A clinicopathological study was made on the endoscopic polypectomy of the large bowel, besed on 181 lesions (153 cases) which had been experienced in the period from September, 1972 to December, 1976 at the Cancer Institute Hospital, and the following results were obtained. 1) Of 181 polypectomized materials, 132 lesions were histologically diagnosed as benign, and 49 lesions were regarded as to be clinically malignant, including those which were histologically diagnosed as borderline atypia and malignant. 2) As with the size of the polypectomized materials, those smaller then 2.0cm comprised 91% (164/181), and as with the macroscopic form, 77% of them were pedunculated. 3) Of 34 lesions which were histologically diagnosed as malignant, 28 lesions were focal carcinomas and 6 of them were invasive carcinomas. All the focal carcinomas were pedunculated in the macroscopic form, while 4 lesions of the invasive carcinoma were subpedunculated and 2 lesions of them were sessile. Five lesions of the invasive carcinoma were referred to colectomy and the remaining cancerous tissue was found in 2 lesions. No lymph node metastasis was found in all the colectomized lesions. 4) The polypectomized site was histologically examined in 23 lesions and it was disclosed that 21 lesions of them were found to be in the state of ulcer or ulcer scar which did not reach the proper muscle layer (Ul-II or UI-Os). It was confirmed that the polypectomy was safely performed in most cases without doing any damage to the proper muscle layer. It was also confirmed that an ulcer which was caused by the polypectomy healed completely in approximately 60 days in most cases.5) The endoscopic polypectomy is indicated for pedunculated and subpedunculated lesions without limit of their size on the ground that it can be performed safely with no technical difficulty. However, it is not indicated for sessile lesions larger than 1.0cm because most of them are invasive carcinoma or advanced carcinoma which eventually requires colectomy.

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Among malignant neoplasmas of the esophagus, so-called carcinosarcoma is very rare and known to present interesting histological features. But it is yet controversial weather sarcomatous component of this tumor is in epithelial or non-epithelial origin. A 67-eayr-old male was admitted to Hamamatsu Medical Center with a chief complaint of poststernal discomfort for six months duration. Upper G. I. series, esophagogastric endoscopy, esophago-gastric biopsy and esophageal cytology with balloon method showed squamous cell carcinoma which was a small polypoid lesion surrounded by elevated mucosa and sarcomatous-like tumor which was a large, constrcited mass in the mid-lower esophagus and early gastric carcinoma, type ha on the posterior wall of the midbody. Resected specimens showed a small polypoid lesion surrounded by elevated mucosa with shallow ulcerations and a large ovoid mass, 8.5 × 5.0 × 4.0cm in diameter with a narrow stalk in the esophagus and a flat, protruding lesion in the stomach. Histopathological findings showed so-called carcinosarcoma which was squamous cell carcinoma (a small polypoid lesion and elevated mucosa) associated with transitional change to sarcomatous pattern (a large ovoid mass) in the esophagus and early gastric carcinoma, type ha which was well-differenciated adenocarcinoma (m). The literatures of so-called carcinosarcoma were reviewed.

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The present study deals with the effect of sepsis on the occurrence and course of acute gastroduodenal lesions seen in patients with severe injury. In the sepsis group, acute gastroduodenal lesions were occurred in all of 15 patients, while they were found in 51 of 70 cases without sepsis. The difference was significant ( p <0.025). The frequency of acute gastric ulcer was higher in the sepsis group than in the non-sepsis group. The location of acute gastric ulcer was mainly in the corpus in patients with sepsis, but in non-sepsis group it was found in the antrum as well as the corpus. Acute hemorrhagic gastritis was found in the corpus in the both group. The complication of sepsis caused gastrointestinal bleeding and deteriorated the clinical course in 11 of 15 cases. These results suggest that sepsis may effect the occurrence and course of acute gastroduodenal lesions.

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Early-stage cancer located on the upper part of the stomach, especially near the esophagogastric junction, is still difficult to diagnose, and frequently undiscoverd until it is too late. Minute cancers so far discovered, in particular, are few in number, and much remains obscure about their morphology, , including such problems as strophic and metaplastic changes in the mucous membrane over the said area. We looked into diagnosis and morphology of minute cancers of the said region in patients encountered by us. Subjects consisted of 12 patients with early-stage gastric cancer the size of 2 cm or less in maximum diameter, a margin of which was within distance of 2 cm from the junction. Total 13 such lesions were found in them. Our findings were as follows : (1) Straight-view fibescope is more useful in observation snd biopsy of small lesions adjacent to the junction, while lateral-view fiberscope has slight advantages with small lesions off the junction, (2) of small, early-stage gastric cancers near the junction, those adjacent to the junction are frequently protuberant, and those off the junction tend to be concave, (3) the majority of small, early-stage gastric cancers near the junction are histologically highly differentiated.

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During the period from April, 1974 to February, 1978, 667 postoperative choledochoscopies were carried out in 220 cases, in those including 73 cases with retained biliary stones and 28 cases with intrahepatic stones. Non-surgical retrieval was successful in 71 cases with retained biliary stones and 24 cases with intrahepatic stones respectively. Thirty-eight out of 71 patients undergoing endoscopic stone retrieval repuired a single session, whereas in the remaining thirty-three and all of the cases with intrahepatic stones multiple sessions were required for complete retrieval of stones. Multiple sessions were indicated for the following cases, large stone more than 1.3 cm in diameter, multiple retained stones over five, inadequate T-tube sinus tract. Moreover, repeated postoperative choledochoscopy should be employed to ensure the ductal cleaning whenever any doubt in roentgenological findings were existed. Non-surgical retrieval with endoscopic guidance is the method of choice for removal of retained biliary stones after choledochotomy. Multiple sessions make this procedure more reliable in such cases with problems mentioned above.

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Up to now, as for EPCG, the examiners have only paid attention to the morphologic changes, but not to the functio-nal changes of the biliary system. We considered that the examination of the function of the biliahy system was very important, too. During EPCG, tke gallbladder contraction by oral intake of egg yolk or caerulein injection was observed. And it is called "functional EPCG". In cases of hepaic failure and gallbladder diseases which show nonvisualization of the gallbladder by oral cholecystography and intavenous cholangography, we could get information of the function of the gallbladder by this method because of direct cholangiography. Furthermore, we could observe the change of the gallbladder infundibulum and cystic duct in detail by this method, better than oral cholecystography and intravenous cholangiography. So that, this method helps to diagnose and understand the mechanism of biliary dyskinesia well.

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A case of gastric lymphosarcoma is reported, which have been observed both endoscopically and roentgenologically as long as seven years. The pathological changes were found in gastric mucosa in eight different regions of the stomach. Some of the lesions showed an elevated figure, some depressed and the other showed a combination of a partly elevated and partly depressed figure. Only one of these lesions persisted all through the time, while the other lesions were not constantly found. They disappeared, while re-appeared and then disappeared again. Although no malignant signs were recognized on the biopsy specimen of gastric mucosa, the resection of the stomach was finally performed. Histological examination of the resected specimen revealed widely distributed lesions of gastric lymphosarcoma with-out reactive lymphoreticular hyperplasia. The transitory changes of the lesions observed clinically seems to have been brought by a maligmant cycle of the sarcoma.

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A new method of dilating stenotic stoma after surgery was devised. Laminaria, which has been used in the obstetric and gynecological conditions, was used. Its tip was sharpened in order to make the insertion easier, and a thread, which was pulled off when removed, was tied on its top. Laminaria, clasped by the grasper, was easily inserted into the stenotic stoma under direct endoscopic vision. After five or six hours it was removed by pulling off the thread. A good result was obtained by two trials of this technique. The advantages of this method comparing to the other methods are of extreme safetiness and effectiveness.

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Typical jejunal ulcers were found most frequently in cases with gastrojejunal anastomosis by Billroth II method. We reported 4 cases of stomal ulcer wtth long-term observation. There vere the reasons that operation was not done actively, because one patient had chronic hepatitis and other three patients refused surgical management. We reconfirmed that stomal ulcer had the tendency to persist or recur frequently, although tt is already well known, and realized keenly that surgical maagement is necessary for the treatment of stomal ulcer. The relationship between recurrence of stomal ulcer and jaundice, and or seasons were studied. Valuability of endoscopic examination in following up stomal ulcer vas stressed

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