The relationship between mucosal enzymatic activity and structural character of the surface of intestinal metaplasia in the stomach was investigated through the observation of biopsy specimen under the dissecting microscope. During gastroscopy, the existence of intestinal metaplasia was detected by spraying methylene blue solution and specimen was taken from the part of intestinal metaplasia. The biopsy particles were stained histochemically in our own special way for the detection fo enzyme activity (alkaline phosphatase, leucine aminopeptidase, maltase, lactase). On teh other hand, superficial structure of these specimens were odserved to see if they were rather similar to the gastric or intestinal mucosa. These two factors were compared in 577 specimens. Results 1) The existence of enzymes were detected in different manner. 2) The superficial appearance of intestinal metaplasia was similar to the gastric mucosa in 77% and to the intestinal mucosa in 23%. 3) The intestinal metaplasia with similar superficial structure to the small intestine was significantly higher in mucosal enzymatic activity than those with gastric mucosa like structure. ALPase (p<0.02)

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A comparative study of pancreatograms, three-dimensional reconstructions of the pancreatic ducts and histological findings was performed in chronic pancreas injury dogs following Freund's complete adjuvant injection. 1. Abnormal pancreatograms consisted of dilatation (simple, undulatory, bead-like), irregularity and stenosis. 2. In normal pancreatograms, three-dimensional representation of the ducts were cylindric and smooth in surface. Histological findings of the pancreatic ducts and adjacent parenchyma were almost normal. 3. Reconstructed ducts of simple dilatation in pancreatograms were cylindric, smooth in surface and enlarged in diameter. The histological study showed severe dilated ducts with flattened epithelia. In addition to, periductal and interlobular fibrosis with slight inflammatory cell infiltration was observed. 4. Three-dimensionally reconstructed figures of undulatory dilated ducts showed slight tortuosity of main ducts, and distorsion, dilatation and anastomosis in some of branches. Histological findings of the tortuous regions showed slight irregularity of the lumen, but no remarkable changes of epithelia were observed. Inter and intralobular fibrosis with inflammatory cell infiltration often invaded the lobules, although periductal fibrosis was generally slight. 5. Three-dimensional representations of the bead-like dilatation showed severe tortuosity, and irregularity and uneven surface. Branches were increased in number, tortuous, communicated with one another and some of them disappeared suddenly. Histologically, the ducts showed irregular lumina and many ramifications, but papillary hyperplasia or metaplasia of epithelia was not revealed. Inter-and intralobular fibrosis with inflammation and parenchymal destruction were severe. In summary, this study showed that bead-like dilatation in pancreatograms was a result of severe chronic pancreatic injury, and correlated closely with “distorsion” of the pancreatic ducts due to pancreatic strain which was attributed to parenchymal destruction and fibrosis with inflammation rather than caliber variations and epithelial changes. Furthermore, the pathogenesis of the undulatory changes of the ducts might be a same mechanism.

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Questionuaires in quiring the complications of gastro intestinal endoscopy were sent to 103 hospitals in YAMAGUCHI Prefecture, and the answer was obtained in 78.6% (81 hospitals). Gastrointestinal endoscopic examinations reported in 188, 428 cases and the examinations included upper gastrointestinal examinations (179, 057 cases), biopsy (21, 124) endoscopic polypectomy (329 cases), ERCP (1, 760 cases), Romanoscopy (6, 894 cases) and endoscopy in emergency (289 cases). The overall rate of complications was 0.05% (89 cases) and mortality rate was 0.004% (9 cases). Complications included hemorrhage (27 cases), perforation (12 cases) dislocation of jaw joints (11 cases), subcutaneDus emphy-sema (7 cases), laceration (6 cases), difficulty in removing (5 cases) and the others (20 cases). We made a comparative study of the past reports from the survey by Schindler (1940) to the survey of Japan by T. Takemoto (1975). Analysis of this survey indicated that complication of hemorrhage was more than perforation in number. This reason was thought by becoming widespread of biopsy and endoscopic polypectomy and coming into use of fiberoptic instruments in place of flexirid instruments. The value of gastrointestinal endoscopic examinations is now well established and the number of examination will be more on the increase. So the complications of endoscopic examination will increase in number. We must call attention to a potential risks of the complications.

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At the 3rd European Congress of Gastro-intestinal Endoscopy (Budapest, 1976), the present authors have reported the findings of the blood flow in the gastric mucosa of the corpus and the antrum and the endoscopic findings of stomach cancer by means of dye (10 ml. of 0.1 w/v% Evans Blue or 0.2 w/v % Indigo carmine) infusion into celiac artery. Thereafter, the blood flow and the supplying area of the left gastric and right gastro-epiploic arteries were observed by I. A. D. method with superselectivec annulation into these arteries (Figure 1 and Figure 2). In 48 lesions of 44 patients with stomach cancer, the hemodynamics in the lesions and their surrounding mucosa was observed. To prove the significance of I. A. D. method, the microvascular patterns were compared between mucosal lesions of cancer and their surrounding area. In the lesion of well differentiated adenocarcinoma, the mucosal vessels are decreased in number with evident varieties of turtuous, dilated and cystic patterns (Figure 4). And so, the endoscopic findings of the redness in those lesions of well differentiated adenocarcinoma are considered to be due to the blood pooling in those dilated and cystic vessels in the mucosa orr submucosa (Figure 3). On the other hand, in the lesion of pooly differentiated adenocarcinoma (signet ring cell carcinoma), the mucosal vessels of the lesions are extreamly decreased in number with fine and chaotic petterns, comparing to those of the surrounding normal mucosa (Figure 6). The endoscopic findings of discoloration in lesion of poorly differentiated adenocarcinoma are due to those poor vascularisation (Figure 5). The deformity of mucosal vascular mesh in malignant lesions corresponded with fundamental types of involving carcinoma. And so, the I. A. D. method would serve in observation of the abnormal hemodynamics, at the border between malignancy and surrounding area. Recent method of I. A. D. using vasoconstrictor (epinephrine 10 μg.) revealed that the cancerous lesion is more clearly demarcated from surrounding mucosa in early lesion of well differentiated adenocarcinoma than I. A. D, photographs without vasoconstrictor (Figure 7). Therefore, the use of vasodilator in poorly differentiated adenocarcinoma, on the contrary, the application of those medicaments in I. A. D. method (pharmaco-I. A. D. or P. I. A. D. method) would be and useful diagnostic approach for determination of extent of cancer spread in the mucosa or submucosa, which is so difficult to point out as “poor distensibility” or “rigidity” of the stomach wall by means of fluoroscopic examination. By further improvement of the procedure of I. A. D. method, this new technique of endoscopic examination would serve in pathologic or physiological study on not only stomach but also other digestive organs.

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Seven cases with shortening of the main pancreatic duct in ERCP were studied. Almost all of them complained of upper abdominal discomfort or pain, poor appetite and four of them had remarkable emaciation. Their signs and symptoms mimic chronic pancreatitis or carcinoma of the pancreas. Laboratory data and drip infusion cholangio-graphy showed on abnormalities in all. Pancreatic scanning showed subnormal in a half of them but celiac angiography revealed no abnormality in all casess studied. The functional impairment of the exocrine pancreas was observed in only a case but hyperamylasuria or abnormal response of the blood amylase after pancreozymin and secretin administration were odserved in all of them. Postmortem pancreatogram of a case (Case 1) coincided with ERCP in all cases that the main pancreatic duct was short and distributed only to the pancreatic head. By the instillation of methylene blue into the papilla major and cogo red into the papilla minor, the pancreas was divided into two regions. The blue and red stained pancreas coinsided respectively with the distribution of the main pancreatic duct and the accessory duct. No communication of both ducts was detected but the pancreas was almost normal macro-and micro-scopically. As the cases with the short main pancreatic duct in ERCP complain of many GI troubles without special changes in the pancreas, we would like to propose a new clinical entity such as "Short main pancreatic duct syndrome" or "Malf nsion syndrome of the pancreas" for these cases.

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In the last 2 years, we experienced 18 cases of postbulbar duodenal ulcer. The analysis was made on clinical, radiographic and endoscopic findings of the disease. 1) In our series of 18 cases, there were 17 men and 1 woman. The average age was 42.6. 2) As a complication of this disease, bulbar ulcer were seen in 55.6% and gastric ulcer in 11% of all cases. 3) As the radiographic findings, ring stricture were seen in 94.1% and nische in 76.5% of 17 cases. Barium-filled image in the restand right anterior oblique projection was more effective than another image, and hypotonic duodenography was very useful technique in diagnosing of this disease. 4) Endoscopically, these ulcers were confirmed in 75% of all cases. In order to observe the ulcer in detail it is important to use both of the side-viewing type and the end-viewing type of the small caliber duodenofiberscope, depending upon choice.

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　IIa集籏+IIb型の早期胃癌症例を経験した.胃X線,内視鏡像でIIa subtype,疵状胃炎などと鑑別が必要であったが,結節性隆起が集籏しており,広範囲にわたっていたため悪性を疑い手術を施行した.組織学的には幽門腺領域に存在する分化型腺癌であった.随伴したIIb変はretrospectiveにも術前の診断は困難であった.

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Cancer of the common bile duct have been diagnosed for the most when jaundice appeared. Non-icteric patients with cancer of the common bile duct were uncommonly diagnosed before surgical operation. Two patients out of 40 cases with cancer of the common bile duct which werediagnosed by ERCP were non-icteric when they were diagnosed. Case 1 is 65 year old male, with elevation of Transaminase and Alkaliphosphatase. ERCP was performed, revealing cancer of the common bile duct. At surgery tumor was removed. Histology revealed Adenocarcinoma. Case 2 is 44 year old male. He had complainted of epigastric pain. Intravenous cholangiography showed nonvisualization of the biliary tree. While liver function test showed quite normal. ERCP revealed cancer of the common bile duct with infilitration into the liver hilus. At surgery infiltration of cancerof the common bile duct into the liver was observed and tumor could not be removed. Biopsy specimens at exploratory laparotomy revealed Adenocarcinoma Tubulare Scirrhosum.

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