As the etiology of reflux esophagitis, the following causes are considered; (1) lowered esophageal sphincter pressure, and (2) long stay of reflux fluid, which may influence on induction of esophagitis. As this time, the gastric atrophic pattern was investigated in 30 cases having ref lux esophagitis in order to clarify the relationship between ref lux esophagitis and gastric acid output. The cases with gastrectomy were excluded from this study. Twenty six out of 30 cases (86.7%) showed the "closed type" and progression of the gastric atrophic pattern toward oral side seen with age in chronic gastritis was not observed in these cases. Moreover, we examined 22 cases of sliding hiatus hernia. Eleven of them complicated reflux esophagitis, and the gastric atrophic pattern showed the "closed type" in all of them. From the analysis of gastric atrophic pattern in these cases, it is concluded that the "closed type" plays an important role in developing reflux esophagitis.

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Using endoscopic introduction of hydrogen electrode, we measured gastric blood flow and its distribution between the antrum and upper body with or without gastric ulcers. We also measured blood flow in the center, marginal wall of ulcers and surrouding normal mucosa. In the control subjects the blood flow was 49.9±11.8m1/min/100g for the antrum and 60.5±13.5m1/min/100g for the upper body (P<0.01). In ulcer patients the data were 50.5±13.3ml/min/100g and 58.8±16.2m1/min/100g respectively (P<0.05). The flow showed slight decrease with the advance of age in both antrum and upper body. In the ulcer patients the blood flow in the antrum and the upper body was slightly higher when the ulcers were in the healing stage than that in the active stage. In the patients with healing stage ulcers the blood flow increased in the marginal wall of ulcers when compared with that in the normal surrounding mucosa, and the marginal wall flow was lower than that of the normal surrounding mucosa when the ulcers were in active stage. In 6 out of 7 patients with intractable or often recurring ulcers the blood flow in the marginal wall of ulcers showed significant decrease compared with the normal surrounding mucosa. These facts lend further support to the idea that the blood flow in the marginal wall of ulcers must necessarily be of importance for the development of healing of the ulcer.

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Tatsuka et al, reported a local injection of 95% ethanol as a new endoscopical treat-ment of gastric protuberant lesions. In performing this method, the present authors dis-covered that 99.5% ethanol injection has an excellent hemostatic effect. The authors in-jected 99.5% ethanol into the cut-end of the stalk of 7 massive hemorrhaged cases encounter-ed while performing double snare polypectomy. In all cases, the hemorrhage stopped within 5 to 15 minutes. In 9 patients with hemorrhagic gastric or duodenal ulcer who were judged at emergency endoscopical examination as needing some hemostatic treatment, an injection of 99.5% ethanol into the bleeding site achieved a satisfactory hemostasis in all of them. Ethanol injection into the surrounding tissue close to the bleeding vessels, a few inject-ing sites selected usually at 1 to 2mm away from the bleeding vessels, 0.1 to 0.2 ml at a time, could instantly suppress even the pulsatile bleeding with no hazards. If this method is used carefully with enough endoscopic skill, this may become the first choice for the gastro-intestinal hemorrhage except varices.

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Superficial gastritis has been classified as a type of chronic gastritis, since a report of Schindler in GASTRITIS 1947. However, Benedict reported that superficial gastritis is only acute gastritis or shows normal mucosa histologically. In this investigation, we studied superficial gastritis endoscopically. The common endo-scopical features were patchy reddening, edema, adherent mucus, and/or comb-like redness (kammrotung). We especially studied the patchy reddening and comb-like redness (kammro-tung). Normal pits were observed on the redness of superficial gastritis by a magnifying endoscope, and this could be distiguished from erosion. We studied the relationship between the redness of superficial gastritis and the atrophic pattern by an endoscopic congo-red method. 88.40 of the superficial gastritis cases showed the closed type of atrophic pattern. The cases in which comblike redness (kammrotung) was observed in the antrum showed only C1 and C2, endoscopic atrophic patterns of Takemoto and Kimura. In 37 cases of superficial gastritis in which redness was observed, we performed second endoscopic examination after 1 month; and in 21.5% of the cases we could not observe any redness. It is concluded that superficial gastritis should be classified into two types; chronic type in which redness is always observed, and acute type in which the redness disappears after some interval of time.

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To investigate the relationship between patchy marking and hepatocellular carcinoma (he. patoma), 103 cases of chronic liver diseases and 25 cases of hepatoma were examined. Patchy marking was obseved in 29.0% of total cases of chronic liver diseases. Moreover, patchy marking was seen in 47.8% of positive cases (30 cases) for liver cell dysplasia which has been focused as possible precancerous lesion, on the other hand it was also revealed in the incidence of 40.0% of hepatoma bearers. The incidence of HBsAg-or HBsAb-positive cases was 20.7% in patchy marking bearing cases. The elevation of serum α-fetoprotein over 200 mg/ml was seen in 37.9% of cases associated with patchy marking, while it was shown only in 12.5% of the cases without patchy marking. Liver cell dyspasia was highly seen in the cases of chronic liver diseases, bearing hill-shaped nodules. Regarding to the incidence of liver cell dysplasic and significantly increased α-fetoprotein level among the cases with patchy marking, it might be concluded that the patchy marking is very important factor to set up a concept of high risk group for the development of hepatoma in the cases with chronic liver diseases.

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Esophageal leiomyoma is rare compared with the esophageal carcinoma. Reports on the endoscopic polypectomy of the esophageal leiomyoma are only 12 cases including our case in Japan. A 61-year-old man visited our hospital for hematoemesis and tarry stool. We found a hemorrhagic polypoid lesion at the upper esophagus. Endoscopic polypectomy was performed as an emergent treatment successfully. Removed specimen was 1.0 ×0.7×0.7cm in size with an erosion at the top of the pedunculated tumor. Histologically it was leiomyoma localized to the tunica propria. Our case is one of the absolute indication for the endoscopic polypectomy. This case had a history of enucleation of a gastric leiomyoma at the fornix 9 years before.

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Case reports of the early cancer at the esophagogastric junction have been rarely found. By use of a forward viewing panendoscope, we were able to find a case of early cancer at this area. A 65-year-old man had been treated and followed up with a diagnosis of gastroduodenal ulcer and a small lesion of elevated type carcinoma at the esophagogastric junction was noticed by endoscopy with biosy. Histologically the specimen revealed well differentiated adenocarcinoma (tub 1) of 11 a type at the esophagogastric junction. Depth of invasion was in the submucosa. We have referred to the literature of the early cancer at the esophagogastric junction (5 cases), and discussed in comparison with our case.

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Endoscopic papillotomy is a useful and safe method for patients with common bile duct stones. There are several types of papillotome, but they are not always satisfactory to use, for example, poorness of durability and difficulty of insertion into papilla of Vater, etc. These ploblems are inherent in the common structure: the bare and exposed wire on the tip of canula. Therefore we have made a new type papillotome, in which the wire can be completely withdrawn into the canula, without leaving wire exposed. In Sakura National Hospital, endoscopic papillotomy was carried out on 14 patients with common bile duct stones since July 1978, and in the 11 cases of them the stones were successfully removed. In the latest eight cases in which the new type papillotome was used, all of stones were removed without severe complications. The new type papillotome had strong durability, and it was especially suited for fine incision, i, e, in the cases with duodenal diverticulum or in the cases of reincision.

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A 65-year-old female was admitted to our hospital for the evaluation of right hypochondralgia and loss of weight. She was diagnosed as choledochocele with percutaneus transhepatic and endoscopic retrograde cholangiography demonstrating cystic dilatation of the terminal common bile duct protruding into the duodenum. In this case, the form of choledochocele was different from type IIIa or type IIIb classified by Scholz. Typical sphincteroplasty was done and it was revealed that inner wall of the choledochocele was histologically formed by mucosa of bile duct and outer wall by duodenal mucosa. In Japan, only 11 cases of adult type of the choledochocele including our case were reported.

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A case of early choledochal cancer, which was difficult to differentiate from choledo-cholithiasis preoperatively was reported in this paper. The symptoms, clinical course and results of the laboratory blood test were extremely similar to the characteristics of choledo-cholithiasis, and did not show the characteristics of choledochal cancer. However, upon a close and detailed assessment of X-ray photographs of FRCP, some features to differentiate it from choledocholithiasis were detected. It should be emphasized that it is important to perform direct radiographies of the biliary tract such as ERCP, and PTC, in order to identify early choledochal cancer.

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Recently, new gastrofiberscope with distal camera, FGS-CMXII is produced experimen-tally for the purpose to taking high-quality photographs. FGS-CMXII has 4-way angulation system and fiberoptic light guide system. The most chararteristic points of FGS-CMXII is continuously variable system of shutter-speed with EE system and electronic shutter. The maximum shutter-speed is 1/1000 secound. This f iberscone was used on The stomach was satisfactorily observed as well as other types of fibergastroscope. The photographs with FGS-CMXII were not satisfied us perfectly in the point of color balance and brightness FGS-CMXII must be improved in those points.

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We reported our experiences of pediatric ERCP using pediatric duodenofiberscope-Olympus PJF-BS. Cannulations into the orifice of Vater's papilla wrer possible in all cases (100-0) by PJF-BS, but ERCP by JF-B2 was successful in only 35%. ERCP examination by this eqfipment were performed for pediatric patient of 2 year and 9 months on an average, and youngest age was 2 month after delivery. Not any complication like an injury on gastric and duodenal mucosa was experienced. New devices of more thin fiberscope with side view are expected for smaller and younger age of patients. This equipment was very useful not only for pediatric ERCP but also for general endoscopic examination for upper gastrointestinal tract and ERCP for acult, because of its better viewing and easy manipulation as JF-B₂ and JF-B₃.

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