Upper gastrointestinal mass-survey with the small calibered foreward-viewing fiberscope designated as Olympus GIF-P2 was performed among the employees of the companies as the second step of the screening in 1978 and 1979. Total number of photof luorographic screening during the two years was 3, 457 cases, and 648 cases (18.7%) were checked in detail. Panendoscopies were performed in 449 cases (13.0%) . They included 3 cases0.7% of gastric carcinoma, 20 4.5% of gastric ulcer, 23 5.4% of duodenal ulcer, 4 0.9% of gastroduodenal ulcers, 4 (0.9%) of gastric polyp and 138 (31.0%) of other benign lesions including gastric erosion. On the other hand, gastric mass-survey was performed to 3, 548 employees of the same companies in 1976 and 1977 by photofluorography, and 621 cases 17.5% were checked in detail. Endoscopic examinations with lateral-viewing gastrocamera designated as Olympus GT-PA2 were performed in 372 (10.5%), and they included 2 cases of early gastric carcinoma, 19 gastric ulcer, 2 gastroduodenal ulcers, 3 gastric polyp and other benign lesions. Active or healed duodenal ulcers were found endoscopically in 38 (42%) of 90 cases with bulbar deformity on the photofluorogram in 1978 and 1979. In 25 cases with incompetely visualized bulb, only one (4%) showed a healed duodenal ulcer, and for the rest no active duodenal ulcer was found. In some cases with normal bulbar findings on the photof luorogram, active and healed duodenal ulcers could be found endoscopically. And, in res-pect to the cases with bulbar lesions endoscopically, they could be diagnosed more precisely, for instance as for ulcer stage, active or healed. On the other hand, gastric erosions were noted in 68% of the total cases with incompletely visualized bulb, and the rate was higher than that of bulbar deformity. Furthermore, we reconfirmed that the most important point for getting discernible film was the technical mastering of the instrument. The conclusions of this upper gastrointestinal mass-survey with panendoscope were as follows: 1) We can diagnose correctly the duodenal lesions on the spot, and give a suita-ble therapy or a profitable advice to the patients after the examination. 2) The incidence of gastric carcinoma and active gastric ulcer, which should be treated immediately, found with panendoscopy was not significantly different from that found with lateral-viewing gastrocamera. 3) Among the cases with incompletely visualized bulb on the photof luorogram, there were many cases with gastric erosions and only a few cases with active duodenal ulcer.

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Questionnaires inquiring the complications of gastrointestinal endoscopy from January 1978 to December 1979 were sent to 92 hospitals in Yamaguchi Prefecture and the answer was obtained in 78.2%(72 hospitals). Reported gastrointestinal endoscopic examinations were 51, 307 cases in total and they included upper gastrointestinal examination (47, 129 cases), colonoscopy (2, 358 cases), romanoscopy(1, 820 cases), endoscopic biopsy (9, 733 cases) and endoscopic polypectomy (199 cases). The overall rate of complications was 0.07%(36 cases) and mortality was 0%. Complications included hemorrhage (11 cases), laceration (9 cases), perforation (6 cases) and the others (10 cases). We made a comparative study between the preceding survey (1978, Yamaguchi Prefecture) and the last survey (1980, Yamaguchi Prefecture). The analysis indicated that hemorrhage was the most frequent complication in these surveys but the laceration rate in the last survey (1980) demonstrated us that this complication was higher than our anterior study (1978). Some of the reasons, the extensive use of endoscopic polypectomy and the become of fiber optic instruments in place of rigid instruments, another is the expansion of forward viewing fiberscopes, and easier detection of laceration in esophagogastric junction with carefull observation.

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Pure pancreatic juice was collected from 15 normal subjects, 29 patients with chronic pancreatitis (13 with minimal pancreatitis; MIP, 11 with moderate pancreatitis; MOP and 5 with advanced pancreatitis; ADP diagnosed by ERCP) and 21 patients with cancer of the pancreas (7 with cancer of the head of the pancreas and 14 with cancer of the body and/or the tail of the pancreas) by cannulation of Wirsung's duct under duodenoscopy. Samples were collected at 10 minutes interval for 30 minutes after secretin stimulation (Eisai, 1 u/kg). The volume, total protein concentration, amylase concentration and output, sodium, potassium, chloride and bicarbonate concentration in each sample and total volume, total amylase output and the maximal bicarbonate concentration for 30 minutes were measured. We concluded tentatively that (1) volume responses in each sample and total volume for 30 minutes were significantly decreased in ADP and cancer of the head of the pancreas (Tables 2 and 10), (2) maximal bicarbonate concentration showed a tendency to decrease in ADP (Table 10), (3) amylase concentration and output were elevated in MIP (Tables 4, 5 and 10). The results of these investigations suggest that hyperconcentration is a characteristic feature of the pancreatic secretion in minimal pathology, and volume, bicarbonate and probably enzyme secretion are reduced corresponding to the more advanced pathologies with fibrosis, atrophy and calcification.

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Diagnostic accuracy of ERCP, CT and US was studied in 50 cases of liver, biliary tract and pancreatic diseases. Furthermore, capabilities and limits of combined diagnosis of three examination methods was assessed. The incidence of diagnostic accuracy in combination of three methods of examination was 92% in 50 cases of liver, biliary tract and pancreatic diseases. Of 24 cases with liver and biliary tract diseases, 16 cases (67%) were capable to be diagnoned by ERCP, combined with CT diagnostic accuracy increased to 21 cases (88%). Moreover, the accuracy increased to 22 cases (92%) by adding US. In 26 cases of pancreatic diseases, the incidence of diagnostic accuracy of ERCP was 22 cases (85%), however it increased only by 7 % adding CT and US. This increased incidence was lower than that (25%) of liver and biliary tract diseases. The diagnostic capacity of CT (15%) and US (15%) especially for chronic pancreatitis was low. In cases of malignant tumors of the liver, biliary tract and pancreas, diagnosis was possible in almost 100% using the three combined methods. However all these tumors were advanced. A reliable new method is to be developed especially for early detection of tumors in near future.

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Magnifying fiber-colonoscopy reveals a pit pattern abnormality of colonic polypoid lesions through magnified obsergation. Even those mucosae that seem completely normal under ordinary observation sometimes turn into minute pit pattern abnormalities through magnified observation, and are consequently diagnosed through biopsy as adenoma or hyperplasia. However, biopsy of these minute abnormal pit patterns does not always permit an infallible histological diagnosis. If we could classify a series of pit pattern abnormalities in accordance with histological diagnosis, based on the findings available through the magnified observation, we might contribute enormously to the knowledge of a life history of the minute adenoma as well as its relation to colonic carcinoma. In order to obtain its histo-pathological verification, we made a comparative study of two groups by means of dissecting microscopy which enabled us a magnified observation of fixed materials of the colonic mucosa. The material in the control group was provided from 38 cases of administrative autopsy, and the investigated group was provided by 24 cases of the resected specimen of colonic carcinoma. A magnified observation by dissecting microscopy of the material, revealed a similar pit pattern abnormality as observed in vivo. We used these findings as a standard for further succesf ul exploration for minute ade-noma of less than lmm, or hyperplasia.Results: In the control group, we found 17 adenomas and 107 hyperplasias, while in the investi-gated group we found 32 adenomas and 36 hyperplasias. When the size of the polypoid lesion is over lmm, the incidence of adenoma increases in the inverse proportion to the hyperplasia. The incidence of adenoma in the control group was 34.2 per cent (13 cases out of 38 in total) and 45.8 per cent (11 cases out of 24 in total) in the carcinoma group.-4 Adenomas of less than lmm were detected in the control group (3 of the rectum and 1 of the sigmoid colon), while in the other group, 7 adenomas were found throughout the entire colon. Concerning the severity of atypia in the control group 94.1 per cent consisted of slight atypia, while the other showed 46.9 per cent of moderate to severe atypia. Ten adenomas less than 1mm in both groups cosisted of 8 with slight atypic and 2 with moderate atypia.

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As one of the factors in abdominal pain of the irritable colon sydrome, our attention was directed to the storage of feces. For the purpose of investigating the relationship between abdominal pain of the irritable colon sydrome and the storage of faces, the following method was divised : a balloon was positioned at the sigmoid-descending colon and was inflated. Then, the change of the colonic motility was measured at various portions of proxymal colon. By this method the storage of feces in the sigmoid-descending colon simulating the motility of the colon was recorded.

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Colonscopy has been widely utilized for diagnostic and therapeutic purposes in adults with cob-rectal disorders. In contrast, experiences with this procedure in the infants and children has been limited. One of the reasons was a lack of the colonoscopes which were suitable to the infants and children. Ordinary colonoscopes for the adults were neither suitable nor safe to children, and there has been a need for proper instruments in pediatric colonoscopy. Recently, two types of small caliber colonoscope, type CF -P and CF-11 (Olym-pus), have been developed. For the last 18 months, 24 infants or children under the age 15 were examined using small caliber colonoscopes in our clinic. Some of them had a repeat examination, making a total number of examination to be 53. General anesthesia was required in 1-10 year-old children for the total colonoscopy or endoscopic polypectomy. A colonoscope was introduced successfully to the site needed in all cases and 20 polyps were safely excised endoscopically. Therefore, colonoscopy in infants and children can be accomplished with safety and ease with the small caliber colonoscopes and the technical achievements in adult colono scopy

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A magnifying view of microvessels of the rectal mucosa by a recto-sigmoid scope (SIG-SL-AX, Machida, × 10) was, with help of coventional observation, useful not only to determine the stage of ulcerative colitis but also to differentiate it from similar diseases. In normal, a honeycomb pattern of microvessels consisting of circular pattern of microvessels around Lieberki hn glands was observed. While it was difficult to observe a honeycomb pattern of vessels in an active stage of ulcerative colitis, repairments of honeycomb pattern were seen in an inactive (=intermediate) stage. A circular pattern of microvessels in an inactive stage was, however, irregular. In a remission stage, improvement of regularity of microvessels was prominent, and almost normal honeycomb pattern was observed. A magnifying view was helpful to determine especially an inactive stage of this disease. In cases similar to ulcerative colitis, such as atypical ulcer and nonspecific erosion of the rectum, the vascular pattern was not considered to fit to any stage of ulcerative colitis. Since a detailed observation with this endoscope is easy and simple, this type of scope seems useful for a routine examination of the rectum.

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Twelve cases of transient ischemic colitis were studied from clinical point of view. (1) The average age was 51.1 years old, ranging in age from 28 to 73 years old, with the majority in the 4 to 5 decades. No sex predominance was noticed. (2) Any preceeding factor was not found as etiology of this disease. (3) The sigmoid colon or the transverse colon were mostly involved, on the other hand, the splenic flexure, the most frequent part in the literature, was less involved. (4) Sudden onset of abdominal pain, diarrhea and bloody stool were noted as main symptoms, and these symptoms were relieved within 3 to 4 days in many cases without particular treatment. (5) Radiological examination showed "thumb-printing" in many cases and longitudinal linear ulcer was thought to be characteristic endoscopic findings. (6) From anlysis of our cases and literatures, it was suggested that the spasmus of minute vessels played important role for occurrence of this disease.

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Case 1; a 69-year-old female was admitted with aplastic anemia and hemosiderosis. She received iv drip infusions of 15g/day of Carbenicillin (CB-PC) and 3g/day of Cephazolin (CEZ) for seven days because of septicemia. Twelve days after the iv drip she developed abdominal pain with watery diarrhea. Colonoscopy showed small yellowish white plaque-like elevations in the descending and rectosigmoid portions. These lesions were concentrated in the rectum area and anal site while the intervening mucosa appeared normal. Barium enema revealed numerous small sessile polypoid lesions in the transverse, descending and rectosigmoid colon. Case 2; a 14-year-old female was admitted with acute myeloblastic leukemia, receiving antileukemic chemotherapy and iv drip infusions of 9g /day of CEZ. Eleven days after the start of CEZ she complained of abdominal pain and bloody diarrhea. The findings of colo-noscopy and barium enema were similar to those of case 1. CEZ or CB-PC were discontinued to give and steroid hormone were administered rectally with Gentamicin and physiological saline on both cases. The symptoms improved rapidly. Complete recovery of the colonic mucosa was obtained 20 to 30 days later as shown by the follow-up colonoscopy. Colonoscopy is the most useful examination for the diagnosis of pseudomembranous colitis, and should be performed as soon as possible in patients developing diarrhea after taking antibiotics.

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Juvenile polyp is one of the most frequent diseases in infants and children with lower GI bleeding. Until 1979, 111 cases of juvenile polyp have been reported in Japan.A 7-year-old female was admitted to our hospital with the chief complaint of rectal bleeding. Colonscopy under general anesthesia revealed a pedunculated polyp with erosions on its surface in the ascending colon. Endoscopic polypectomy was immediately performed without any troubles, and the polyp revealed hamartomatous growth histologically, consistent with juvenile polyp.Although peranal resection was commonly performed for the treatment of rectal juvenile polyps and laparotomy for the colonic lesions, the advent of flexible f iberoptic endoscope has facilitated observation of the colonic mucosa and removal of polyps of infants and children with more ease and safety.

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