the gastric mucosal surface which was knowen histologically as the intermediate zone. Gastrin producing cells in the gastric mucosa, which showed FIP, were rarely seen by immunof luorescence. Moreover, the rapid change from FP to FIP was estimated by observations in endoscopical comparison with two specimens from the resected and residual stomach. Therefore, we consider that the FIP indicates the atrophic border of the gastric mucosal surface. The magnifying endoscopic observation of the surface appearance of the intestinal metaplasia showed FSP and SP. By methyleneblue staining method, degrees of the methylene blue absorption were divided into "dense" and "rough" by magnifying observation . Tissue alkaline phosphatase activity in the intestinal metaplasia seemed to be in proportion to the degree of methylene blue stain. The fine gastric mucosal pattern at the surface of the gastric cancer was very irregular and easily differentiated from ordinary pattern. As the conclusion, we suggested the usefulness of the magnifying endoscopy in application of patho-physiological approach to the gastric mucosal changes in several gastric disorders.

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The clinical significance of the gastric type epithelium surrounding mucosa of duodenal ulcers were studied endoscopically and histologically.Results:1) The gastric type epithelium in the duodenal mucosa showed the same features as the gastric surface epithelium histologically. The villi were indentif iable with redness and swelling under the endoscopic observation. It was considered that the gastric epithelium did not have any absorptive ability because it remained unstained in the methylen blue solution.2) From the studies of the resected specimens of the duodenal ulcers, the gastric type epithelium never occurred in the phase of active ulcers. But, as the healing of ulcer progress it appeared more often and also increased in severity.3) In 114 of 144 cases (79. 2%) of duodenal ulcers revealed the gastric typs epithelium at biopsy under the direct viewing endoscopy. Also it appeared more frequently as healing advanced. The gastric type epithelium appeared more increasingly in proportion to the patient's age and to the period of long history of the so-called difficult healing ulcers.4) The gastric type epithelium seemed to play a role of a defence factor and devaloped as metaplasia in the healing process of regeneration of ulcerative or erosive lesion in the duodenal mucosa.5) In the follow-up studies of the gastric type epitheliu-m by biopsy, it appeared more frequeatly among the cases undergoing remissions within 3 months. While the frequency did not increase in the cases with remissions requiring more than, 3 months. From these results, the follow up studies of the gastric type epithelium by biopsy are very effective in the evaluation of the prognosis of duodenal ulcers.

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As the new treatment for the severe stenosing stoma after esophageal replacement, the authors have performed endoscopic incision with electric current of high frequency, since 1972. Under esophagofiberscopic control, a radio-knife with flattend tip (Fig. 2) was attached to the stenosing portion through the biopsy channel of the fiberscope, and electric current was supplied very briefly less than 1 second. (Fig1, 3) Postoperative stenosis was improved clinically in 44 out of 48 cases. This method was able to apply to the stenosis which occured after the abdominal, intrathoracic, and retrosternal esophageal replacement, but was not to antethoracic esophaeal replacement. (Fig. 3, 4, 5) This was also applicable to the esophageal transection for varices. (Fig. 6)

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In colonoscopic findings of ulcerative colitis, frequently, there is a discrepancy between ordinary observations and histological findings: some of the cases, which were considered to be in quiescent stage by the former, were revealed to be in active stage by the latter. To dissolve the discrepancy we used the magnifying colonoscope. The 15 cases, which were diagnosed in quiescent stage by ordinary odservations, were checked. According to the shape and the arrangement of the orf ice of Lieberktln's gland, we classified the cases into 4 grades from 0 to III and compared them with the histological findings and the clinical course. As a result, the classifcation correlate to the histological findings and the duration of the quiescent stage in grade 0 and I is longer than that in grade II and III. Therefore, the use of magnifying colonoscope is effective for clinical judgement of the recovery to some extent. At present, it could not be a better method than biopsy because it is impossible to observe the total lesion by magnifying colonoscopy. However, it cotld be more effective in the near future, if we would be able to get the useful findings in judging the prognosis.

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The 41 cases of advanced cancer were examined which was similar types to early gastric cancer from standpoint of the depth of cancer cell infiltration mainly by means of X-ray and endoscopy. These cases were experienced in our clinic, from 1967 to 1977. The following results were obtained. 1) The 92. 7 per cent of similar types to early gastric cancer were depressed type such as IIc, IIc+III and III+IIc type. 2) Most cases of mis-diagnosis consisted of small lesions which were between 1 and 2cm in the geatest diameter, of wedge-shaped cancerous infiltration, pm cancer, and with ulcer or ulcer scar. 3) When we diagnosed the depth of cancer infiltration, we should estimate the existence of following various characteristic features which were helpful for the estimation of the depth of malignant involvement, and sm invasion. That is, these characteristic features were consist of finding at the margin of convergent fold, depth of depression, stiffness around depression, surrounding transluency on the compression image, and so on. When diagnosis of the depth of cancer infiltration was done by them synthetically, the rate for accurate diagnosis of depth of cancer infiltration increased up to 71 per cent. 4) The prognosis of similar types to early gastric cancer was good, and five years survival rate was 85 per cent.

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I. medizinische Klinik, Stadtisches Krankenhaus, Kemperhof, Koblenz, West Germany Endoscopic papillotomy (EPT) in patients with juxtapapillary diverticula is reported. EPT has been performed in 60 cases between Feb. '75 and Oct. '77. Indications were choledocholithiasis with or without gallbladder stones (50 cases), papillary stenosis (4 cases) and others (6 cases). In these 50 patients with choledocholithiasis 12 cases had juxtapapillary diverticula. EPT was successfully performed in all 12 cases with juxtapapillary diverticula and stones were removed with basket catheter or delivered spontaneously after EPT in 10 cases (83%). Retroperitoneal perfor ation was observed in one patient, but cured after adequate antibiotic therapy. EPT was considered to be a contraindication for juxtapapillary diverticula because of a risk of perforation. But from our result it is concluded that EPT is also useful and effective procedure for removal of choledocholithiasis with juxtapapillary diverticula.

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Recently, we have encountered three cases of pneumobilia during this one year and all three cases had the clinical symptoms and signs suggesting cholelithiasis. With the experience of three cases, duodenofiberscopic procedure and ERCP were turned out to be most valuable in making diagnosis. One of the three cases presented here was revealed to be caused by the incompetence of the sphincter of Oddi and the remaining two, parapapillary choledochoduodenal fistula; in one of the latter two, we had the chance to perform hypotonic duodenography before spontaneous formation of the fistula. The other of the latter two was of considerable interest in that the requrgitation of the cotrast medium through the spontaneously formed fistula both into the bile duct and the pancreatic duct was seen. The stone in the common bile duct was successfully removed by the endoscopic sphincterotomy. After the procedure, the orifice of the pancreatic duct became visible through the incised papilla and hypotonic duodenography after papillotomy disclosed contrast medium which regurgitated into the pancreatic duct.

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