Cases of active upper gastrointestinal bleeding were divided into 3 groups ; 45 cases treated by endoscopic Nd-YAG laser, 13 cases treated by endoscopic argon laser and 41 cases as control group treated by other hemostatic methods. Hemostasis for over 72 hours was achieved in 93% of the Nd-YAG laser group (42 of 45), in 77% of the argon laser group (10 of 13), and in 63% of the control group (26 of 41). The mean blood transfusion volume before therapy were not so different among the 3 groups. The mean blood transfusion volume after therapy in severe cases was 1, 490 ml in the Nd-YAG group, 2, 070 ml in the argon group and 5, 050 ml in the control group. In moderate cases, 560 ml in the Nd-YAG group, 930 ml in the argon group and 2, 290 ml in the control group. In moderate cases, need of surgical operations within a month after therapy was 7% in the Nd-YAG group (2 of 28), 11% in the argon group (1 of 9) and 38% in the control group (10 of 26). Using argon laser, bleeding from exposed blood vessels, the diameter of which were over 1.5 mm, could not be stopped. No severe complication was observed using endoscopic laser hemostasis. From these results, it was concluded that the endoscopic Nd-YAG laser hemostasis was effective to stop the gastrointestinal bleeding. However, further studies are necessary in which laser hemostasis is compared with other endoscopic hemostatic methods.

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Peritoneoscopic investigations of alcoholic liver injury were performed, and described some characteristic findings in its relationship to histological findings, which were compared to hepatitis-B associated liver diseases (HB group). We classified peritoneoscopic figures of the liver surface into six patterns : smooth, minimal change, uneven, crapy, granular and nodular. Among them, "crapy" and "granular" patterns were characteristic to alcoholic group compared with HB group. Histologically, "granular" pattern was micro-nodular and "crapy" pattern was deeply related to the liver cell necrosis and connective tissue fibrosis associated with pericellular fibrosis which was considered to be one of the most characteristic findings in alcoholic liver injury. "Irregularly undulating liver surface" was another characteristic finding which was also thought to be related to the liver cell necrosis. In addition, yellowish and brownish tone of color were more frequent in alcoholic group than HB group. Reddish asteroidal markings, broad depression and crowded fine lymphovesicles were also well related to alcoholic group. These findings were considered to be useful to peritoneoscopic diagnosis of alcoholic liver injury, together with crapy and granular patterns of the liver surface. In alcoholic group, acute alcoholic hepatitis possessed these findings very well.

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The usefulness of endoscopy in mass screening of the stomach was studied. The rate of detecting gastric cancer was 0.07% before the introduction of endoscopy (the rate of patients who received close examination was corrected) and 0.13% after the introduction of the endoscopy (correction rate). In the areas in which specialists visited to perform screening using endoscopy, the rate of detecting gastric cancer was 0.08% in period I (using a GT-PII type of endoscopy), 0.13% in period II (using a GT-PA or GTF-S₂, S₃) and 0.16% in period III (using a GTF-S3 in all cases), indicating a high rate of detection. On the other hand, in the areas in which the screening using endoscopy was not performed, the corresponding figures were 0.08%, 0.06% and 0.08%, indicating a tendency not to develop.The results suggested the usefulness of this kind of screening. When the photographing conditions of each kind of endoscope according to the site of the stomach were studied, the rate that was not photographed was 19.3% in the area surrounding the pylorus and 16.7% in the f ornix of the stomach and the greater curvature of the upper part of the corpus ventriculi in patients without disease, if the GTF-S₃ is employed. In patients having diseases, it was 28% in the area surrounding the pylorus and the greater curvature of the all sites throughly because there is the possibility that attention will be focused on only one lesion. The fibergastroscope was more useful than the gastrocamera with regard to succeeded rate of photographing, re-examining rate, and incidence of accidents. Reviewing endoscopic films that were photographed one year or more earlier defining gastric cancer demonstrated that the possibility of retrospectively diagnosing gastric cancer was 60% and that the rate of overlooking and misdiagnosing was 25%. The advance of gastric cancer was found to be not so rapid from the results of the analysis of observing its course. If endoscopy is completely performed, screening once a year is enough. And I believe that even screening once every two or three years may be of use in many cases.

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We investigated the fundamental of a new endoscopic measuring system consisting of low power argon ion laser, transmission diffraction grating made of glass fiber, and microcomputer for graphic processing. The fiber grating is made of a single layer of uniformly directed glass fibers. When two layers of fiber grating were piled up with a right angle crossing of the fiber bundle to each other, and laser beam made enter the grating, two dimension array of diffracted beam was gained. Determination of the diameter of the in vitro model of the gastro-intestinal lesion was possible, when the pattern of diffracted beam was projected on the lesion. By means of graphic processing for de tecting the deviation of the laser pattern on the lesion, it was thought possible to measure the height, depression and declination by the order of 1mm. Since the fiber grating is so small as to be put into the top of the ordinarily used endoscope, diffraction pattern can be projected on the gastro-istestinal lesion. As the measurement by this system needs no more process than the routine endoscopic examination does, the compliance of the system with the patient might be more favorable than the former endoscopic measuring systems. The system must be useful for clinical evaluation of the healing process of the peptic ulcer and the experimental cancer reseach.

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To elucidate the cytoprotective effect of prostaglandin, the effect of 17 S-20-dimethyl-6-oxo-prostaglandin E 1 methyl ester (PGE₁ denv.) on gastric mucosal blood volume and gastric secretion was studied in five normal volunteers. Mucosal blood volume at 20 different regions in the stomach was measured by a reflectance spectrophotometry during endoscopy. After the measurement of mucosal blood volume before PGE₁ deriv, administration as control, 5μg of PGE₁ deny, was given orally. At 30 min after PGE₁ deriv, administration, an endoscopy was inserted again into the stomach and the measurement of mucosal blood volume was performed and finished in 20 min. This examination was repeated 1 week later with 10μg of PGE₁ deriv, administration in the same volunteers. After 5 or 10μg of PGE₁ deriv, administration, the mucosal blood volume increased at all regions in the stomach. Especially, in the antral region, the increase was statistically significant. However, 10μg of PGE₁ deriv, administration showed almost the same increase of mucosal blood volume as that of 5μg PGE₁ administration. The effect of PGEI deriv, on gastric secretion was also studied in these 5 volunteers. Gastric acid secretion and volume output had a tendency to be decreased. In conclusion, 17 S-20-dimethyl-6-oxo-prostaglandin E₁ methyl ester increased the mucosal blood volume, but had a tendency to decrease gastric secretion. These results may relate the powerful cytoprotective effect of prostaglandin E₁.

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Colonoscopy was performed in 519 patients with colorectal polyps during a period of 2 years and 10 months from July 1979 to April 1982, including 170 (32.8%) patients with multiple polyps. 512 polyps were exised at 386 examinations and 483 polyps were totally or partially retrieved. A retrieval rate of the excised polyps was 94.3% and tended to be lower in proportion to an increase in number of excision at one procedure and a decrease in size of a polyp. Total colonoscopy was performed in 64% of polypectomy procedures. 39.3% of the polyps were present distal to the descending colon. 381 (82.4%) of the excised polyps were adenoma, including 36 (7%) of focal carcinoma and 5 (1%) of early invasive carcinoma, all of which were classified into early cancer. All of early cancers were over 6mm in greatest diameter and two of invasive ones were than 7mm. As complication, massive bleeding was encountered in 2 (0.5%) patients and no perforation was noted. The following considerations were recommended to retrieve the excised polyps in case of multiple occurrence. Two polyps in the proximal colon can be simultaneously retrievedd using a basket forceps. In case of multiple polyps throughout the colon, at least two procedure should be attempted at different times, one for the right colon, the other for the left colon. Biopsy should be obtained from a small polyp, but it is not always necessary to retrieve a polyp smaller than 5mm. However, a polyp over 6mm in size should be retrieved and recorded on the exact location.

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Stimulating cancerous lesion in the colon and rectum by argon laser light of 488 and 515.5nm wave length transmitted through a light-guiding glass fiber bundle of an endoscope, we endoscopically observed fluorescence excited in the cancerous tissue using special filter (Kodak Wratten gelatin filter) without oncotropic photosensitive agents. Regardless of size, advanced cancers clearly showed orange red fluorescence rather densely on the marginal wall of the tumors in 17 of 22 cases studied. The clear fluorescence of orange red color was densely viewed also on the ulcer bed of the craters in 7 of 22 cases. In all 5 cases of early rectal cancer, the tumor was ovserved dark orange, and spotty or patchy fluorescence of the orange red color was spasely viewed on the tumor. As it is still difficult for ordinaly endoscopy with natural light to detect early colorectal cancer today, the endoscopic observation of fluorescence of colorectal cancer excited by argon laser is considered significant, and this method would be an usefull diagnostic procedure for early detection of cancer in the large intestine.

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In order to know the extent of infiltration of depressed type gastric cancer endoscopically, we studied the color change of cancer area after spraying of Prostaglandin E₁(PGE₁), Prostaglndin F₂α and Epinephline (EP). Results were as follows : 1. Color change after spraying PGE₁ (4μg/ml) did not make a lesion clear. (Table 2, 3) 2. Color change after spraying PGF₂α (200μg/ml) made a lesion clear with redness. (Table 4, 5) 3. Color change after spraying EP (200μg/ml) made a lesion clear with redness in the early phase, but the redness turned to be pale in the later phase. (Table 6, 7 ) 4. Color change after spraying EP follow by PGEI made a lesion clear with redness the same color as the surrounding mucosa. (Table 8, 9, 10) It was concluded that the spraying method of vasoactivators is useful for the diagnosis the extent of infiltration of depressed type gastric cancer. The pharmacological mechanism of mucosal vessels response by this method should be worked out.

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The prototypes III and IV have a high image resolution power, for example, clearly visualizing the gastric wall in five layers, and with improvements of apical defection system, it becomes possible to introduce the scope (prototype IV) down into the descending portion of the duodenum. With satisfactory improvements, the prototype IV is clinically evaluated as a well accomplished ultrasonic upper G-I endoscope, and the scope will be surely contributory to the diagnosis of small mass lesions in the head of the pancreas and also for the estimation of the range and deepness of the gastric cancer invasion.

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A 72-year-old woman with a history of anterior mediastinal mass for 3 years (Figure 1) was admitted for evaluation of facial edema. There was no history of liver disease and tests of liver function on admission were normal (Table 1). Esophagogram and endoscopic study showed varices of the upper esophagus, but none in the lower (Figure 3, 4, 5) . Serial brachial venography demonstrated obstruction of the right and the left brachiocephalic veins and the superior vena cava. The hemiazygos vein was filled after upper esophageal venous plexus was visualized (Figure 6). Downhill varices have been divided into two types i. e., upper portion type and entire type, based on whether the obstruction is over the junction of the azygos vein and the superior vena cava or below it. However, this case could not be applied to this classification. Therefore we suggest that downhill vaices should be divided into two types depending on whether the azygos vein and the hemiazygosvein are both occluded or not (Figure 7).

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We controlled bleeding from exulceratio simplex (Dieulafoy) in two cases by endoscopic local injection of HS-E solution. Case 1:A 72-year-old man, who had a partial gastrectomy for peptic ulcer 20 years ago, admitted to the hospital with severe anemia. The bleeding continued and we could not find the point of bleeding nevertheless severaltimes of endoscopic examination. At the third week of the admission, we observed a jet of blood from the greater curvature of the remnant stomach. Immediately we injected HSE solution at the point of bleeding and could stop it. Case 2 ; A 59-year-old man admitted to the hospital complaining hematemesis and tarry stool. Re-bleeding was noticed twice after admission. On the 6th hospital day, we found an exposed vessel at the anterior wall of the fornix and injected HS-E solution. We could not detect any peptic ulcer surrounding the exposed vessel, therefore we diagnosed these two cases as exulceratio simplex. It tends to be considered that an operation is the only treatment for the bleeding from exulceratio simplex. However we think that it could be stopped by injecting HS-E solution endoscopically as in our experiences.

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A case of Osler's disease with multipe arteriovenous malformations in the gastrointe stinal tract is reported. The patient was a 46-year-old man complaining of tarry stool. His elder brother had epistaxis and subarachnoidal hemorrhage. At the time of admission, the palpebral conjunctiva was anemic and several telangiectatic small red spots were observed on the lips and tongue. Laboratory findings revealed red cell count 2.50 millions, hemoglobin 7.1g/dl, and serum iron 39?Eg/dl suggesting iron deficiency anemia. No recognizable abnormalities in blood coagulation system were detected. X-ray examination of the stomach showed two small ulcers in the middle body. Gastroscopic examination revealed not only the ulcers but also other lesions of multiple telangiectatic red spots in the middle to upper body. Histological findings of biopsied specimen from one of the telangiectatic spots showed dilation of capillaries in the superficial lamina propria of the stomach. X-ray examination of the colon showed no abnormal findings. Colonscopic examination showed a few telangiectasia on the hepatic flexure and descending colon. Selective celiac angiography confirmed the presence of arteriovenous malformations in the stomach, showing dilated small vessels and poolings of the contrast medium in the peripheral arteries. The changes were also detected by selective superior and inferior mesenteric angiography.

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A case of duodenal lipoma removed by endoscopic polypectomy was reported. A 53-year-old female was admitted to our clinic with complaints of epigastric distress. Upper GI barium meal and endoscopic examination revealed a polypoid lesion in the duodenal bulb. Endoscopic polypectomy was performed, and the polyp was successfully removed without any accidental complication. The resected tumor was 16×13×12mm in size and histologically diagnosed as a benign submucosal lipoma. The cases of duodenal tumors with endoscopic polypectomy so far reported in Japan were reviewed and the significance and problems of endoscopic duodenal polypectomy were discussed.

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A 73-year-old man was admitted with a complaint of general fatigue of one-yearduration. Physical examination showed no abnormality. Laboratory data showed abnormal elevation in alkaline phosphatase, y-glutamyl transpeptidase, leucine aminopeptidase and SGOT values. Ultrasonography showed dilatation of the bile duct and a floating stone in the common bile duct. Endoscopic retrograde cholangiography showed the stone in the common bile duct and serrated stenosis of the lower common bile duct. Percutaneous transhepatic cholangial drainage (PTCD) was started and the fistula was gradually enlarged by increasing the size of replacing catheters from 8Fr to 2OFr during one month. PTCS was performed through the fistula. After lithotomy by PTCS, three polyps with papillary surface were found at the stenotic lesions of the lower common bile duct. "Biopsy specimen showed fibroadenomatous hyperplasia. The polyps were resected piecemeal by PTCS. After four months, cholangiography through PTCD catheter showed a slight deformity at the lower common bile duct without any residual stones. He is well being eight months after discharge. This is the first case diagnosed preoperatively among nineteen reported cases of benign epithelial tumor of the extrahepatic bile duct exclusive of the gallbladder in Japan. PTCS is useful in definite diagnosis of lesions of the bile duct and a convenient procedure of treatment in selected cases.

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