The gastro-duodenal epithelial border was examined in 150 cases by means of retro-flexion in the bulb using small caliber panendoscope with an application of methylene blue spraying method. Results : 1) The borders were divided into two types, as follows : type I of which border located just on the pyloric ring, type II of which border located in the bulb far from the ring. The frequencies of these two types were 17.3% and 82.7% respectively. 2) The cases with closed type of atrophic border in the stomach showed dominantly type II (98.6%) but the cases with open type showed both type II (67.9%) and type I (32.1%). 3) The border showing type II was most commonly seen in the cases without intesti-nal metaplasia in the antrum, on the contrary in the cases with marked intestinal metaplasia, the frequency of type II was the same as type I. 4) The type of the border observed by endoscopy coincided with that of the resected tissue. 5) As for the distance between the gastro-duodenal epithelial border and the center of ulcer in 36 duodenal ulcers, it was revealed that the duodenal ulcer appeared closely to the border and 91.7% of them located within the distance of 10 mm from the border (average distance : 7.2 mm). 6) Finally, the cases with a pyloric ulcer seen in the bulb and an island of gastric epithelium observed among the duodenal epithelium near the gastro-duodenal epithelial border were presented.

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107 cases of esophageal varices experienced in our hospital since 1974 were classified according to the criteria of endoscopic findings. Bleeding occurred in 26.3% of white varices (Cw), 44.7% of blue varices (CB) and there was a statistical difference between Cw and C_B (p>0.05). Bleeding was found in 13.3% of varices in inferior location (Li), 35.6% of that in medical location (Lm) and 60.0% of that in superior location (Ls). There were statistical differences between Li and Ls (p <0.01), and also Lm and Ls (p <0.05), respec-tively. Classified from the form of varices, bleeding occurred in 10.0% of small varices with string-like or superficial venous dilatation (F1), 47.2% of medium-sized varices (F₂) and 54.5% of large and nodular varices (F₃). There were statistical differences between F₁ and F₂ (p <0.01), and F₁ and F₃ (p <0.05), respectively. Red-color sign (R-C sign) was demon-strated in the majority of the bleeding cases, particularly cherry-red spot, hematocystic spot and diffuse redness were more frequently demonstrated in the bleeding cases. Esophageal transection (36 cases), splenectomy and perigastric devascularization (1 case), proximal gastrectomy and splenectomy (3 cases), shunt operation (3 cases) and splenectomy alone (5 cases) were performed. Esophageal varices disappeared or improved in 86% of cases who received an esophageal transection. However, varices did not disappear by the surgical treatment of esophageal transection alone. Bleeding recurred in two of 5 cases who did not improved endoscopically. In conclusion, the present study strongly suggested that esophageal transection with splenectomy and perigastric devascularization is more effective than esophageal transection alone as surgical treatment of esophageal varices.

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Usefulness of pan-endoscopes was assessed in detecting cancers of the stomach in the early stage in comparison with conventional fiber endoscopes.Results : 1) A small diameter pan-endoscope for the upper gastrointestinal tract (the Olympus Optical Company, the Fujinon Optical Inc., the Asahi Optical Company, the Machida Manufacturing Company) was superior to a conventional big diameter endoscope as screening instrument in detecting cancers of the stomach and establishing a definitive diagnosis. 2) The examination with it is less painful to the patient. Failure to introduce the instrument is quite rate. No serious accidents have been experienced. The small diameter pan-endoscope is considered to be very useful for screening examination. 3) Randomized samples over 50 years of age, 2, 463 males and 1, 497 females were examined with a small diameter pan-endoscope for detection of stomach cancer, producing a cancer detection rate of 1.9% in the male, 1.1% in the female. A rate of early gastric cancer to total cancer was 71% (45 cases). From the evidence presented herein, the small diameter pan-endoscope has become an extremely useful tool for routine examination of upper gastrointestinal tract and it would virtually substitute x-ray examination after some problems have been solved.

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Sixteen cases of primary biliary cirrhosis (PBC) were chronologically investigated by peritoneoscopy. An analysis of the liver surface appearence was made including the dye contrast method. The implications for clinical manifestations were studied based on these findings. Ordinary alterations of the liver surface appearence according to the progress of PBC started with gentle undulations (formation of roughly bounded areas from one to three cm in diameter by dye contrast method) and progressed to subtle irregularities (minute bounded areas from 0.3 to 0.5 cm in diameter by dye contrast method) and finally supposed to progress to biliary cirrhosis. Out of these, the gentle undulations and roughly bounded areas are thought to have diagnostic significance for the liver surface appearence of PBC in a relatively early stage. With the dye contrast method, the concaved areas of the gentle undulations were the locations in which altered portal areas were more densely distributed and, on the contrary, the convexed areas contained less altered portal area. The formation of roughly bounded areas was considered to manifest the status of rather advanced fibrosis of these concaved portions. As for the findings of atypical liver surface of PBC, the following cases were observed : reddish markings which indicates portal and periportal inflammation with an irregular liver surface as in chronic active hepatitis, smooth liver surface which is observed from onset in extensive cholestasis over a thirteen years of prolonged period, and other hepatic impairment as is observed with chronic alcoholic hepatic impairment. In these cases, the diagnosis of PBC was often difficult when based only on the peritoneoscopic findings.

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Endoscopic retrograde cholangiopancreatography (ERCP) is a widely used technique for diagnosis of pancreatobiliary diseases. However, selective visualization of the biliary tract by means of ERCP is not necessarily easy. The purpose of this study is to investigate the usefulness of the adoptation of stretch-ing method with super-wide-viewing duodenoscope in ERCP. Super-wide-viewing duodenoscope with 105° of view angle (DUO-X, Fujinon) was used in 149 ERCP examinations and relatively narrow-viewing duodenoscope with 64° (JF-B₃, Olympus) in 87 examinations. The rate of successful selective visualization of the bile duct with DUO-X was higher than that with JF-B3 (93.5% compared to 77.8%), on the contrary those of the pancreatic duct with both instruments were equivalent (97.0% and 96.8%, respectively). The result of selective cholangiography in the 61 ERCP examinations, in which stretching technique with DUO-X was introduced, was significantly (p <0.01) superior to that in the 45 examinations by means of pushing method with JF-B3 (Rate of success was 96.7% compared to 77.3%). The mean examining time of selective cholangiography with stretching method and DUO-X combination in successful 30 cases was 11 minutes and 24 seconds. Stretching of the duodenoscope could be performed easily in the majority of the examined cases except for a few with markedly ptotic or severely deformed stomach. In conclusion, the combination of stretching technique and super-wide-viewing duodenoscope is an excellent method for selective cholangiography in ERCP.

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In the last 5 years, we experienced 24 cases of postbulbar duodenal ulcer, including 4 cases in the teens. The analysis was made on clinical findings and prognosis about 4 cases in the teens. 1) In our series of 24 cases, there were 4 cases (16.7%) in the teens and all were males. 2) The onset of ulceration seemed before and after the day of an entrance examina-tion of high school. 3) All the patients complained of severe symptoms. 4) No significant difference was noted on gastric secretion (B. A. O., M. A. O.) be-tween bulbar ulcer and postbulbar ulcer. 5) It was our impression of these 4 cases that the prognosis of postbulber ulcer in the young was generally not good.

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A patient with intractable gastric ulcer who could not undergo surgical treatment because of other complication was treated with cimetidine. The ulcer healed rapidly and cimetidine was reduced in the dosage but continuously administered for prevention of recurrence of the gastric ulcer. The patient had been followed in endoscopically for two years. Crystal violet dyeing endoscopy also had been occasionally performed for observing a pH value of the gastric mucosa. We found that the functional atrophic border, indicated by the pH value could be moved according to dosage of cimetidine in this study. From the above, It is clearly proved that movement of the functioral atrophic border from the area of ulceration to the cardiac area is important. Based on these results, we succeeded to prevent the recurrence of the gastric ulcer with the smallest dose of cimetidine.

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A 38 years old man was admitted to our hospital because of slight fever and epigastric dull pain. The laboratory data revealed marked elevation of serum ALP, γ-GTP, and LAP, but no definite pathological finding was discovered by liver scintigram, computerized tomography and ERCP. But, peritoneoscopic examination revealed some yellowish-white round nodules, 2-3 mm in diameter, on the liver surface of both lobes, the peritoneum and the colon. Microscopic examination of liver tissue obtained at laparoscopic examination revealed a small tuberculous granuloma composed of Langhans giant cells and central caseation. With drug therapy of INH, SM, and EB, slight fever and abdominal pain were disappered. Not only ESR and CRP were normalized, but also serum ALP, γ-GTP, and LAP were apparently decreased. The 2nd peritoneoscopic examination at 4 months later showed that the yellowish-white nodules changed into small white spots without capillary vessels around them.

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A 48-year-old male was admitted to our hospital on Augast 10, 1981 because of intermittent fever. Family history and past history were non-contributory. Two months before entry, he had an intermittent fever of two weeks' duration which fell down with oral administration of antibiotics. After this episode, he had been asymtomatic until one week before admission when he again began to suffer from intermittent fever. On admisson, he was a well-nourished man in apparent good health. On physical examination, the liver was palpable seven finger-breadths below the costal margin. Jaundi-ce and tenderness in the right upper abdominal quadrant were not recognized. The labora-tory findings revealed the followings : erythrocyte sedimentation rate 98 mm/hour, periphe-ral white blood cell 14, 400/cumm, S-GOT 34 U/L, S-GPT 84 U/L, γ-GTP 112 IU/L, Al-P 603 IU/L, LAP 178 IU/L, CRP 7 mm and Limulus test (+). 99 mTc scintigram, Ga scinti-gram, Ultrasonography and computed tomography of the liver showed an enlarged liver without focal lesions. On the 8 th hospital day, laparoscopy was performed. Several yellow micro-nodules were observed on the surface of reddish and enlarged liver. The liver biopsy specimen of one of the nodules revealed a liver abscess with neutrophil infiltration in sinusoids of the liver. The cultures of urine, blood, bile, bone marrow and liver biopsy specimen were negative. The esophagogastroduodenoscopy, barium enema and drip infu-sion cholangiography did not reveal any abnormalities except for a small diverticulum of the ascending colon. Antibiotics therapy was instituted immediately on the patient's admission and on the 48 th hospital day the fever fell down. At the same time, erythrocyte sedimentation rate and serum Al-P were also markedly improved. As delineated above, this patient was a case of multiple cryptogenic hepatic micro-abscesses and the laparoscopy was the crux of the diagnosis.

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A 39 year old man was admitted to hospital in April, 1978 with complaints of watery diarrhea and vomiting. He had suffered from rheumatoid arthritis since 25 year old. On endoscopic examination, whitish granular mucosa and so many nodular protube-rances was observed at the duodenum and upper portion of the jejunum. Examination of biopsy specimen of the small intestine revealed amyloid deposits. This seems to be the first case of amyloidosis diagnosed by endoscopic examination of the small bowel, and the peculiar mucosal appearance observed with endoscopy may be the specific finding of amyloid deposits in the small intestine.

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Colonoscopy has become very popular method in the field of diagnostic gastroenterology, although its history is short starting in the late sixties. In order to evaluate the present status of colonoscopy the enquetes containing the following items were sent to major institutes. (1) number of scopes held and the number of examination performed in 1980. (2) indication of colonoscopy. (3) types of scope used. (4) the depth of the colon to which the scope is inserted. (5) use of fluoroscopy (6) use of sliding tube (7) use of torsion and angulation of the scope (8) requests as for the improvement of the scope Total of 345 enquetes were sent and 202 (62%) of answers were obtained. The results are as follows. (1) Colonoscopy was performed in less than 100 cases a year in 114 institutes. Institute with more than 300 colonoscopies a year was 75 in number. (The data is of the year 1980) (2) The number of colonoscope used is as follows : one scope, 69 institutes ; more than four, 36 institutes. (The data is of the year 1980) (3) The commonest indication of colonoscopy is for cases with abnormal barium enema (52%), and the scope is selected acording to the barium enema findings. (4) Colonoscopy is performed with intention to insert up to the ileum, in 108 institutes (52%). (5) In more than three quarters of institutes, f luorocopy is used. (6) Sliding tube is used in most hospitals.

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