We have endoscopically studied 2, 013 gastric polyps in 1, 201 cases. Among them, 89 polyps in 52 cases have been followed-up endoscopically and histopathologically during 5 to 12 years, and the following results were obtained. 1) The incidence of gastric polyps has kept increasing each year, 2) The gastric polyps were encountered more frequently among the aged. 3) The gastric polyps were found more frequently in the greater curvature of the lower third of the stomach, in the posterior wall of the middle third, and in the anterior wall of the upper third. 4) In the 52 followed-up cases, the number of polyps changed in 20 (38.5%) cases; 16 of the 20 cases showed increase in number, 2 cases showed decrease and disappearance, and in 2 cases polyps were fallen-off. 5) Twenty-nine polyps (32.40) among the 89 changed morphologically; 6 lesions grew continually, 19 lesions became larger and then smaller and 2 lesions were fallen-off. 6) The speed of growth of the gastric polyps varied, but on an average, it took a long time relatively: it was 2 years and 8 months when a polyp changed from Yamada's type I to II, 4 years and 7 months from the type II to III and a year and 6 months from the type III to IV. 7) Histopathologically, 1, 882 polyps (93.5%) among the 2, 013 were hyperplastic polyps and 131 polyps (6.5%) were adenomas (ha-Subtype, dysplasia). 8) Among the 89 followed-up polyps, 3 lesions (3.40) revealed malignant change, 2 of which were diagnosed as adenomas and one of which was as hyperplastic polyp at the first biopsy examination.

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The gastric mucosal surface was observed using the magnifying fiberscope (FGS-ML, GIF-HM), and the fine gastric mucosal patterns, which were even smaller than one unit of gastric area, were examined at a magnification of about 30 times, for the purpose of the study of localized gastric lesion. For simplification of these patterns, we newly classified them in the following way; A, AB, B, BC, C, CD, and D. Type A has only dotted gas-tric pits, and B has broken-liner depressed parts. C has striped continuous grooves, while D has rounded mesh-like grooves. AB, BC and CD are mixed patterns of A and B, B and C, and C and D, respectively. Besides, we classified subtypes in the following way; Cl (regular), C2 (rough), C3 (irregular), D1 (regular), D2 (slight-irregular) and D3 (high-irregular). The gastric hyperplastic polyp showed type BC or CD. ATP showed type C3. The gastric protruded carcinoma showed type C3, however, the gastric depressed carcinoma showed D3. The gastric ulcer showed CD, Dl and D2 depending on the stage. The gastric ulcer which had difficulty in healing showed type D. Therefore, differential diagnosis of these benign lesions and malignant lesions can be diagnosed by this method. In our series, many cancers were of the high-irregular type (C3, D3), and were easily differentiated from benign lesions.

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The following endoscopic examination was performed to detect the relationship between aging and intestinal metaplasia or atrophic border in gastric mucosa. Endoscopic direct methylen blue staining method and endoscopic congo red test were performed at the same time to the patients with chronic gastritis who has otherwise no gastric lesions. Endoscopic congo red test was performed in 455 patients. And cardiac atrophic border was observed in 56 patients. Atrophic border tended to advance toward corpus not only from antrum, but also from cardia. Endoscopic direct methylen blue staining method was performed to 155 patients. Intestinal metaplasia was more frequently seen with aging and staining area of intesti-nal metaplasia also tended to spread with aging process. In antrum, flat type was seen most frequently. Most of depressed type were seen in younger generation on the contrary elevated type and combined type were seen in older generation. In corpus, flat type was seen mostly. The type of intestinal metaplasia around cardia was all flat type. The staining degree of intestinal metaplasia increased with aging at antrum and corpus. As atrophic border advanced to the corpus, intestinal metaplasia was more frequently observed and the staining area of intestinal metaplasia increased in size.

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Laser has been utilized for endoscopic therapy of the protruding lesions. Animal experiments were performed before applying it to clinical trials. The results obtained from animal experiments and the findings by clinical trials were reported. 1. The beam of YAG laser is able to enter a microscope lens system and be focused on the proximal end of a 80;cc diameter quartz fiber with the aid of a micropositioner. 2. The transmittance of this optical fiber is about 50% for YAG laser. 3. This waveguide protected by a thin flexible tef lon tube can be passed down the biopsy channel of any standard f iberoptic endoscopy. (GIF-P2, GIF-D3, GTF-B2, GF-B2) 4. The distance from the tip of the waveguide to the lesion can be varied without moving the endoscope because the waveguide can be inserted and withdrawn in the same way as a biopsy forceps during diagnostic endoscopy. 5. Directions for use of laser are the radiation method and the contact method. The depth of injury in the tissues induced by the contact methods is deeper than by the radiation mothods. 6. Endoscopic laser treatment was performed in 36 lesions without accidental complications. 7. While performing polypectomy the contact methods are utilized for coagulation of center of polyp and polyp root. 8. The postoperative ulceration has healed within three weeks. 9. The specimens removed by endoscopic laser photocoagulation cannot be withdrawn except for the pedunclated polyp. Therefore, while performing endoscopic laser polypectomy it is desirable to try to remove the polyp of Yamada and Fukutomi type I, II and IV.

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Correlations of the pancreatic duct image and the patholog calf indings were studied on the differeutal diaguois between pancreatic cancer and chronic pancreatitis. Eight cases of pancreatic cancer and chronic pancreatitis were examined six of which showed the constricted main pancreatic duct on image. The results are as f ollowr : Chronic pancreatitis which showed constricted pancreatic duct is relatively short in disease period. When monocentric change at the constricted part on the pancreatic duct image is found, pancreatic cancer shoud be considered first. The charactristics of the pan-creatic duct image with monocentric change are: (1) no remarkable change is recognized in pancereatic duct image at the papillary side of the constricted part; (2) no "hardness" is recog-nized on the image of the main pancreatic duct at the constricted part; and (3) transitional image which indicates multiple change is recognized in the image of pancreatic duct at the tail side of the constricted part.

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In 2, 878 gastric mass survey cases (over 40 year old male), abnormal duodenal bulb findings on photofluorographs were found in 8.2 per cent in total, including 4.9 per cent duodenal bulb deformity and 3.3 per cent deficient barium meal filling to bulb. Those cases were examined with panendoscope (GIF-P2) and duodenal ulcer or ulcer scar and duodenitis were found in 67.0 per cent of the deformed bulb cases and 36.6 per cent of the deficient barium filling cases. With these value the incidence of duodenal ulcer falls 4.2 per cent of total examinees. The incidence of multiple or linear duodenal ulcer of these endoscopically confirmed cases were 42.5 per cent of the ulcers found among subjects with deformed bulb and 15.4 per cent of the ulcers found subjects with deficient barium meal filling (p<0.025) and the incidence of duodenal ulcer scar of the two groups are 43.2 per cent and 69.2 per cent respectively (p<0.05) . The incidence of deformed pyloric ring confirmed endoscopically is 61.9 per cent in multiple or linear ulcer cases and 35.1 per cent in single ulcer cases (p<0.025) . These data suggest that the difference of the features of the duodenal ulcer between deformed duodenal bulb cases and deficient barium meal filling cases is due to mainly the difference of the function of the pylorus.

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Between May 24, 1958, and March 30, 1979, 2, 646 peritoneoscopic examinations had been performed. In 2, 639 cases of them, liver biopsies had been performed. During that period 15 accidents (0.57%) occurred, those were 1) disturbance in producing pneumoperitoneum and inserting of the trocar due to extensive peritoneal adhesions, 2) intraperitoneal hemorrhage, 3) paralytic ileus, 4) shock resulted from local anesthesia, and 5) hematemesis from esophageal varices after peritoneoscopy. All 5 cases of intraperitoneal hemorrhage resulted both from liver biopsy and puncture of the spleen were cured by conservative treatment. Two ileus after peritoneoscopy were caused by liver biopsy of obstructive jaundice and leakage of Mitomycin C which injected into the tumor for treatment of hepatoma. Patients with heart diseases, including heart failure, angina pectoris and old myocardial infarction were about 20%, but no serious complications were occurred during peritoneoscopy. In 2, 646 cases, no fatalities occurred.

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The authors measured disaccharidase (maltase, sucrase, lactase) activity of intestinal metaplasia, surrounding a gastric cancer, a gastric ulcer or a gastric polyp. Intestinal metaplasia at 1.5cm-2.0cm and 3.5cm-4.0cm distant from a focus was examined by gaschromatography, and immunohistochemical study of a-f etoprotein (AFP) labeled with FITC was also performed. 1) No difference of disaccharidase activities were shown in any part surrounding the gastric ulcer and gastric polyp. 2) As the distance from the focus was longer disaccharidase activities of intestinal metaplasia became higher, and those of intestinal metaplasia in the stomach without gastric cancer showed the highest values. 3) Immunohistochemical existence of AFP in gastric cancer was recognized in 20 of 41 cases (48.8%). 4) AFP was recognized in 66.7% of moderately differentiated adeno-carcinoma and 76% of signt ring cell carcinoma. While it was recognized in 37.5 % of poorly differentiated adeno-carcinoma and 33.3 % of well differentiated adeno-carcinoma. 5) Localization of APP was recognized at cytoplasm in poorly differentiated adeno-carcinoma and signet ring cell carcinoma. It was recognized at epithelium of gland and basal membrane in well differentiated adeno-carcinoma. 6) In the intestinal metaplasia surrounding a gastric cancer which contained APP, APP was recognized in 9 of 20 cases (45%). But APP not recognized in the metaplastic tissue surrounding a gastric cancer which had not APP.

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A 49-year-old female was admitted because of abdominal fullness, vomiting and low grade fever. Hypotonic duodenography disclosed a stenosis of the third portion of the duodenum. Endoscopy with JFB3 revealed a few erosions and white coats on the oral side of the ste-nosis, and biopsy specimens were classified into group-II. No tuberculous changes were found on the chest X-ray. At laparatomy, tumor like resistancy with enlarged regional lymph nodes was felt near the ligamentum of Treitz. Resected specimen showed an ulcer with a marginal ulcer scar and ulcerative lesions on the oral side. Histopathologically, Langhans' giants cells and caseating granulomas were found in the lamina propria of the mucosa, submucosa and the resected lymph nodes. With these findings this case was diagnosed as primary tuberculosis localized to the duodenum.

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Clinicopathological aspects of multiple early gastric cancers (M-group) were compared with those of single early gastric cancer (S-group). 1) Frequency of M-group was 2.1% of all gastrectmized cases with cancers (60 out of 2, 924 cases) between the period from 1968 to 1977 and that of S-group was 16.8% (492 out of 2, 924 cases). 2) Sex ratio (Male: Female) was 7.6: 1 in M-group and 3.2: 1 in S-group. Mean age was 61.1±9.7 in M-group and 58.3±17.5 (mean±SD) in S-group. 3) Macroscopical findings showed that the elevated or protruded lesions preponderated in M-group (66 out of 150 lesions, 44.0%) in contrast to S-group in which the depressed or excavated lesions were predominant (323 out of 492 cases, 65.7%). 4) The cancers were well differentiated adenocarcinoma in 113 out of 150 lesions (79.3 %) and poorly differentiated adenocarcinoma in 31 lesions (20.7%) in M-group, on the other hand in total 150 lesions of . S-group, they were in 96 lesions (64.0%) and 54 lesions (36.0%) respectively. 5) In total 79 lesions of M-group, the cancers developed in pyloric gland area in 66 lesions (83.60) and in intermediate zone in 13 lesions (15.40). No lesions located in f undic gland area. In total 106 lesions of S-group, they were 63 lesions (59.40), 36 lesions (34.0%), 7 lesions (6.6%) respectively. 6) In M-group, the border line between pylolic and f undic gland was observed on higher site of the stomach than S-group. 7) There was a tendency that the extent of the intestinal metaplasia was more widely distribution in M-group than in S-group. More close relationship to the atrophic gastritis was suggested in M-group than in S-group. It is emphasized that these characteristics of multiple early gastric cancers should be kept in mind on occasions of endoscopic examination,

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