Recetly, urgent endoscopic examination has been undergoing for upper gastrointestinal hemorrhage. And, various types of panendoscope which can observe from the esophagus to the bulbular portion are made. Forward oblipue viewing endoscopy (FGI-FO) is newly developed by MACHIDA Co. also for this purpose. The most characteristic point of FGI-FO is angles of view directed obliquely 30 degrees from the longitudinal axis of the instrument. We have used this fiberscope on 102 cases and following results are obtained. The esophagus was satisfactorily observed as well as forward viewing instruments. The stomach was entirely observed, and in about half cases the gastric angle was easily observed in front. The duodenal bulb was easily orientated for observations.

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The smaller caliber forward-viewing fiberscope designated as Olympus GIF-P₂ was described and its clinical use in 897 patients was reviewed. The major advantages of the GIF-P₂ are improved flexibility and maneuverability. The instrument was employed not only for routine upper GI endoscope but for many purposee as follows; (1) retroflexion in the esophagus and duodenal bulb, (2) further examination of operated stomach, (3) pediatric diagnostic upper GI endoscopy and removal of foreign bodies, (4) functional endoscopic examination of upper GI tract, (5) ergent endoscopy, (6) polypectomy, (7) snare biopsy (Schilingenbiopsie), (8) FRCP, (9) peroral direct cholangioscopy (PDCS) through incized papilla after endoscopic papillotomy (EPT) and (10) ERCP and EPT after Billroth II resected stomach. The GIF-P₂ is evaluated superior to other standard panendoscopes and offers many improvement and advantages.

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With the development of fiberoptic instruments, gastric biopsy under direct vision has become a routine diagnostic procedure for the diagnosis of gastric cancer. However, a false negative biopsy is occasionally encountered despite the advances in instrument and biopsy technique. The purpose of this work is to review false negative biopsies in our series of the period from January 1969 to December 1974. A total of 1718 biopsy examinations were performed during the period and a false negative result was obtained in 199 examinations. The 199 included 62 of Borrmann IV type, 47 of Borrmann III type, 37 of cancer of the cardia and 54 of others. The rate was 22.4 percent in recurrent tumor, 22.2 percent in Borrmann IV type, 18.6 percent in cancer of the cardia and 36.8 percent in others. The high false negative rate of biopsy was expected in the former three types, because cancer cells were present mainly in the submucosa. It is surprising that the lesions endoscopically presenting as benign ulcer had a high false negative rate, being 17.8 percent which was high next to cancer of the cardia. The others accounted for less than ten percent. The major causes of false negative biopsy are considered as follows : Submucosal infiltration, 54.3 percent; technical error, 36.7 percent. These two accounted for approximately 90 percent and the other causes were noted in less than three percent.

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Choledochoscopic examination on the choledochitis was performed on 206 patients with the cholecystolithtasis and choledocholithiasis. Also common bile duct biopsies were obtained in 56 patients. Choledochitis was endoscopically divided into following four Grades; I non, II slight, III moderate and IV intense, respectively. In cholecystolithiasis 12.7 per cent of patients showed Grade II and III, whereas in choledocholithiasis 61.2 per cent of patients were categorized as Grade II-IV. There were erosions, mucous degeneration and stratified proliferation in the epithelia of 27.6 per cent of patients with cholecystolithiasis and 63 per cent with choledocholithiasis. Assuming that the choledochitis is confined to the infiltration of both lymphocytes and plasma cells or neutrophils in the epithelium, 10.3 per cent of patients with cholecystolithiasis and 37.0 per cent with choledocholithiasis exhibit such inflammatory cellular changes. These changes were more frequently observed in the deeper layer of the tunica muscularis in patients with choledocholithiasis (77.3 per cent) than in those with cholecystolithiasis (26.7 per cent). Subepithelial hyperplasia of the connective tissue in patients with choledocholithiasis and cholecystolithisis was seen in 70.4 and 27.6 per cent each. Hypetrophy or atrophy of the muscular fibers in the choledochal wall were more prominent in patients with choledocholithiasis (40.7 per cent) than in those with cholecystolithiasis (17.2 per cent). In summary, patients with choledocholithiasis are much more characterized by prominent erosions, mucous degeneration and stratified proliferation of choledochal epithelia than those with cholecystoliasis. Extension of inflammatory cells in the choledochal wall are more dominant in patients with choledocholithiasis than those observed in cholecystolithiasis. Subepithelial hyperplasia of the connective tissue and hypertrophy or atrophy of muscular fibers in the choledochal wall had the same tendency. Comparing both the endoscopic grade of the choledochitis with the histological inflammatory changes in the choledochal wall, there appeared a high correlation in patients with choledocholithiasis.

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The authors have obtained 120 colorectal polyps from 94 patients by endoscopic polypectomy until December 1977. The final histological diagnosis was as follows; adenocarcinoma, 14 (m, 9 ; sm, 5) ; borderline lesions, 2 ; adenoma, 79 ; hyperplastic polyp, 8 ; others, 2 and so on. The incidence of carcinoma in the removed polyps was 11.8%. The anatomic distribution of the 14 carcinomas was as follows ; rectum, 5 ; sigmoid, 6; descending, 1; transverse, 1; ascending, 1. The main symptom of the patients with adenocarcinoma was rectal bleeding which was found in 9 patients. There were three patients whose polyps were found during period a follw-up after a pr-vious colorectal surgery. Ten follow-up patientls were treated by endoscopic polypectomy. Periodical follow-up examinations are very much necessary for the patients who have been previously treated carcinoma or adenoma of the large intestine. Endoscopic examination should be scheduled 6 month later in patients whose polyp excised endoscopically was carcinoma. Roentgenologic examinations should be performed at yearly intervals for 4 years and at 2 or 3 year intervals thereafter.

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The propositus, age 58 male, complained of bloody mucoid discharge and was admitted to Nagoya University Hospital, August 1973. In July 1977, the son, age 29, was admitted with the same complaint. Barium enema (Figure 1, 4), undertaken on both patients, showed findings of ulcerative colitis invading the total colon. Sigmoidscopic examination and biopsy specimens (Figure 2, 5) confirmed these findings. Several months of drug treatment led to total remission in the father's disease and temporary in the son's. (Figure 3, 6) Recently, the son experienced a relapse. (Figure 7 colour) Twenty one cases of ulcerative colitis were found among 10 Japanese families, (Table 1) (In western countries, the frequency of occurrence is much higher.) Of these 10 families, parent-child occurrence was found in 5 ; 3 were mother-daughter, 1 was mother-son, and 1 was father-son. In the other 5 families, occurrence was among siblings ; 3 between brothers, 1 between sisters, and 1 among three siblings. In the three families of which afflicted persons lived together, the involvement of genetic, environmental, and psychological factors is suggested. In the other three families of which afflicted persons did not live together, a genetic etiology of the disease is suggested.

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ERCP with a side view duodenofiberscope JF-B2 was performed to a 53-year old male who had a previous history of Gastrectomy of Billroth II type, revealing cholecystocholedocholithiasis.At the first time, endoscopic papillotomy was carried out with a front view fiberscope GIF-P2 and a stone in the bile duct was removed. After confirming the removal of the stone in the bile duct, cholecystectomy was performed. Both Sohma type and Ikeda-Classen type cutting knives were used in this case. A slender front view fiberscope GIF-P2 is useful for ERCP or EPT for Billroth II gastrectomized cases.

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There have been a few reports of polypoid type gastric cancer, followed up for more than 5 years. We recently experienced such a case. A 66 years old woman visited our hospital because of slight epigastric distress on March 1971. A small oval polypoid lesion was noted by gastroscopy and the biopsied specimens showed an atypical tubular structure suggesting cancer. She refused operation and was followed up. Roentgenologically the polypoid mass had not enlarged for the first 4 years, but for the following year did enlarge in its diameter. The 2nd biopsy was done on July 1976, revealing adenocarcinoma. She was operated on September 1976. Histological examination of the operated specimen showed moderately differentiated tubular adenocarcinoma, remaining in mucosal layer.

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