Patients with chronic renal failure frequently complicate several gastrointestinal disease such as gastritis, multiple gastric erosions, and peptic ulcer. On the other hand, there have been very few reports about these patient's gastric mucosa under hypergastrinemia. Therefore, we evaluated endoscopic appearance of gastric mucosa and gastric acid secretion of these patients with mainly chronic renal failure treated with long-term haemodialysis. Twenty-six patients with chronic renal failure were investigated on the gastro-duodenal disease, endoscopic Congo-red study, biopsy of gastric mucosa, including serum gastrin level, serum histamin level and gastric acid secretion. The conclusions are as follows: 1) At endoscopy almost all patients had multiple gastric erosions and the majority of these erosion was associated with bleeding. 2) Gastric atrophic border of these patients indicated C-1, C-2 pattern in about seventy percent of all cases, then located more distal than that of normal persons. 3) Gastric acid secretion was somewhat high in BAO, but fairly impaired in MAO in comparison with normal person. 4) According to the degree of chronic renal failure, serum gastrin had the tendency to increase its level statistically. 5) Serum gastrin was in high level in proportion to the progress of gastric mucosal atrophy.

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We recently developed a probe for cryosurgery which is inserted through the esophagegastrof iberscope. The tip of the probe is made of brass and it is 4.5mm diameter and 7mm length. The guide tube has doubel lumens and made of Teflon (Figure 1). Using liquid carbon dioxide at pressure of 20kg/cm², the temperature of the tip becomes -63C. Applying the esophagogastroscope TCE-ID (Olympus) this probe was contacted to the mucosa of the stomach and esophagus of the dog for 3 to 5 minutes, and wounds were cured within 2 4 weeks without making any perforation (Tablel). These equipments were used clinically after the experiments. Case 1: A 57 year-old female. Figure 2 shows postoperative stage of the esophagus after esophageal dissection for varices. One month after discharge, however, she had a recurrent stenosis (Figure 3). For this patient a contact freezing method was applied 2 times in a couple of weeks about 20 minutes at one procedure (maximum 5 minuties at each contact) (Figure 4). However the stenosis recurred again after 7 weeks, and the same method was applied following bougie nage after the procedure. After bougienage (Nolaton #8) for two months the patient was dischaged without stenosis (Figure 5). Case 2: A 24 year-old male. Figure 6 shows an esophageal stenosis caused by swallowing sodium hydroxide. A cnotact freezing methode was applied for this patient for 20 minutes (Figure 7). Since a bougie could not used in this case because of previous perforation of the esphagus, the patient had to have esophago-gastrosomy eventually after temporal cure of the stenosis. It is concluded that cryosurgery using a new probe which had been developed at our institute will be effectively applied for an esophgo-cardiac stenosis which is caused from benign disease.

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For the accuracy of surgical resection, it is important to determine the extent of gastric cancer infiltration especially to oral side. In this study, biopsies were carried out at a distance of 2cm from the apparent infiltration border of the gastric cancer in 156 cases. Carbon ink was injected at this site. Malignant cells were found on the biopsy specimen in only one case. 31 cases were inoperative. Consequently, we studied 125 cases which were operated on for gastric cancer. Surgical resection was performed at a point past the carbon ink injection site. The relationship between the carbon ink injection site and the gastric cancer infiltration border was investigated on the resected specimens. In one case, the infiltration border of gastric cancer was found beyond the carbon ink injection site. The two cases cited above were diagnosed previously as Borrmann type IV gastric cancer, and histologically they were signet ring cell carcinoma.

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In order to imporove the diagnostic abilities in ERCP, we evaluated the wide-view typed, newly devised duodenofiberscope, type FD-QB (Fujinon). To 125 cases with hepato-biliary and / or pancreatic disorders, ERCP was applied 140 times, and cannulation was successfully performed 136 times. In the cases with hepato-biliary disorders, endoscopic cholangiography was succeeded 95 times (90.5%) in 105, while 35 times (100%) in endoscopic pancreatography. However, in all 18 malignant cases we succeeded in getting endoscopic cholangio-or pancreatography. As a result, the f iberscope, type FD-QB, was evaluated as one of the useful equipments for observation of almost all part of gastroduodenal mucosa, and for ERCP, that is, with this endoscope we could get enough to close to the papilla Vateri for cannulation, following a direct wide visualization of the orifice. Furthermore, ERCP procedure could be usually carried out in simplified manner, and EST was succeeded in 3 cases smoothly.

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To investigate the change of the liver surface directly related to the early hepatocellular carcinoma (hepatoma) during hepatocarcinogenesis, we examined laparoscopically the rat liver surface continuously fed with 3'-methyl-4-dimethylaminoazobenzene. The red spot reported previously was corresponded with the more productive cell population, as compared with the surroundings by means of the liver biopsy under laparoscopy. In the laparoscopic changes of hyperplastic nodule to hepatoma, the hyperplastic nodule was white or yellowish nodule with the smooth surface, and several nodules were surrounded by fine small vessels. The surface of the hyperplastic nodule at the late stage became irregular and the vessels increased on their surface. The vascular change seen through hepatocarcinogenesis was suspected to coincide with the stage of red spots, and to be the arterial vessels increased on the surface of hyperplastic nodule as well as hepatoma.

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Among problems often encountered with high-frequency-current-applied endoscopical polypectomy, such as leakage of electricity, electric shock, bleeding, perforation, burns, intra-colonic gas burst etc., the most difficult to cope with are unpedictable profuse bleeding and perforation. With the intension to establish a reliable formula for controlling such major bleeding and concomitant fateful perforation, the present authors developed a double-snare method polypectomy. That is: through one channel of the 2-channel fiberscope, a venyl-insulated wire-loop snare for strangulation to stem blood flow is first set on the stalk of a polyp at its base. Another wire-loop snare to work as a scapel is led throuth the other channel to take its place where to cut stalk, some millimeters away up in parallel with the first strangulating snare. After polypectomy, stragulation with the snare is gradu9lly loosened to confirm no more bleeding from the cut-site of the stalk. If bleeding remains persistent, the strangulating snare is again tightend to stop the bleeding, and some hemostatic method is applied using electrocoagulation, hemostatic clip or pure ethanol injection; either will be applied via the second channel (Fig. 2). In 37 patients receiving the double-snare polypectomy, since 1975 for a total of 40 gastric polyps and one colonic polyp over 15 mm in largest diameter. Profuse bleeding was noted from the cut-site of the stalk in 7 polyps. Resumed tightening of the strangulating snare and any hemostatic method shown in Fig. 2 was selected. Bleeding could be stopped in all cases. In another distinctive advantage, the method, with the application of a special technique, can turn a sessile polyp to a pedunculated one, thus making easier approach possible (Fig. 3). This may will be cited as another merit of the new method, capable of minimizing a high-risk of perforation especially in colonic polypectomy.

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Antibiotic induced colitis (A.I.C.) has recently been observed frequently, 20 cases of A. I. C. were observed endoscopically in our hospital in the past three years. The patients ranged in age from 15 to 75 years, averaging 45 years. 4 cases of them were male and 16 cases of them were female. The common symptoms were diarrhea, abdominal pain and bloody stools. Endoscopic features of A. I. C. has been divided into pseudomembranous colitis and non-pseudomembranous colitis. The latter is further classified into 3 types. 1) pseudomembranous colitis (2 cases). 2) non-pseudomembranous colitis. a) non-specific type (10 cases). b) aphtoid colitis type (5 cases). c) linear ulcer or linear erosion type (3 cases). Any type of A. I. C. did not relate to the underlying diseases, the kind and dose of antibiotics and the route of administration. But patients with pseudomembranous colitis were elderly and patients with non-specific type recovered in a shorter period than others. It is concluded that an endoscopical analyiss plays an important role in solving the causative factors of A. I. C..

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We have experien ceda case in which an intragastric gallstone was discovered and removed endoscopically. The patient was a 65-year-old female whose chief complaints on admission were fever, decreased body weight and epigastric pain. The abdominal plane x-p revealed gallstones in the right hypochondrial region. Although detailed roentgenologic examination of the stomach was difficult because of her severe nausea and food residue in the stomach when examined, a blackish mass was detected in the stomach by endoscopy. Gastric mucous membrane appeared normal, however, mucous membrane of the posterior wall of the duodenal bulb was observed to be reddish. The endoscopically removed intragastric mass was of 2.7×2.4×2.0cm in size, 7.45g in weight and 1.037 in specific gravity. It was proved from the several analytical studies that the removed mass was a cholesterol gallstone. When cholecystectomy was performed, it was recognized that the gallbladder had a number of calculi and was adhered to the posterior wall of the duodenal blub. However, formation of a fistula was not detected. It was postulated, therefore, that the intragastric gallstone in this case may first be discharged into the duodenum and then entered into the stomach through the pyloric ring.

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A comparative study was made on the characteristics between endoscopic findings and histological findings in the 38 cases of elevated gastric carcinoma of the stomach (35 Borrman I, 3 early elevated carcinoma), which had been resected in the pariod from 1972 to 1979 at the Department of Surgery I of Kanazawa University School of Medicine.The following results were obtained: 1) The differentiated carcinoma of the stomach has the following characteristics. a) the surface configulation of elevation is comparatively smooth. b) the colour of elevation is not faded. c) the characteristics of the elevated margin is comparatively smooth. 2) The undifferentiated carcinoma has the following characteristics. a) the surface has the irregular nodeles. b) the colour of elevation is fade. c) the characteristics of the elevated margin is a levee-shaped elevation.

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Seven cases of inflammatory fibroid polyp were encountered among 355 patients with gastric polyp subjected to endoscopical polypectomy using high frequency currents during the period from September 1973 to March 1979. Two cases were diagnosed as the inflmmatory fibroid polyp before the removal by magnified-endoscopy. The characteristic endoscopic findings of these lesions were that (1) ulceration, occasionally multiple, developping close to the top of the elevated lesion, (2) these ulcerations heal, forming scar in relatively shorter time, (3) papillary features at the reddened area showed no much difference from normal mucosa and can be clearly distinguished from characteristic papillary changes of the hyperplastic polyp. There were no complications experienced at the time of polypectomy or thereafter in these 7 cases.

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A 63 year-old female was admitted to our hospital because of a severe diarrhea and weight loss in Jan. 1976. She was well untill three and a half months prior to admission. About two months before admission, alopecia, nail atropy and hyperpigmentation gradually appeared. Laboratory investigation revealed marked hypoproteinemia (4.7 g/dl), hypoacidity of gastric juice and hypergastrinemia (over 800 pg/dl). All other function tests of the liver were normal. Roentgenographic examination of gastrointestinal tract showed diffuse polyposis in the stomach, intestine, colon and rectum. Endoscopical examination of the stomach revealed innumerable hemispheric polyps especially in the antrum. Microscopical examination of the polyps was cystic dilatation of glands, mucus hypersecretion and inflammatory cellural infiltration. There was no evidence of malignant changes in polyps. No particular matter was noted in the family history and her past history. Microscopical examination of the liver was remarkable fatty metamorphosis.

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A 56-year-old man was admitted to our hospital because of right pneumothorax. Xray examination of the stomach revealed a well-difined, small polypoid lesion with smooth surface in the gastric antrum. Endoscopic examination showed a semipedunculated polypoid tumor having glittering surface. The tumor was depressed, when it was touched by biopsy forceps, and was thought to be a small submucosal tumor of soft cosistency. So endoscopic polypectomy was performed for definitive diagnosis. The resected tumor, measuring 10×8×9 mm, was a monolocular submucosal cyst, histologically diagnosed as the simple retention cyst of Palmer or the glandular retention cyst of Nomura. Although gastric cysts are rare, some of them have been found endoscopically with the recent advent of endoscopic polypectomy.

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A 58 year old man complaining of right upper quadrant pain, high fever and jaundice was admitted to our hospital. Examination revealed drowsiness and shock state with elevated total bilirubin and serum amylase. Abdominal Computed-Tomography (CT) was carried out and demonstrated a high density area in the distal common bile duct, and enlarged intra- and extra-hepatic duct and main pancreatic duct . We suspected acute obstructive suppurative cholangitis (AOSC) due to impacted gallstone at the Papilla Vater by CT. Urgent endoscopic sphincterotomy (EST) was carried out for liberation of AOSC. The papilla was remarkably enlarged and a portion of blackish brown stones with pustural coated was observed through the orifice of common bile duct. The papilla was incised with needle type diathermy and impacted gallstone was fallen down to the duodenum. E. Coli was found in the infected bile. Two days after EST, a bilirubin stone, measuring 12×10×10mm, was found in feces . Total bilirubin and serum amylsse level had been normalized 10 days later. There was no complication due to the examination.

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The patient was 66-year-old man, suffering from bloody stools. X-ray examination and endoscopic examination showed colonic diverticulosis associated with colonic polyps, one of which was hemorrhagic on the top surface and was considered to be causative of bloody stools. Histopathologic exmination of polyps revealed that one polyp was cancer in adenoma and the others were tubular adenomas. Colonic diverticula were present in the descending colon, while 4 polyps, Yamada's type, I were present on the left side of the transverse colon, a polyp of Yamada's type II in the descending colon, a polyp in the oral end of the sigmoid colon, and a polyp of Yamada's type III (cancer in adenoma) in the sigmoid colon. In this case diverticula were located mainly in the neighbourhood of the polyps in the colon. Regional and causative relationships among diverticulum, adenoma and carcinoma in adenoma were discussed.

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Ultrasonography has recently come to play an important diagnostic role in diseases of the liver, biliary tract and pancreas. It is a scanning through the abdominal wall, which means that the presence of digestive tract gas or subcutaneous fats can interfere with the transmission of ultrasound with the resulting failure in delineation of small lesions or qualitative diagnosis. The interference most frequently affects scanning of the pancreas. We lately had an opportunity to use an echoendoscope timed at preventing such interferences and providing scans at close range, and examined its possibilities in diagnosis particularly of pancreatic diseases. The trial, mosel has a transducer fitted within the tip of an endoscope (GF-B₃), and permits mechanical sector scanning. We tried it first on an experimental model, then on autopsy cases, operative cases and general clinical cases, in that order. Its resolution was relatively high, and the gastric wall, pancreas, liver, aorta and vertebra were successfully identified. The stability of pictures, however, was not good. Besides, image could be obtained only through a 90-degree field, and grasping of the scanning direction was difficult. With such shortcomings, it will need positive improvements to serve as a useful diagnostic tool for general use.

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We had experiences with the Ultrasonic Endoscope (U.E.) developed by Olympus Co.and Aloka Co.. We found that we could confirm a scanning point of the U.E. by using the abdominal ultrasonography at the same time. Moreover, we could obtain the accurate anatomy of the endoscopic ultrasonogram by comparing the endoscopic ultrasonogram with the abdominal ultrasonogram. Then, we examined 10 cases of pancreato-biliary disease by using the Endoscopic Ultrasonography (EUG) and the abdominal ultrasonography at the same time. As the result, we found that the tail of the pancreas was visualized by scanning at the posterior wall of the upper and middle body of the stomach and the body of the pancreas was visualized by scanning at the posterior wall of the angulus. In one of the 10 cases, we succeeded in inserting the U.E. into the 2nd. portion of the duodemum and we could visualize the head of the pancreas by scanning at the point of Vater's papilla. This case was thought to be the first report in Japan. We reported the details of our experience with the Endoscopic Ultrasonography in this paper.

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This paper presents experiences with a new slimmest flexible sigmoidoscope (Model FS-34A). This scope is forward-viewing and fixed focusing. The effective length is 700 mm and the angle of view is 95°. The tip deflection is 180° on Up and Down, 100° on Left and Right This scope has clinically been used in 150 cases of routine examination including 10 cases of endoscopic polypectomy. The features of this scope are the slimmest insertion tube (11.5mm), large channel (3.5mm), remarkable bending radius and unique second bending portion. It provides easy insertion and minimizes discomfort for patients. This scope can be reached easily to the splenic flexure in 10 cases in our series. Also, retrograde observation is possible in the rectum or sigmoidcolon. It allows observation and biopsy from various angle.

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