The normal function of the gallbladder play a role of 'buffer', which make it difficult to visualize the intrahepatic bile ducts satisfactorily during EPCG. To demonstrate the intrahepatic bile ducts during EPCG, caerulein or CCK-PZ and morphine were injected, and the latter made sphincter of Oddi contract tightly and prevented the contrast medium from flowing back out of the orifice of the duodenal papilla. And they were called 'pharmacological EPCG'. Comparisons were made on three groups of the visualized intrahepatic bile ducts. The groups were: (1) 51 cases without any injection, (2) 14 cases with injection of caerulein or CCK-PZ and (3) 16 cases with injection of morphine. All cases had normal gallbladders and bile ducts. The best visualization of the intrahepatic bile ducts was obtained in group (3), the second-best visualization in group (2), the poorest visualization in group (1). Findings on the intrahepatic cholangiograms were investigated in 65 cases of liver diseases in which ducts beyond the fourth branches were demonstrated. Characteristic findings on the intrahepatic cholangiograms were present in some types of liver diseases. So, EPCG can be contributory to diagnose liver diseases when it demonstrates complete visualization of the intrahepatic bile ducts. Up to now, as for EPCG, the examiners have only paid attention to the morphological changes, but not to the functional changes of the biliary system. We considered that the examination of the function of the biliary system was important, too. Gallbladder contraction by ingestion of the egg yolk or injection of the caerulein was observed during EPCG. And it was called 'functional EPCG'. Even in the cases of hepatic failure or gallbladder diseases which showed nonvisualization of the gallbladder by oral cholecystography and intravenous cholangiography, the information of the function of the gallbladder could be obtained by this method because of direct approach. Furthermore, observations could be made on the change of the gallbladder neck and cystic duct more in detail by this method, in comparison to oral cholecystography and intravenous cholangiography. So, this method helps to diagnose and understand the mechanism of biliary dyskinesia well.

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Fifty-eight biopsied specimens from the part of intestinal metaplasia of the gastric mucosa were treated with alkaline phosphatase (ALP) and leucine aminopeptidase (LAP) staining methods. From the patlerns of the enzymological reaction, the intestinal metaplasia could be classified into following three types. Type 1: ALP activity (-), LAP activity (-) Type 2: ALP activity (-), LAP activity (+) Type 3: ALP activity (+), LAP activity (+) Then we studied the relation between endoscopic appearances and enzyme activity of the intestinal metaplasia. The fine surface structure of the metaplastic mucosa corresponding to biopsy were obserbed by the magnifying f ibergastroscopy (FGS-ML). These fine endoscopic patterns were classified into 5 types: FP, FIP, FSP, SP and MP, modified after Yoshii's classification. The ability of methylene blue absorption was also examined endoscopically. The fine surface appearance of the intestinal metaplasia corresponded to FSP, SP or MP. The relationship between degree of methylene blue absorption and fine endoscopic appearance was FSP<SP<MP, and degree of methylene blue absorption in the ALP positive intestinal metaplasia tissue was higher than the ALP negative intestinal metaplasia tissues. Tissue ALP-and LAP-activity in the intestinal metaplasia seemed to be in proportion to the degree of methylene blue absorption.

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This is a clinical and endoscopic study of gastric erosions. The varioliform erosion is occasionally classified into "disappearing" type (gastritis erosiva) and "continuous" type (gastritis verrucosa). However, it is difficult to distinguish these two types by only one endoscopic examination, and final dicision needs repeated observations for a long term. In this paper, it is proposed to classify gastric erosions into "varioliform", "punctiform in addition to the former classification and mixed" type. "Punctiform" is subdivided into "flecked" and "dotted" type. 1. Under repeated endoscopic observations, gastritis erosiva usually changed from varioliform to flecked type and further to dotted type, while gastritis verrucosa did not show any morphological change. 2. The subjective symptoms in varioliform were more manitest than those in punctiform. The onset of symptoms was most frequent in March, April and November. Gastric erosions were found most often among the fourth decades, and over 50% located in the antrum. 3. Gastric erosions and duodenal ulcer were frequently found together. 38.6% of all patients with duodenal ulcer also had gastric erosions. The duodenal ulcer was found in 54.1% of all patients with gastric erosions. As the duodenal ulcer improved, some of the coexistent gastric erosions also changed from varioliform to punctiform. On the other hand, in case that the duodenal ulcer deteriorated, the erosions changed to varioliform again. 4. A decrease of maximal acid output (MAO) was observed according to the change from varioliform to punctiform. This was not seen in the cases of duodenal ulcer without gastric erosions. This may suggest the close relationship between gastritis erosiva and the acidity of the gastric juice. 5. It was difficult to distinguish gastritis erosiva from gastritis verrucosa by biopsy. Also histological findings of gastritis erosiva was not characteristic of any stage, for an inflammatory cellular infiltration was the only and common finding. It is suggested that the appearance of gastric erosions is greatly related to the damage of the mucosal barrier as well as the acidity of the gastric juice.

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The authors measured disaccharidase (maltase, lactase) activity of gastric cancer (focus), intestinal metaplasia surrounding focus and intestinal metaplasia, 1.5cm-2.0cm distant from the focus, by gaschromatography and immunohistochemically studied by α-fetoprotein labeled with FITC. 1) Maltase and lactase activities showed no difference in part of early cancer and advanced cancer. 2) Maltase and lactase activities were higher in well differentiated cancer than poorly differentiated cancer. 3) As the distance from the focus was bigger, maltase and lactase activities become higher, and those of intestinal metaplasia in the stomach without gastric cancer showed the highest values. 4) Immunohistochemical localization of AFP in focus of poorly differentiated type was found in the cell membrane or cytoplasm. 5) We could find a positive APP or negative APP in intestinal metaplasia surrounding gastric cancer with AFP. 6) We could not find immunohistochemical localization of APP of intestinal metaplasis in the stomach without gastric cancer.

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Thirty four cases of pancreatolithiasis have been observed in a series of 3431 ERCP which was perfomed in our clinic during a period from December 1969 to September 1978. The clinical features and ERP findings were compared between alcoholic and non-alcoholic groups. Although age distribution in male demonstrated peak between 30-50 years of age, the stone were found in all age groups of female. Incidence in male was 7 times higher than that in female. The incidence of clinical symtoms, consisting of abdominal pain, low back pain and diarrhea, was slightly higher in alcoholic than in nonalcoholic group. Diabetes mellitus and hepatic dysfunction were more frequently assosiated with alcoholics than with non-alcoholics. As rare complications, two cases of idiopathic choledochus dilatation, which were not associated with alcoholabuse, and a case of annular pancreas showing alcoholic damage of pancreas, were observed. Pancreatic stone located mainly in the pancreatic ductal system and, in relatively localized cases, stones often presented in the distal portion of ductal stenosis. Although, the size of the stone in the alcoholic group was smaller than that of the non-alcoholics, there was no difference as to the relationship between ductal stenosis and stone size. Marked dysfunction of the exocrine pancreas was frequently detected in the cases having small and diffusely distributed pancreatic stone.

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A 50-year-old female had epigastric distress. Upper GI series and endoscopy revealed a polyp with stalk in the duodenal bulb. Endoscopic polypectomy was performed and the polyp was successfully removed without any accidental complications. The resected polyp was 27×20×16mm in dimension. Histologic study showed massive hyperplasia of Brunner gland beneath normal duodenal mucosa.

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In all diseases, the clinical stage inf luenses a difficulty in diagnosis. The same situation is observed in nonspecific colitis and a number of patients of ulcerative colitis are indis-tinguishable from Crohn's disease of the large bowel especially in relatively early stage. A patient was a 39-year-old man with chief complaints of diarrhea, fever and melena. At first colonofiberscopy showed an aphthoid ulcer on the sigmoidal mucosa and also from the histological findings of biopsy specimen the Crohn's disease was suspected. But the disease progressed to cover the entire colon after the lapse of a few months and ultimately this patient's colitis was diagnosed to be an ulcerative colitis. Meanwhile the symptoms improved dramtically by the use of choromycetin but no evidence of bacterial infection was found. It should be stressed that the differentiation of nonspecific colitis had to be made after comprehensive evaluation of the findings such as follows: 1) clinical manifestations, 2) radiological and endoscopic features, 3) histological findings of biopsy specimens, 4) clinical course.

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