In this report, a comparative study was made on the early gastric cancer in Korea and Japan with respect to the age of patients and the type, depth of invasion and metastasis to lymphnodes. The data of 161 cases of the early gastric cancer were all from the reports published in Korea, and the data in Japan were from the ones by Tasaka, Hayashida and Honda. This comparative study showed no differences except for a few respects. In regard to the age distribution, there were higher frequency of the disease in the forth decade, and lower in the seventh decade in Korea than in Japan. As to their type, I, ha, and IIb were less frequently discovered, while type III was more frequently seen in Korea than in Japan. The case with a lesion lager than 3 cm in the longest diameter was less frequently observed in Karea than in Japan. The incidence of the early gastric cancer was 6.5 per cent among 1, 910 cases of resected gastric cancer in Korea, which was slightly lower compaired with that of the report by Honda.

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Investigations were made on the effect of the Nd-YAG and argon lasers on the normal gastric wall to determine the proper power and duration of irradiation required to stop gastric bleeding without injuring the gastric wall. The generator of the Nd-YAG laser was NEC SL-115 and that of argon laser was LEXEL 295. The red He-Ne laser beam is coupled coaxially with an invisible Nd-YAG laser. Both Nd-YAG and argon laser beams are transmitted by the same quartz fiber with a 800 micron diameter, enveloped with a teflon tube. The CO2 gas jet exits from the tip of the tube. A 20 to 50 watt Nd-YAG laser and 3 to 5 watt argon laser were exposed to the nor-mal gastric wall at a distance of 1cm for a period of 2 to 10 seconds. Investigation was also made on the depth of the photocoagulation effect of both lasers by observing the cut surface. At a distance of 1cm, 30 to 40 watt irradiation of Nd-YAG laser for 3 seconds, that is 341 to 455 joule per square cm energy density, and 5 watt irradiation of argon laser for 3 seconds, that is 57 joule per square cm energy density, whitened the whole submucosal layer without injuring the gastric wall. Laser irradiation of these powers may be suitable for the hemostasis of gastric bleeding. Bleeding from gastric ulcers, made by the ulcer maker in the stomach of heparinzed mongrel dogs, was endoscopically stopped completely, without perforating the canine stom-ach, by both laser irradiation of the above powers.

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Specimens obtained by conventional forceps biopsy technique are not always adequately large, but also deeply excised. Furthermore, it should be pointed out that many parts of specimens are destroyed with this method. To clarify the etiology and the pathophysiology of chronic gastritis, jumbo biopsy, that is, suction biopsy under direct vision by fiberscope, was deviced. In this preliminary study, we used a therapeutical fiberscope FGS-XI which has a chan-nel, 5mm in diameter, for a large forceps. This fiberscope is 80cm in length with 13mm in diameter. Biopsy forceps is 3.2mm in diameter with 12mm in lenght, and has a chan-nel for suction of gastric mucosa on one side. The end of the internal silinder is a cutter for excision of gastric mucosa. Suction for biopsy was done with pressure of 30-60cm Hg. The mean diameter of excised tissue was about 4mm, although the largest one was 8.3mm in diameter. Muscu-laris mucosa was seen in all specimens, and sometimes submucosal tissue. These specimens were adequately large, being enough for this study. However, observation of the fornix and the lesser curvature was difficult, because the fiberscope was somewhat large and rigid.

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By removing a plastic hood from the tip of the conventional colonofiberscope Olympus CF-MB3, a hoodless colonofiberscope was made on a trial basis. (This was proposed by Dr. Tsuneyoshi Yao at the meeting of Kyushu District Endoscopic Apparatus Improvement Committee.) The hoodless colonofiberscope was used on 44 occasions in 38 patients including 20 occasions in 14 patients with ulcerative colitis. The removal of the hood from the tip resulted in an improved "draining" and complete removing of the attached stool. Moreover, insertion, observation and biopsy without pretreatment have become feasible. Thus, the hoodless colonofiberscope seems a quite useful apparatus for emergency colonoscopy or colonoscopy severely ill patient and for follow-up of ulcerative colitis.

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The endoscopic MB-C. E method, methylene blue (MB) staining method combined with Congo red-evans blue (C. E) test, was developed to investigate chronic gastritis min-utely. This method made it possible to determine the degree and the txtent of intestinal metaplasia by preceding MB staining method, and the area gastricae and fundic-pyloric glandular border by scattering C. E solution. This method was done in 52 subjects aged 31-77 years, and the endoscopic findings were studied. The preceding MB staining method was possible in accurate endoscopic di-agnosis of intestinal metaplasia in all cases. Demonstration of the area gastricae which were clearly delineated more than half of the gastric mucosa was noted in 73% in the py-loric gland area and in 85% in the fundic gland area by scattering C. E solution, and endo-scopic discrimination of fundic-pyloric glandular border was possible in 50 of 52 cases (96 %). The side effect with the MB-C. E solution was never encountered in except 1 of 15 patients who showed a slight increase in GOT.

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The utility of the ERCP has been generally acknowledged and this diagnostic method has been widely utilized, however, there are still problems on some aspects. In this respect, we have attempted to take a moving picture of the ERCP in order to visualize the entire process of injection and excretion of the contrast medium. The following are the results of our experience (1-6) and some of the expectations by this method (6-8). 1) Recording the motion of the contrast medium adds the diagnostic value in case of marked deformity of the biliary tract due to dilatation, operation or malignant tumor. 2) Precise differential diagnosis of malignant biliary tract stenosis is possible by studying the peristalsis of the common bile duct. 3) While performing the ERCP, the examiner's attention has to be paid simultaneously to endoscopic views, x-ray TV monitor and the patient, and thus the examiner may fail to concentrate attention of each of them. Repeat studies of the cine-films whenever desired enable one to avoid possible errors of fluoroscopic diagnosis. 4) Because of simultaneous filling of many intrahepatic ducts with the contrast medium, one may overlook the findings of some branches. Cine-films enable one to study the details of each branches. 5) It is also valuable in follow-up studies of patients after biliary-tract operation. 6) Cine-films are necessary and useful on evaluation of the sphincteric function at the papilla of Vater. 7) Comparative studies of pre- and postoperative cine-films, especially in view of papil-lary functions, will enable one to evaluate the indication and efficacy of the biliary-tract operation. 8) We expect that the ERCP cine-films will also contribute to the study of the effect of gastrointestinal hormones of the digestive system.

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Endoscopic cholangiogram "ECG" with or without oral egg yolk or caerulein injection was applied for the diagnosis of adenomymatosis of the gallbladder in nine patients. For comparison, four different groups of diagnostic cholecystogram was used as follows: (1) oral or I. V. cholecystogram, (2) oral or I. V. cholecystogram with oral egg yolk or caerulein injection, (3) ECG, (4) ECG with oral egg yolk or caerulein injection. Although the gallbladder was visualized by group(1)in all cases, the best diagnostic yield was obtained by group(4). Group (3) and(2)gave the second and third best result respectively, while the diagnosis with group (1)was poor. It was concluded therefore, that ECG with oral egg yolk or caerulein injection was the best method for the diagnosis of adenomyomatosis of the gallbladder.

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Laparoscopic findings of the liver in ten cases with primary biliary cirrhosis diagnosed by direct vision needle biopsy was investigated (PBC). Two characteristics features of laparoscopic appearances were recognized on the liver surface of PBC patients. One demonstrated gentle protuberances, ranging from 0.5 to 3cm in diameter. The other showed vaguely outlined white markings with tendency to be interconnected. The protuberance was noticed in seven cases and the white marking in eight. All cases had gentle protuber-ances and / or white markings. In three of four patients with asymptomatic PBC, reddish patches, 0.5 to 3cm in di-ameter, irregular in shape and distribution were found. From serial laparoscopic observa-tions, the patches were found to decrease a reddish tone and to become low protuberances with mesh-like white markings. The transition of reddish patches to protuberances with white markings was in close coincidence with progression of histopathological changes in PBC classified by Scheuer and had a significant value in diagnosis and staging of PBC. "Reddish patch" is a new laparoscopic sign in asymptomatic PBC. According to histological analysis, the areas with reddish patches coincided with less advanced lesions of intrahepatic bile ducts and the non-patchy areas with more advanced lesions.

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Cardiac function (especially during peritioneal insufflation) was investigated during peritoneoscopy under local anesthesia. Cardiac function was studied by echocardiography. The left ventricular volume was calculated by Pombo's formula. The results were;1. The left ventricular end-diastolic volume decreased significantly (p<0.02) from 119±30m1 in the control to 102±27m1 during peritoneal insufflation.2. The left ventricular end-systolic volume did not change significantly: 37±18m1 in the control, 35±11m1 during peritoneal insufflation.3. The stroke volume decreased significantly (p<0.01) from 83±25m1 in the control to 67±21m1 during peritoneal insufflation.4. The cardiac output decreased significantly (p<0.05) from 5.8±1.5L / min. In the control to 4.7 ± 1.7L / min. during peritoneal insufflation. There results suggested that elderly patients with decreased circulating blood volume and patients treated with diuretics for prolonged periods need to be managed carefully against bradycardia and sudden falls in blood pressure.

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Although colonoscopy is recently improved with advances in fiberoptics and insertion techniques, patients still suffer much discomfort during the procedure. To reduce patient's discomfort during the examination, we have already designed more slender colonoscope than CF-TB of which diameter of the insertion tube is 13.7mm. Based on our idea, a smaller caliber scope, type CF-11 (Olympus), 11.0 mm in diameter, was devised. During the last 6 months, 50 cases were examined by means of CF-11. Suc-cessful insertion rate to the ileocecal area was 98% and the average insertion time was 15.5 minutes. Discomfort of a patient during the procedure was lessened compared to that of the examination with CF-TB. Therefore, the manipulation of CF-il was good enough as well as CF-TB. Moreover, pediatric colonoscopy was easily and safely performed using CF-11 and it was emphasized that CF-11 was available to all patients regardless of ago.

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A case of early ampullary carcinoma was reported. Four years ago a 39year old female was admitted with complaints of pain in the right hypochondrium, anorexia and fever. The values of S-GOT, S-GPT and Al-P fluctuated during the course. After the discharge she occasionally complained of abdominal pain and she was readmitted. Hypotonic duodenography revealed the hemispheric shaped shadow at the papilla of Vater, of which the surface was irregular. Duodenofiberscopy revealed the swelling of the papilla of Vater. And the papillous, gray tumor was emerged from the papilla of Vater. The cytology of the biopsy specimen was positive for cancer cells. The operated specimen showed the tumor, 2.5 × 1.7 × 1.1cm in size, at the papillary region. Histologically the tumor was adenomatous polyp localized in the ampullary region and large part of the polyp consisted of the adenoma, whereas cartinomatous change was recognized partially. No in-vasion was seen at the pancreas, common bile duct, duodenum mucosa and other tissues around the tumor.

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A-47-year-old female was admitted to our hospital with complaints of general fatigue and poor appetite. The plain X-ray film revealed large amount of air in large intestine and free air under both diaphragms (Figure 1, 2), but she had no symptoms of perforative peritonitis. Barium study of small intestine showed many polypoid lesions of various size with smooth surface in ileum (figure 4). By laparoscopy, multilocular subserosal cysts were observed in lower small intestine and air revealed by needle puncture of the cyst (figure 5, 6) . Laparoscopy was though to be useful to diagnose of pneumatosis cystoides intestinalis in small intestine. Because of sclerodermatous change of her skin, hypergammaglobrinemia, positive anti-nuclear-antibody and histological findings of skin, she was diagnosis pneumatosis cystoides intestinalis associated with Scleroderma.

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Recently we experienced a case of colitis which showed peculiar colonic appearance. A 55 year old male was admitted to our hospital with a chief complaint of rectal bleeding. Barium enema study and colonoscopy revealed multiple varioliform elevated lesions scattered diffusely in the lower part of the colon. The course of the illness was self-limited and after about 2 months colonic lesions healed without any specific therapy. This case differed from ulcerative colitis or Chrohis disease in its clinical course and endoscopic findings, but was similar to aphthoid colitis or lymphoid hyperplasia of the colon so we investigated mainly the difference of this case from aphthoid colitis or lymphoid hy-perplasia of the colon. We designated this case as varioliform colitis because of its peculiar colonic appearance.

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