In spite of the remarkable progress of endoscopy in diagnosing early gastric cancer, it is still a difficult problem to find minute or mucosal flat type (II b), and to determine strictly the extent or the depth of infiltration in gastric cancer. Expecting to get better information for these problems, the development of infrared gastro-camera technique was initiated. Olympus gastrocamera with f iberscope type S₂ (GTF-S₂) was employed, which has a small camera with a photoelectric cell and tungsten illumination at the tip of the scope. Kodak Ektachrome Infrared Film (Figure 1, 2, 3, Plate2) of 35 mm 20-exposure roll was cut to 4mm width 284mm length. The film was processed in Kodak Process E-4 chemicals in total darkness. The Kodak Wratten No 12 filter (Figure 4) was settled behind the photo lens. Several kinds of color compensating filters (Fig. 4, 5) over the bulb were tried. By critical selection of illumination balance with double CC 50 C-2 (Figure 5, 6), mucosal and deeper layers' vessel patterns were recorded photographically in yellow'-orange and dark blue res-pectively (Plate 8, 10, 11, 12), that can not be seen in visible light (Plate 7, 9). Intriguing speculation is obvious by observing abnormal vessel patterns in the infrared gas-trocamera, to make it anadditional aid to find minute or mucosal flat type, and to estimate the extent or the depth of infiltration in gastric cancer.

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Carrying out the endoscopic pancreatic parenchymography in 369 subjects, it could be con-firmed that this method gave much clearer parenchymogramms easily and successfully except in subjects with severe chronic pancreatitis than the conventional ERCP, because a surface active agent (surfactant) was mixed with the contrast medium. With our method using Ang-iograf in as a contrast medium, the roentgenographic pattern that the fine branches of the pan-creatic duct were described in the homogeneous parenchym, could be obtained most frequently. Thus, its usefulness for detecting a minute lesion was approved. There was no serious accident during the examination. Hyperamylasemia which may be observed after the ERCP, if any, fell into the normal levels promptly because of the surface active agent. From these results, the usefulness and safety of the endoscopic pancreatic parenchymography could be confirmed clinically.

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One of our recent interests in gastrointestinal endoscopy is how to diagnose minute lesions correctly. For this purpose, several new approaches such as dye-spraying method and close-up observation with the use of a magnifying endoscope have been attempted. We have previously reported that the endoscopical magnifying observation by using a mag-nifying colonoscope, type CF-MB-M, which is able to magnify the colonic mucosa about 10-25 times larger, is useful for the observation of minute mucosal changes and the early detection of colonic cancer. A newly developed magnifying colonoscope, type CF-HM, was deviced by Olympus Optical Co. Its close-up observation enables us to magnify the mucosa about thirty-five times larger than the usual colonoscope, so that minute pits, sized 40-50p in diameter, may be clearly in-spected. Working length of CF-HM is 1420mm, which is long enough to observe the ileocecal area. The tip-bending mechanism of the scope is strong enough in four directions. During the last five months, 120 examinations were performed in 85 cases by using this CF-HM. After the usual preparation for colonoscopy, the mucosa was observed in the same manner as in conventional colonoscopy. Then, in order to make the magnifying observation easier, 0.2-1.0 % methylene blue solution was sprayed directly on the mucosal surface through a tef lon tube passed through the biopsy channel of the scope. Helped by a zooming effect of the lens system, both an ordinary distant view and amagnif ied close-up view can be commanded with ease. Minute pits of the mucosal surface were visualized more clearly than in the observation by the conventional magnifying colonoscope, type CF-MB-M. This is more favorable to dis-tinguish the stage or severity of ulcerative colitis or to differentiate an early cancer from a benign adenoma. The usefulness of CF-HM was emphasized from the viewpoints as a pan-colonoscope to examine the whole parts of the colonic mucosa and the possible role of an excellent magnify-ing colonoscope at the same time.

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Considerable time has passed, since endoscopy was introduced for the routine examination of duodenal ulcer, and endoscopic follow-up cases have been accumulated. The authors studiedd the course of 246 duodenal ulcer cases observed by endoscopy (1031 examinations). Short course. A healing ratio of duodenal ulcer was 56% for the period of 4 weeks, 60% for 8 weeks and 67% for 12 weeks. A considerable number of ulcers healed before 4 weeks elapsea, but after that, an increase in healing ratio became slower. At any time point the healing ratio of single ulcer was highest and that of linear ulcer lowest. Long Course. A recurrence ratio was separately calculated for each observation period; 20% up to 1 year, 41% up to 2 years, 57% up to 3 years and 68% up to 4 years. The ratio was almost equal to that of gastric ulcer. It was lowest in single ulcer and highest in linear ulcer in all the periods. The site of recurrence was the same as or close to that of former ulcers in most cases. In cases of kissing ulcers recurrence usually occured in one of the ulcers. Nearly 50% of the ulcers unhealed during the observation period were linear ulcers. Ridge formation is one of the characteristic endoscopic findings in duodenal ulcer. This was not always persistent but fluctuating in 30%. Most of ridge formation were found in linear or kissing ulcers but it sometimes occurred in single ulcer. This seems to be caused not only by scar formation but also by functional abnormality. Ridge formation was a little more often in recurrent and unhealed groups than in healed and "remaining healed" groups, but this finding did not help much in estimating a prognosis of duodenal ulcer. Scattered erosions-so called "shimof uri"-were found in 17% of all cases, persistent ly seen in only 7 % of them and fluctuating in the others during the observation period. These were found in any types of ulcer, most frequently in linear ulcer and most often associated with an ulcer at healing stage. Ulcer improved in 48% endoscopically after scattered erosions appeared. A history of overt bleeding was found in 25.2 % in the present series. Forty per cent of them had more than 2 episodes. In 55% overt bleeding was the initial symptom of duodenal ulcer.

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Recently, the various type of pan-endoscope are made for several purposes. About pan-endos-cope which can observe from the esophagus to the bulbous portion, small caliber type seems to be sufficient. particularly for the routine examination and the 2nd screening examination of gastric mass-servey.In 100 cases that was required the 2nd screening of upper G-I tract in mass-servey, the endoscopy using the small caliber fiberscope FGI-X₁ (Machida) was done easily and less pain-fully as well as using the small caliber f iberscope GIF-P₂ (Olympus). As a conclusion, this FGI-X₁ type pan-endoscope was very sufficient for the 2nd screening of gastric mass-servey. Specifications of this f iberscope are as follows: forward field view, out diameter 9.5mm, angle of view field 75°, working length 1.045mm, bending angle up to 180° down to 90°, right and left 120°.

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The value of T-tube papillotomy is discussed. T-tube papillotomy is alternative method to the conventional endoscopic papillotomy in cases with T-tube drainage, if papillotome cannot be inserted into the common bile duct through the orifice of the papilla. It is easier to in-troduce papillotome into the common bile duct, the papilla of Vater and the duodenum via T-tube. The correct direction and the length of incision can be controled endoscopically. It is concluded that the described method will be useful when traditional endoscopic papil-lotomy fails.

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Multiple submucosal cysts of the stomach are relatively uncommon and are difficult to diag-nose without surgical intervention. Present paper reports a case of multiple submucosal cysts of the stomach in which preoperative diagnosis was affirmed with biopsied specimen taken from the submucosal lesion after an endoscopic electro-dissection of the overlying mucosa. The histology of the resected stomach later confirmed this preoperative diagnosis. Cyst-formation in the stomach is thought to be either congenital (enterogenous cysts) acquired. Judging from the histology, this case was considered to be of an acquired type The recurring chronic gastritis accompanied by mucosal destruction could have led to this cyst-formation during the process of mucosal repair. There were converging folds in the stomach. This rugal convergencies was, however, not associated with any histological evidence of ulcerative alteration in the mucosa. On the other hand, histology demonstrated a cyst opening to the gastric fovea. The shrinkage of such a cyst might result in this rugal convergency.

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A 58 years old female was admitted to our institute, complaining of general fatigue, nausea and vomiting. Upper GI series and endoscopy revealed a large pedunculated polyp (30×27mm) at the lower corpus of the stomach. Existence of malignancy could not be neglected completely. although all of the biopsy specimens were compatible to an benign adenomatous polyp and endoscopic polypectomy was performed. Bleeding was not recognized at the time of endoscopic polypectomy. During endoscopy which was done 5 days after the endoscopic polypectomy, a massive bleeding occured and urgent operation was performed. Resected specimen was his-tologically diagnosed as tubular adenocarcinoma, invading the sub mucosal layer and regional lymphatic vessels. From this experience, it is advised to pay attention to the possibility of bleeding on occasion of an endoscopy immediately after endoscopic polypectomy.

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