The ulcerative disease of colon was made in rabbit by the oral administration of 1% aqueous solution of amylopectin sulfate. The agent was given intermittently, that was, rabbit was fed amylopectin sulfate for two days and then received water without the agent for five days. This cycle of feeding was repeated many times for 6 weeks maximally. After two times of the repetition, ulcerative lesion was indused in 17% of the rabbits used in this experiment. The endoscopic dye scattering method made possible to show abnormal patterns of mucosal surface. Dissecting microscopic specimen revealed irregurarity of colonic mucosal area and irregular arrangement of cryptal openings. Scanning electron microscopic findings showed disappearance of cell border surrounding cryptal openings, loss of microvilli and transformation of microvilli like polypoid or hair shapes. After 4 or 6 times of the repetition, a macroscopic ulcerative lesion was induced in 67% of the rebbits used in this experiment. The ulcerative lesion made in this experiment was histopathologically very similar to ulcerative colitis in man. Endoscopic examination revealed petechiae, erosions and rough mucosal surface diffusely. In some cases the dissecting microscopic study revealed the disappearance of colonic mucosal area. Scanning electron microscopic study showed severe changes of colonic mucosa, destruction and a decrease in cryptal openings and a further decrease in number of microvilli. These findings were very significant considering the similar ones in ulcerative colitis in man.

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Application of endoscope using hydrogen electrode enabled us to measure gastric submucosal blood flow without any surgery nor damage to the subjects. Gastric submucosal blood flow and its distribution between the antrum and corpus was measured in dogs under the influences of several agents known to affect gastric secretion. Resting submucosal perfusion was 75.3±13.5 ml per min per long of submucosa for the antrum and 47.3±12.7 ml per min per 100g of submucosa for the corpus. The effect of feeding on submucosal blood flow was studied and a remarkable increase of perfusion in the corpus with a little blood flow increase in the antrum was noted. Graded doses of AOC-tetrapeptide by cotinuous intravenous infusion stimulatedsubmucosal blood flow in the corpus and the antrum and increased the corpus/antrum perfusion ratio, except at the maximal dose. Secretin infused under no stimulation did not affect the blood flow but following gastrin stimulation decreased submucosal perfusion. Betazole hidrochloride increased blood flow in both parts, predominantly in the corpus. Epinephrine infusion increased perfusion, and norepinephrine infused continuously decreased resting and Histalog-stimulated submucosal perfusion, but single injection of both agents brought about a sudden increase of perfusion acompanied by a gradual decrease of blood flow. The present study lends further support to the validity of H₂ gas clearance method using endoscope as measurement of gastric submucosal blood flow. It is further shown that redistribution of submucosal blood flow from the antrum to the corpus did not occur with AOC-tetrapeptide and Histalog stimulation.

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Morphology of pancreatic ducts which were visualized by endoscopic retrograde cholangiopancreatography have been investigated in normal 554 cases. lnf luence of age on the shape of the main pancreatic duct, the position of the head and the tail of the pancreas and caliber of the main pancreatic duct were analized. Shapes of the main pancreatic duct were classified into 6 types. They were: 1) L-shaped (observed in 59.8%), 2) S-shaped (14.3%), 3) Horn shaped (10.6%), 4) Horizontal (8.5%), 5) Oblique (4.3%) and 6) Reversed L-shaped (2.5%). The case in which the main pancreatic duct was running down straightly from the papilla of Vater to the tail was not encountered in our series. The relationship between the shape of the main pancreatic duct and aging was not significant. The relations between the age and the position of the head and tail of the pancreas were following: a) High position of the head of the pancreas (the papilla of Vater lies over the level of Ll) was observed in 40.2% of the group from 20 to 30 decades (younger group), in 28.4% of the group from 40 to 50 decades (middle age group) and in 13.6% of the group more than 60 years (elderly group); b) Low position of the head of the pancreas (below L3) was observed in 7.2% of the younger group, in 10.1% of the middle age group and in 27.3% of the elderly group. High position of the tail of the pancreas (over the level of Th12) was observed frequently in the younger group. On the other hand, ptotic position of the tail of the pancreas below the level of L1 was observed mostly in the elderly group. High frequency of ptotic position of the pancreas in the aged people was statistically significant. The relation of caliber of the pancreatic duct and the age was following i) At the head of the pancreas, the mean caliber of the main pancreatic duct was 4.06mm in the younger group, 4.39mm in the middle age group and 5.04mm in the elderly group; ii) At the body, the caliber was 3.07mm in the younger group, 3.42mm in the middle age group and 3.70mm in the elderly group; iii) At the tail, the caliber was 1.84mm in the younger group, 1.95mm in the middle age group and 2.09mm in the elderly group. The differences of the means among the three groups are all significant statistically (p<0.05).

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Endoscopic retrograde cholangiography (ERC) was carried out for 104 patients who complained of epigastric pain or discomfort suggesting biliary diseases. ERC was succeeded in 77 patients (74.0%). Among the 77 patients, 49 were revealed to have biliary diseases by ERC. ERC was unsuccessful in 27 patients and main causes of failure were thought to be a dislocation of the duodenal papilla into a diverticulum and a state of postgastrectomy after Rillroth I operation. Operations for biliary diseases were performed in 43 patients, of whom 34 were with successful ERC and nine were with unsuccessful one. Among the operated patients, unsuccessful ERC frequently resulted when they had Lemmel's syndrome; unsuccessful in four out of six patients with the syndrome. Lemmel's syndrome could be diagnosed, even in cases of failed ERG, by an endoscopic confirmation of the duodenal papilla in a diverticlum and compatible symptoms. ERG was repeated twice in 12 patients, of whom five were successful on both occasions. ERG failed at the first trial in the other seven patients, but succeeded at the second trial in three. It is a matter of course that a repetition of the examination may result in a success. Dripping infusion cholangiography (DIG) was attempted prior to ERG for 52 patients and was contributory in 23. Operated patients were 39.1% of the group with a successful DIG, 41.4% of the one with unsuccessful DIG and 25.0% of that in which DIG was not attempted. DIG may play a role of screening test for determining indications of ERG.

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The fine gastric mucosal patterns of the gastric mucosal surface were observed using the magnifying endoscope (FGS-MLII) at a magnification of about 30. For simplification, new classification was made on the fine gastric mucosal patterns in the following ways; A, AB, B, BC, C, CD, D. The A has only dotted gastric pits. The B, C and D have broken, continuous and mesh-like linear grooves respectively. The AB, BC and CD are mixed patterns of A-B, B-C and C-D. At first, the gastric mucosa with atrophic gastritis was observed by magnifying endoscopy with dye-spraying techniques, such as the endoscopic congo red test and the methylene blue stain. The A was seen on the normal f undic mucosa and the B was mainly observed on the intermediate zone (atrophic border). The C was seen on the pyloric mucosa with or without intestinal mataplasia. The D was often seen on the regenerated mucosa, which showed markedly atrophic pyloric mucosa.

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The patient, a 44-year-old man with epigastralgia was admitted to the author's hospital. X ray and endoscopic examinations of the stomach revealed three independent lesions. (1) The first was a sharply demarcated depression with ulcer scar above the gastric angle in the lesser curvature. Biopsy specimen showed it to be signet ring cell carcinoma. (2) The second was an irregular depression with converging mucosal folds on the posterior wall near the great curvature of the gastric angle. Biopsy specimen showed it to be tubular adenocarcinoma. (3) The third was a discolored, shallow depression accompanying ulcer scar on the anterior wall of the gastric angle. Biopsy specimen showed no malignancy. The resected stomach was examined histologically after partial gastrectomy. pathological findings : (1) Lesion above the gastric angle in the lesser curvature : IIc. Histologically, it was signet ring cell carcinoma, m. (2) Lesion on the posterior wall near the great curvature of the gastric angle : IIc+III. Histologically, it was moderately differentiated tubular adenocarcinoma, m. (3) Lesion on the anterior wall of the gastric angle: IIc. Histologically, it was signet ring cell carcinoma, m. They were all considered independent lesions because there was on histologic continuity nor was any intravascular invassion recognized.

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A 61-year-old female with liver cirrhosis was submitted to peritoneoscopy. A small yellowish-white nodule on the left liver lobe was later discovered on the peritoneoscopic phtograph. Second peritoneoscopic examination was carried out to take biopsy from the nodule on account of the difficulty to deny hepatoma. The nodule was biopsied by Robbers' forceps directly, and diagnosed histologically as liver cell dysplasia.

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A case of resected small hepatocellular carcinoma was reported. The patient was 58 year old male with post-hapatitic liver cirrhosis and an association of hepatoma was definately diagnosed by peritoneoscopy. Serum α-fetoprotein level was 3200 ng/ml and HBs-Ag was negative. Peritoneoscopically, a small encapsulated yellowish tumor with a diameter of (about 2 cm) was seen at the right hepatic surface. Right lobectomy was performed and histology of the specimen, showed primary hepatocellular carcinoma (Edmondson's type II, of trabecular and pseudoglandular pattern) with post-hepatitic liver cirrhosis. Peritoneoscopy is very helpful for the diagnosis of a resectable small solitary hepatoma on the hepatic surface.

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A 67-year-old male was admitted with a chief complaint of general malaise. He had experienced epistaxis frequently since the age of 40 and anemia had been noted since 4 years before admission. On admission, he had marked hypochromic anemia, however, no recognizable abnormality in blood coagulation system was detected. Endoscopic examination revealed multiple telangiectasiae in the upper portion of the corpus of the stomach. Endoscopy performed on his two off springs revealed lesions of the same type, which was thus confirmed as hereditary osler's disease. Selective celiac angiography confirmed the presence of arteriovenous shunts in the stomach manifested by dilation and pooling of dye material in peripheral vessels in the of area left gastric artery. This lesion was considerd to be the main cause of gastrointestinal bleeding of this patient and YAG laser photo-coagulation was performed. The patient has been followed-up still now for-years.

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Two kinds of small diameter scope for upper gastrointestinal endoscopy are accomplished by Machida : they are f ibergastrointestinal scopes FGI-SD and FGI-SO. SD stands for small diameter with direct(forward) view and SO for small diameter with oblique view. FGI-SD is 9.8 mm ∅ in diameter with forward view, and FGI-SO is 8.8mm ∅ with oblique view of 30°. The visual angle is fairly wide of 80°, and the focus is fixed with 4-90mm visual distance. The apex flexes in four directions, 180° up and 90° down, and 120° bilaterally. Both of these scopes are well equipped with biopsy function. The main characteristic is its great extent of flexibility due to small diameter, which successfully covers possible mechanical demerits of forward view, mainly in the observation of the stomach, for which lateral view has been considered most suitable. With the present scope of FGI, lesions on the lesser curvature and/or on the posterior wall are successfully observed as en face, owing to the extraordinary flexibility of the scope. The fiberscopes used for the upper G-I endoscopy, at present, are fiberesophagoscope (FES), fibergastroscope (FGS-BL), fiberduodenoscope (FDS) and panviewfiberscope (PFS). The frequency in use of these scopes was 12.0%, 38.1%, 17.9% and 32.0% respectively in its order before FGI was accomplished. After this scope of small diameter FGI was introduced, the frequency, however, has changed greatly into 5.2%, 31.9%, 9.3%, and 6.2% respectively. The remarkable changes were the frequencies in use of FES, FDS and PFS, decreasing from 12.0%, to 5.2%, from 17.9% to 9.3% and from 32.0% to 6.2% respectively. And the frequency in use of this FGI was far up to 47.4% this year, which was almost a half of all cases examined. This interesting result strongly suggests that FES, FDS and PFS were greatly replaced of its role by the new small diameter scope FGI in the routine upper G-I examination, being restricted mainly to the precise examination in each part. At the same time, this figure of 47.4% fluently certificates the useful availability of FGI as an universal scope for the routine observation of the esophagus, stomach and duodenal bulb. The mechanical principles of the fiberscope consist of abilities of image resolution, observation, function (flexibility, controllability, biopsy facilities, etc.), documentation and durability. These principles will, however, contradict each other. When the diameter is decreased and flexibility is accordingly increased, for example, resolution power will inevitably decrease. But, owing to enormous technical progress, these mechanical principles are so well balanced and co-ordinated as to produce an ideal scope FGI-SD or FGI-SO. With this one scope, the esophagus, stomach and bulb are easily surveyed. But, it should be always reminded that a perfect survey should be performed from corner to corner and possible inferiority of image resolution or demerits of forward view in the examination of the stomach could be possibly covered only by close-up observation, which is successfully secured by its supreme flexibility. When this fundamental attitude is preserved throughout the examination, then, in the strict sense, this scope FGI would be properly evaluated as an universal scope for the routine upper G-I endoscopy.

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In recent years gastrointestinal endoscopy has made great progress in Japen. For further advancement establishment of educational system in endoscopic examinations seems essential. The postgraduate education of physicians in endoscopy can be divided into two courses, namely long-term and short-term. The long-term course is designed for training of endoscopy specialists over a period of three to five years, and the short-term course for basic endoscopic training over a period of two to three months. The long-term training is composed of two or three stages. The first stage is the period for understanding the fundamentals of endoscopy as well as the patient's condition. For effective training in this initial stage, lectures, bed-side teaching and conferences for case studies should be provided with the use of various teaching aids, such as color television, videotapes and cine films. The second and third stages are designed for training of gastroscopic biopsy and upper gastrointestinal panendoscopy. The latter part of this phase is devoted for training in endoscopic retrograde cholangiopancreatography, colonoscopy, emergency endosc opy and endoscopy of the small intestine. The object of the short-term education is endoscopic training of trainees, general practitioners or foreign physicians. The training course for peritoneoscopy is to be outlined separately. Further deliberations are required among the members of this society in regard to the selection of teaching centers and teaching staff.

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