A pre-operative accurate estimation of a proximal border of the infiltration from an esoph-ageal carcinoma is essential for the decision of the range of resection and the field to be irradiated. The autor studied esophagoscopically the mode of infiltration of an esophageal carcinoma to the oral side and classified the findings into a small elevation, a fold-like elevation, an erosion and flat changes which includes all the other superficial changes. These esophagoscopic findings were histologically evaluated and clarified their nature. Many supplementary studies were made for the purspose of detecting submucosal malignant infiltration, by means of a dye sprinkling method, a magnified esophagoscope with 25 times magnification (FES-ML), a thorny needle biopsy and a cytologic examination. Sprinkling of a blue dye was useful in the fine observation of a reddening or a small elevation by giving a contrast, and it also made the margin of erosions clearer by staining the white fur. A sprinkling of Lugol's solution resulted in an easier identification of the intra-epithelial infiltration. A magnified esophagoscopic observation was effective for the diagnosis of an exposed cancer or a subepithelial malignant infiltraion by detecting the disappearance of normal capillary network. It was also effective for the differential diagnosis of benign or malignant erosions and small elevations. A thorny needle biopsy was effective for the diagnosis of subepithelial infiltration for reasons of accuracy of aiming and enough amount of collected cells. When a proximal border of the malignant infiltration was estimated by using those methods, radio-opaque clips were placed to show it, for the purpose of helping a surgical intervention or irradiation.

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Although endoscopic retrograde cholangiopancreptography (ERCP) has been widely accepted in the diagnosis of pancreatic and biliary tract diseases, complications associated with ERCP have been reported occasionally. The complications are categorized in terms of those attributed to instrumentation and those caused by injection of a radioopaque contrast material into the biliary tree or pancreas. Among them, biliary tract infection is most dangerous. To prevent biliary tract infection after ERCP, complete sterilization is required. The outside and biopsy channel of duodenoscope should be washed repeatedly with soap solution, 70% alcohol, 2% glutaraldehyde and water in this order. A manometer for monitoring injection pressure and cannula are sterilized with ethylene oxide (Table 1). The authors recommend not only routine administration of antibiotics or chemotherapeutics, but also the use of these agents mixed into the injectate. In the last 9 years, 1477 ERCPs were performed at our institution. Of 1477 cases, ERCP and ERC alone were achieved in 657 cases. Biliary tract infection following ERCP was observed in 7 (1.1%) of the 657 cases. No serious complications have been encountered. Biliary tract infection was complicated with ERCP in 2.2% of the initial 185 procedures without use of a chemotherapeutics (thiamphenicol) mixed into the injectate but in 0.6% of the subsequent 472 procedures in which this was applied. Patients with bile duct obstruction demonstrated by ERCP (Fig. 3) should be treated surgically for decompression, to avoid subsequent infection. In patients with obstructive jaundice, ERCP should be performed after having improved jaundice by an external biliary drainage (Fig. 4).

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A comparative study between histological findings of the liver biopsy under direct vision and peritoneoscopic findings of the liver surface by a magnifying laparoscope was performed in 30 intrahepatic cholestatic patients with clinical jaundice. The results were as follows : I) A peritoneoscopic sign of cholestasis was the green spot on the liver surface. The green spots were observed by a magnifying laparoscope in patients with the total serum bilirubin of over 3mg/dl. II) The color density and size of the green spots observed by a magnifying laparoscope are well correlated to the size and range of intralobular distribution of bile plugs on the histology. III) Cholestasis of a slight degree could be detected as brown-reddish green spots by a magnifying laparoscope. The brown-reddish green spots corresponded microscopically to the deposits of bile pigments, but not to bile plugs. IV) In spite of the difference in causes, the peritoneoscopic findings of cholestasis were almost the same. In acute hepatitis B, however, the green spots were somewhat turbid, which might be due to the inflammatory thickening of the liver capsule. V) From these results, it may be concluded that the peritoneoscopic analysis of cholestasis by a magnifying laparoscope will correlate well with the histological analysis by a microscope.

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In order to observe minute changes of liver surface, a highly magnifying peritoneoscope (Fig. 1, 2, Table 1), whose magnifying power was 100 times, was newly devised and studied about its usefulness in normal and cirrhotic rat liver. On the surface of normal rat liver, this highly magnifying peritoneoscope clearly revealed the status of terminal portal veins (Fig. 4) as well as the sinusoids and liver cell-plates arranged in a radiating fashion (Fig. 5). On the other hand, on the surface of cirrhotic rat liver, more numerous portal veins were seen and most of them appeared to be narrowed (Fig. 19), interrupted (Fig. 14) or stretched (Fig.15). Furthermore, normal arrangement of the liver cell-plate was lost and thickening of cell-plates (Fig.20) were diffusely seen. The number of sinusoids extremely decreased. The experiences mentioned above may signify that this highly magnifying peritoneo-scope may well demonstrate minute changes in various liver diseases.

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Radiological and endoscopic examination for upper gastrointestinal and colon diseases has become routine according to recent advances in radiography and fiberoptic instrumen-tation. However, a current preoperative diagnosis of the small intestine remains difficult because of limitations of the usual endoscopic method. Up to date, small intestinal endoscopy has been developed along three main lines; (1) a push-type fiberscope, (2) a rope-way-type fiberscope and (3) a sonde-type fiberscope. In our clinic, the sonde-type endoscope (SSIF, Olympus) which resembles a Miller-Abbott or Cantor tube was applied to 73 patients during the last six years. According to our devices in instrumentation of SSIF, a recent insertion rate into the distal part of the small intestine has been becoming much better and various small intestinal lesions could be diagnosed endoscopically. Although SSIF had neither a biopsy channel nor an angulation mechanism, it could be inserted into the distal part of the small intestine in a short time without any hazard. Moreover, narrow or stenotic lesions which would interfere with passage of the push-type scope or the transintestinal string, were amenable to examination by SSIF. A disadvantage of SSIF is lack of a biopsy channel. However, one of out recent ideas on SSIF enables us to devise an aspiration apparatus for obtaining intestinal fluid. Testing the intestinal fluid for occult blood helped to localize sources of bleeding and was also valuable for bacterial and immunological studies. Therefore, with further improvement of SSIF and the insertion technique, we will be able not only to inspect all parts of the small intestinal mucosa and to diagnose lesions more easily, but also to approach to the patho-physiological aspect of the small intestine.

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Getting the world modernized, becoming the life style much complicated. This may be reason why functional colonic diseases have increased in incidence. The colonic motor function of man is still unclear paticularly, at the portions includ-ing ceacum, ascending colon and transverse colon. We tried entire colon manometric stu-dies using a 2 channel colonoscope and large diameter sliding tube. Intraluminal pressure of the colon was messured be an open-tipped method with water perfusion. At the same time colon motility was also messured at many portions of the proximal colon. Some problems were pointed out through this trial, because mechanical stimulation to the colon by insertion of the endoscope and premedication gave influence to this studies.

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A case of lymphangioma of the stomach, which developed at the angular region, is reported. In addition, 27 cases of the disease are reviewed on the basis of the literatures as reported in Japan. A special mention is made of the problem as to whether or not the lymphangioma in question could possibly be diagnosed preoperativelly as cyst of the stomach. Results obtained are as follows : Age incidence of the disease was 51 years of age on the average. As for the sex incidence, males had a higher incidence than females, male to female ratio being 17 to 10. Among chief complaints, undefinite complaints of the upper abdomen was found most, being in 10 cases (37%) followed by 4 cases of no complaints. Of preoperative diagnosis, submucosal tumor was in 11 cases (55%) and cyst of the stomach in 4 cases (18.2%). Judging from the findings of the gastrointestinal series and/or gastric endoscopy as seems to be justified to assume that (1) changes of the shape of gastric submucosal tumors should not only be more carefully pursued roentgenologically, but also (2) confirmed endo-scopically, and (3) the presence of fluctuation of the tumor should also be detected endo-scopically for the exact preoperative diagnosis of cyst of the stomach, although still difficult in daily clinical activity for one reason or another.

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A 41 year old man was admitted to our hospital complaining of severe abdominal fullness and vomiting on September 28, 1977. Examination of the blood disclosed 11, 000 white blood cells with 14% eosinophils. The upper gastrointestinal series revealed irregular and broadend mucosal folds in the antrum. Although edematous and spottedly reddend mucosa was observed in the superior portin and second portion of the duodenum endo-scopically, the infiltration of the eosinophils was not seen in the biopsy specimens performed simmultaneously. On October patient developed ileus, and the laparotomy was performed. There were many eosinophils in the ascites and the infiltration of the plasmacells and eosinophils in the lymphnodes of the mesenterium. The patient recovered rapidly by the administration of predonisolone and has been in good health in a following year. Eosinophilic gastroenteritis is comparatively rare and usually diagnosed by the eosino-philic leucocytosis in the peripheral blood and the infiltration of the eosinophils in the wall of the gastrointestinal tract, But in the case, in which the eosinophils are infiltrated only in the deeper portion of the wall of the gastrointestinal tract, accurate diagnosis is difficlt. Consequently, this rare disease should be kept in mind on the occasion of the diagnosis of the unknown abdominal disorders.

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Internal biliary fistula occurs considerably rarely, In this paper, a case of cholecysto-colic fistula diagnosed by the colonofibeiberscope was reported. A 60-year-old male, was admitted with complaints of diarrhea and emaciation. A plain abdominal film showed pneumohilia, and duodenofiberscopic findings revealed redness and erosion in the area of the papilla of vater. Barium enema showed abnormal flow through an fistula on the hepatic flexure. Pan-creozymin-secretin test showed lack of bile and 1-factor was disturbed. A cholecystocolic fistul associated with cirrhosis of the liver and carcinoma of the pa-pilla of Vater was confirmed at operation.

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