The main papilla of the duodenum was examined in 72 autopsied cases showing no remarkable changes in the biliary tract and pancreas. Attention was focused on the anato-my of the orifice and longitudinal fold. The length of an oral protrusion was defined as a distance between the upper end of the longitudinal fold and the orifice. The results were as follows: 1) The length of the inraduodenal portion of the common bile duct (IBD) was 12.2 mm, and it showed a positive correlation with the length, height and width of the oral pro-trusion, and a negative correlation with the angle between the common bile duct and the duodenum. 2) The resectable length without perforation of the duodenal mucosa was 10.4 mm, which was 2.6 mm longer than the length of the oral protrusion. 3) The narrow distal segment of the common bile duct was 13.7 mm in length, and 1.5 mm of its length was extraduodenal. 4) The length of an extraduodenal portion of the sphincter of the choledochus was 5.2 mm. 5) In 65% of the cases, the common bile duct and pancreatic duct opened together at the main papilla, and in the other cases they opened separately. 6) The main papilla was supplied by two large arteries, the artery (Artery 1) supply-ing the longitudinal fold, being larger. Artery 1 entered from the border of the proper mus-cle of the duodenum and common bile duct. 7) The resectable length without bleeding was 1.1 mm shorter than the IBD.

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In an attempt to produce a more accurate and direct way of dealing with atypical epi-thelial lesions, the authors removed such lesions endoscopically using a high frequency wave snare which had been confirmed as Group-III by biopsy. Perforation and serious bleeding were not encountered. Two of them proved to be cancerous. These flat-topped elevations less than 18 mm in diameter were removed safely and effectively without any residual of atypical epithelium. These lesions approximately 20 mm in diameter were also removed effectively on the basis of some histological evidence obtained from the retrieved specimens. The findings led us to analyze the snare wire method from the following viewpoints:1) Relationship between proliferative potential and degree of atypia, 2) rate of atypical epithelium to carcinoma transformation, 3) false negative in the diagnosis of Type ha early gastric carcinoma, 4) rate of sm invasion of Type ha early gastric carcinoma, smaller or larger 2 cm in diameter, 5) depth invasion of early elevated carcinoma and rate of lymphatic and hepatic metastases, 6) importance of immediate treatment of elevated early carcinoma in order to raise a 5 year survival rate. We have formulated a feasible policy for dealing directly, accurately, and practically with atypical epithelium: I. In cases less than 18 mm in diameter, SNARE WIRE METHOD should be aggres-sively applied. II. In cases approximately 20 mm in diameter, subsequent policy is determined depending on the distribution of atypia of the retrieved atypical epithelial lesions.1. When atypia is superficially present, no other steps would be required. 2. In case in which a retrieved specimen showed intraepithelial malignancy (m) a further approach should be chosen based on distribution of atypical epithelium.3. Cases in which sm cancer is suspected should require surgical intervention including lymphatic dessections.

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Suppression of gastrin-stimulated gastric acid secretion was observed by endoscopic cogo-red test with six mongrel dogs. Discoloration into bluish-black in the acid secreting area was observed not only with conventional endoscope but also with magnifying endoscope and dinamically with cinecamera. All dogs had at least two tests: the first test was done following tetagastrin administration alone (4 μg/kg i. m.), the second test was done follow-ing combinated administration of tetragastrin and cimetiding (6 mg/kg i. v.), H2-receptor antagonist. Four dogs had the third test in which proglumide (120 mg/kg i. v.), antigastr-inic, was given as an inhibitor of acid secretion. Three dogs had the fourth test in which secretin (6U/kg) was given as an inhibitor. All tests were performed under pentobarbital anesthesia. Cimetidine administration remarkably reduced the secreting area, weakened bluish-black color and delayed appearance of the color. Proglumide and secretin also supressed the dis-coloration though not so remarkable as with cimetidine. The degree of the supression var-ied according to the ; position in the secreting area regardless of the sort of inhibitor. Through magnifying endoscope the colored pits were regularly distributed when gastrin alone was given, but they were irregular when cimetidine was added. The results suggested that the receptor-site of gastrin is blocked when the receptor-site of histamine is blocked by H2-receptor antagonist and that the distribution a/o sensitivity of parietal cells are not always equal in the acid secreting mucosa of the stomach.

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It was studied that the histological changes of the canine gastric mucosa with Nd-YAG laser application, comparing to those with electrocautery. The effects of electrocautery to the canine stomach were examined endoscopically under the coagulating wave and the cutting wave within 1.0 seconds from low power at level 3 to high power at level 7 in PSD (Olympus). The Nd-YAG laser (Medilas) was fired from 30 W to 70 W with exposure durations of 1.0 to 4.0 seconds. Gastrotomy was performed in order to standarize the distance between the mucosal surface and the tip of the wave guide. Histological findings were examined with Hematoxylin-eosin (H&E) stained, Azan stained and Elastica Van Gieson stained (E. V. G.). The mucosal changes with the electrocautery were a epithelial desquamation limited to the point of the cautery. As the cautery of the power at the level 5 lower than the power at the level 7 made a deeper ulceration or penetration to serosa, so the histological change under the submucosal layer was not propotional to the cauterizing power. The clinical use of electrocautery should be limited within the middle power of the level 5 in PSD. Histological changes of Nd YAG laser emission revealed diffuse degeneration of collagen fiber and the narrowing or obstruction of the vessles in the submucosal layer. It seemed to suggest that the degeneration of collagen fibers with the narrowing of the vessels by Nd YAG laser irradiation decreased the blood flow in the exposure area. Although in some instances the submucosal degeneration of the electrocautery was found to be same as the histological changes obtained by Nd-YAG laser it was difficult to control for the condition of electrocautery.

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One hundred eighty-three gastric protruded borderline atypical epithelial lesions in 170 cases were studied endoscopically and histopathologically. Furthermore, 82 lesions in 71 cases among them have been followed-up endoscopically and histopathologically during 6 months to 12 years with a mean interval of 6 months. The following results were obtained. 1) The gastric borderline aytpical epithelial lesions were found more frequently in the aged among gastroscopic examined patients: 0.1% in 3rd decade and 3.7% in 9th decade. The incidence of coexistent gastric cancers among the patients with these lesions was high-est in the 8th decade and was found more frequently in male patients with the ratio of 12 : 1. 2) Eight (9.80) of the 82 followed-up lesions showed changes in size, 4 (4.90) of which showed decrease in size and the other 4 (4.9%) increase in size.3) Twenty-one (25.6%) of the 82 lesions showed histological changes; 4 of 21 lesions (4.90) turned from group III to intestinal metaplasia, 8 lesions (9.8%) showed histolo-gical changes in cellular and glandular structures (from group III to IV, or viceversa), and 9 lesions (10.8%) were found to show malignant changes in follow-up study. 4) In relation between macroscopic changes and histological alterations, the more had the lesions increased in the histological atypism, the more were the lesions enlarged, and viceversa. However, there were 4 lesions (4.9%) which showed histological changes with-out alterations in size. 5) Cases which have a tendency to increase histological atypism as well as cases which show the gradual increase in size, are recommended to be subjected to polypectomy, piece-meal polypectomy, hot biopsy or surgical operation for more precise diagnostic accuracy and therapeutic purpose.

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In order to clarify endoscopic features of small intestinal disorders, the jejunal mucosa of 52 patients with various diseases was assessed by a push way method with a small intes-tinal endoscope (Olympus, SIF-B) and the results were as follows: 1) A successful insertion rate of the endoscope into the jejunum distal to Treitz's lig-ament was 93%. 2) Ten of 52 patients had a macroscopic lesion in the small intestine, that is, a case of jejunal reticulum cell sarcoma, a case of undifferentiated jejunal sarcoma, a case of smooth muscle cell sarcoma on the third and fourth portions of the duodenum, three cases of intestinal polyps, three cases of jejunal lymphoid hyperplasia and a case of a-chain dis-ease. 3) Scattered white spots and white villi were found in $ patients with protein-losing gastroenteropathy. A patient with alcoholic hepatitis, a patient with acute enteritis and a patient with short bowel syndrome had white villi on the jejunal mucosa. A patient with rheumatoid arthritis with diarrhea and a patient with IgG monoclonal gammanopathy had scattered white spots. 4) Erosions, redness, edema, and hypersecretion were observed on the jejunal mucosa of patients with cholera.

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We have attempted to perform the Endoscopic Retrograde Pancreato parenchymography (ERPP) in 85 cases. In these cases, the contrast medium was the Sodium Iothalamate mixed with Menatetrenone. And we compaired these 85 cases with 80 cases of usual FRCP. As a result, parenchymogram (good and fair) was obtained in 32 cases (38%) on ERPP and in 17 cases (12%) on usual ERCP. The ERPP was obviously superior to the usual ERCP in the visualization of the pancreatic parenchyma. But, we could not obtain the higher rate of visualization of the pancreatic parenchyma as in the reports of Yoshimoto et al. or Akasaka et al.. On the other hand, we studied the diagnostic ability of the parenchymogram about 49 cases with parenchymogram on ERPP and usual ERCP. We considered that we could not easily differentiated the malignant pancreatic diseases, such as pancreatic carcinoma or pancreatic cyst adenocarcinoma, from the benign pancreatic diseases, such as chronic pan-creatitis or agenesis of the dorsal pancreas, by the ERPP alone. And we found that we could not easily discriminate the large malignant tumor of the retroperitoneum from the pancreatic carcinoma though we performed the ERPP. We concluded that we should perform parenchymography and so called ‘branchgraphy’ at the same time in the diagnosis of the pancreatic diease, especially for the small pancreatic carcinoma.

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Although a recent colonoscope has been improved, patients still suffer from much discomfort during the examination. For lessening patients' discomfort, several improvements of the scope has been designed. During the last 5 months, 120 cases were examined by means of three types of colonoscope, CF-H, CF-M and CF-S (CF-H; devised to have a hard insertion tube, CF-M; semi-hard tube, CF-S; soft tube). A successful insertion rate with CF-H and CF-M into the ileocecal area was 100% and 98% with CF-S. The mean time to insert into the ileocecal area with CF-H was 12.6 minutes, 11.7 minutes with CF-M, and 14.6 minutes with CF-S. However, the mean time to insert from the splenic flexure to the ileocecal area with CF-H was much more shorte-ned than with CF-M and CF-S. Discomfort of the patients during colonoscopy with CF-M were much lessened than the examination with CF-H and CF-S. Therefore, CF-M is better for the insertion to the splenic flexure and CF-H is better for the insertion from the splenic flexure to the ileocecal area. It is emphasized that as a desirable colonoscope, the stiffness of the tube is changeable during the examination.

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A 60-year-old woman was admitted because of heartburn and dysphagia. Upper gas-trointestinal X-ray examination revealed a stenotic lesion with a small ulcer in the lower esophagus. However, gastroesophageal reflux and a hiatal hernia were not observed. Esoph-agoscopy revealed a strieture 30cm from the incisors. Proximal to the stricture, a depressed area with a small round ulcer was found. The lower part of the stricture showed exten-sive esophagitis. Columnar epithelia with Goblet's cells and villous pattern were found on the biopsy specimens taken from the depressed area. There was no finding suggesting malignancy. With the diagnosis of Barrett's ulcer the patient was treated with an anticholinergic drug. However, the ulcer had not improved. Then she was started therapy with cimetidine, 800mg per day, which led to improvement of complaints, healing of ulcer and disappearance of columnar epithelium from the depressed area. When treatment with cimetidine was stopped, esophageal ulcer was again seen. These results suggested that Barrett's ulcer might be an acquired condition, and cimetidine therapy would be useful for the treatment of this disease.

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Two cases of infection with Strongyloides stercoralis were experienced. There are many reports of the several lesions produced by infection with Strongyloides stercoralis. Although infection with the parasite is usually mild, sometimes it can be severe or fatal. For the patients who complaint of diarrhea, abdominal discomfort, general fatigue, weight loss and others, the following should be noticed; the inspection of the feces and the changes of the gastrointestinaltract by roentgenological examination. When abnormality of the duodenum are seen in these cases, one should try the fiber-scopic examination and biopsy edematous and reddness mucosa with dirty mucus. In our cases, the clinical courses and histological changes of duodenal mucosa before and after the therapy had been followed by endoscopy. Especially Strongyloides stercoralis and its egg were identified in the biopsied specimen in one of the cases. For the diagnosis of Strongyloides stercoralis infection, it will be necessary, not only to pay attension to the duodenal changes in the cases mentioned above, but also to repeat biopsy through duodenofiberscope.

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A case of Dubin-Johnson syndrome (D-Js) showing remarkable liver fibrosis was reported. The patient was 46 year old male with moderate hyperbilirubinemia and slight liver dysfunction. HBsAg, antiHBs and antiHBc were negative. BSP clearance showed moderate retardation and secondary rise, but ICG clearance was normal. In laparoscopic examination, the liver surface showed slight irregularity and decoloriza-tion to dark gray. Histology of the liver specimen showed remarkable fibrosis, chronic inflammatory cell infiltration, piecemeal necrosis and disappeared D-Js pigments particularly at the periportal area. From these findings, this D-Js case seems to be accompanied with non-B chronic active hepatitis.

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The pancreatogram of 2 cases of pancreatic cystadenoma and 2 cases of pancreatic cystadenocarcinoma, were studied. The pancreatogram of these diseases showed local stenosis or obstruction of the main pancreatic duct, so, it was difficult to distinguish these diseases from pancreatic carcinoma. When the main pancreatic duct showed cystic dilatation, it was difficult to distinguish from pancreatic cyst.

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