The author investigated the result of screening examination of the UGI tract by x-ray fluoroscopy on 4, 568 outpatients and by endoscopy with a thin forward-viewing panendoscope on 5, 043 outpatients of his clinic to determine which should be the method of choice. No significant difference was observed in the frequency of peptic ulcer ana its scar detected. However, much more minute or superficial changes such as small elevations or erosions were diagnosed by endoscopy. The superiority of endoscopy was clearly proved in the early detection of esophageal and gastric cancers. Seven esophageal cancers including one early and one superficial cancer were detected in the endoscopy group versus 3 cancers in the fluoroscopy group. The frquency of early cancers among whole gastric cancers diagnosed and proved by surgery was 14.5% in the fluoroscopy group and 45.3% in the endoscopy group (p< 0.01). In author's impression, no significant difference was observed between the two methods in the adverse effects including minute ones and the acceptability of the patients. In economical preference, the reproducibility and easy keeping of their documentation and facility to master its techniques, endoscopy was again considered to be superior to fluoroscopy.

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X-ray examination is generally performed as the first screening method of the upper G-I tract, and endoscopy is thought to be a closer examination. Endoscopy might be a preferable way, however, as the first screening if one can do it skillfully and reduce the uneasiness or fear of the patients. Since 1981, we have chosen an “endoscopy first” principle instead of “X-ray examination first”. Endoscopic screening was performed on 1196 cases in 15 months from January, 1981 and the results were compared with those of X-ray screening group of 1318 cases in a year of 1980. No significant differences were found in age, sex and symptoms between both groups. The endoscopy group showed significantly higher detection rate of esophagitis, esophageal varices, gastric polyp and duodenal ulcer than the X-ray group (p <0.01). Although the endoscopy group showed only higher detection rate without significance than the X-ray group in regard to early gastric cancer, all the location of the lesions were pointed out, while only 7 out of 9 were done in the X-ray group. 11 cases of early gastric cancer in the endoscopy group were shown with their 13 resected lesions. X-ray examinations seems unable to reveal three of them. The detection rate in whole of the upper GI tract lesions except for gastritis was significantly higher in the endoscopy group than the X-ray group (p<0.005). The questionaires on the examination were carried out to the endoscopy group and 388 patients answered to them. In 66.8% of them, less discomfort was felt than that was expected before examination, while 33% of them expressed that the pain was stronger. After all, 88.6% of those patients answered that they would hope endoscopy again in need of the screening of the upper G-I tract. From these results the followings are concluded : Endoscopy is a better screening method comparing with X-ray examination and possible to use practically as a screening examination for the upper G-I tract.

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According to our criteria (see Figure 1-6), 214 cases undergone polypectomy were reviewed to determine characteristics for permitting safe and reliable polypectomy. These results suggest that the indication of polypectomy as a total biopsy for polypoid lesion can be decided by morphological characteristics (irrespective of epithelial one or non-epitherial one). In terms of the Yamada's classifications, the polypectomy is indicated for Type II to Type IV. In polypoid lesions (submucosal tumor such as Figure 1 & Figure 6), in which there is no indications of the polypectomy, histological diagnosis was made by the use of high frequency treatment. The results obtained in Type I (Figure 1) were extremely poor, indicating difference in histological diagnostic possibility depending upon macroscopical appearance. It was also shown that heterotopic gastric gland and eosinophillic granuloma were commonly seen in the submucosal tumor polypectomized.

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We had reported that 5 layers of gastric wall could be visualized by means of an ultrasonic endoscope. In this paper, we made clear the histological structure of these 5 layers of gastric wall by comparing endoscopic ultrasonogram with corresponding histology. As the result, it was found that both the 1st. layer (hyper echoic) and the 2nd layer (hypo echoic) meant the mucosal layer, the 3rd. layer (hyper echoic) was the submucosal layer, the 4th. layer (hypo echoic) was the muscular layer and the 5th layer (hyper echoic) corresponded to the serosal layer. On the basis of this study, we could diagnose the depth of invasion of gastric cancers by means of the ultrasonic endoscope. Moreover, we clarified in the same way that the laser-irradiated gastric wall was visualized as hyper echoic region by means of an ultrasonic endoscope, and could recognize the area and depth of the degenerated point. This may suggest that ultrasonic endoscope might be useful for the judgement of the effect after laser irradiation to the early gastric cancer.

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It is well known that magnifying endoscopy with chromoscopy is useful for the observation of minute mucosal changes and the early detection of gastrointestinal diseases. Several magnifying colonoscope, i. e. CF-MB-M, CF-HM, had been devised and the minute mucosal structures of the colon were clarified with ease endoscopically. However, ex-tremely small cancerous lesions (focal cancer) were not exactly diagnosed even by these conventional magnifying colonoscopes. Therefore, microscopical cellular diagnosis of cancer was required and further improvement of the magnifying power of the scope was expected. Ultra-magnifying colonoscope, type CF-UHM, was devised for this reason. It enables us to magnify the mucosa 170 times and inspect an individual cell and its nucleus which compose the intestinal gland. During the last two years, 171 cases were examined by means of CF-UHM ; they were 68 cases of colon cancer, 42 of benign polyp, 29 of ulcerative colitis and 32 normal subjects. Before observing the magnified mucosa, dye such as methylene blue, toluidine blue and/or cresyl violet was given in order to stain the mucosa. Dye firstly entered into the vacuous cytoplasm of the goblet cells. Then, the nucleus was stained and the cytoplasm was stained gradually. After 10 minutes, epithelial cells were diffusely stained by the dye and we cannot distinguish between structures of the cell. Cresyl violet stained the nuclei charac-teristically. Thus, each cell and nucleus which compose the intestinal gland were clearly inspected by CF-UHM with the chromatographic aid. Therefore, it was emphasized that diagnostic accuracy for colon cancer will be improved by the observation of the cellular atypism.

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This is a presentation of a case with double pylorus which occurred presumably owing to having taken a large amount of analgesics. The patient was 78-year-old male who was admitted to our hospital with a chief complaint of anorexia. He had a history of having taken a large amount of analgesics for three years. Upper G-I x-ray examination demonstrated two routes communicating between the antrum and duodenal bulb. Irregular dilatation and stenosis were found in the route along the greater curvature. These two routes were also found by endoscopic examinations. A diagnosis of double pylorus having another communication along the greater curvature was confirmed by reversed observa-tion and dye-staining with methylene blue in the duodenal bulb. We presumed that this case was an acquired type of double pylorus from the following reasons; 1) the patient was of advanced age, 2) he had history of having taken a large amount of analgesics, and 3) no contraction was found in the route of greater curvature. In addition, we briefly reviewed 106 cases of double pylorus reported in the literature.

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Lymphangioma occurring in the large intestine is an extremely rare. We have recently encountered a case which was demonstrated a polypoid lesion at splenic flexure on barium enema examination and endoscopic study. The patient, age of 58, male, was hospitalized with complaints of long-term history of hemorrhoid. Barium enema demonstrated a well defined, about 2 cm in size, and smoothly surfaced polypoid defect at the splenic flexure of the transverse colon. Colonofiberscopic examination showed a cystic tumor with fluctation overlying the smooth colonic surface. Endoscopic polypectomy with snare was easily done with carefullness. The bulk of the lesion was excised from normal colonic mucosa. Gross appearance of the excised specimen was a smooth polypoid mass, measured by 1.5×1.0 cm, with cystic spaces containing clear and translucent fluid. Diagnosis of colonic lymphangioma was made by histopathologic confirmation. Conclusively, the characteristic X-ray and endoscopic features were reported as above description.

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We repored a case of the Dubin-Johnson syndrome associated with fatty liver, whose liver did not show the characteristic features of greenish-black color. A 29-year-old man was admitted because of jaundice. On admission, marked obesity, jaundice and hepatomegaly were present. The serum bilirubin concentration was 2.8 mg/dl, and direct bilirubin was 2.1 mg/dl. An extended bromsulphalein (BSP) test showed a late rise curve. On laparoscopy, the liver was not greenish-black but sparsity of black spots was present and observed on the smooth liver surface. The histological findings showed a remarkable fatty liver without any evidence of inflammation. The liver cells containing brown granules were small in number because of fatty degeneration of the hepatocytes.

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In a 51-year-old man with left hypochondralgia, abdominal ultrasonic and CT scan plus angiography revealed evidence of pancreatic cancer. Barium enema and colonoscopic examination showed a smooth polypoid lesion with a depressed head. Colonoscopic polypectomy was done and the resected specimen was a 2.0×2.0×2.5 cm sized lipoma. In Japan, 112 cases have been documented. In these 112, endoscopic polypectomy was performed in only 12. If a lesion is pedunculated or semipedunculated, and snaring is feasible, endoscopic removal can be done.

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During a period of 11 years from June, 1972 to December, 1982, we performed 144 endoscopic examinations to 108 pediatric patients ranging in age from 1 day to 15 years. They consisted of 64 boys and 44 girls. Upper GI endoscopy, colonoscopy and endoscopic retrograde cholangiopancreatography (ERCP) were employed in 51, 51 and 6 patients, respectively. The age distribution was as follows : 4 patients (4.7%) under one year old, 41 (38%) between 1 and 6 years, 34 (32%) between 7 and 12 years, 29 (27%) between 13 and 15 years. In general, upper GI endoscopy was performed under general anesthesia in patients aged 8 years or younger, and topical pharyngeal anesthesia in those aged 9 years or older, and it revealed abnormal findings in 39 (77%) : foreign body in 14, gastic ulcer in 12, duodenal ulcer in 7, gastric cancer in 2, others in 4. Colonoscopy was performed under general anesthesia only in patients who underwent polypectomy or the examination for the ileocecal region and it revealed abnormalities in 26 (51%) : ulcerative colitis in 8, colonic polyp in 7, colitis in 4, Peutz-Jeghers syndrome in 3, others in 4. ERCP yielded a diagnosis of congenital bile duct dilatation in 2. In the present series, endoscopic examination was applied to pediatric patients and was very effective in making a diagnosis, excising polyps and removing misingested foreign bodies.

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A newly deviced colonoscope, type CF-10I (Olympus), was evaluated clinically concerning to insertion, manipulation and observation comparing with CF-IBW widely used in the world. An expert having experience over 10 years performed 100 cases of colonoscopy with CF-10I and CF-IBW, respectively. A beginner having experience less than one year performed also 100 cases with CF-10I and 70 cases with CF-IBW. The insertion rate to the cecum by the expert was 100% with both CF-10I and CF-IBW, whereas that by the biginner was 88% with CF-10I and 86% with CF-IBW. Average time for the insertion to the cecum by the expert was 11.7 and 11.4 minutes with CF-10I and CF-IBW, respectively. The average time by the beginner was 16.2 and 20.5 minutes with CF-10I and CF-IBW, respectively. Thus, there was no difference between two scopes for the expert, while CF -10I was better than CF-TRW fnr the hecrinner ber cause of a 1ittle shorter insertion time. We considered that this new colonoscope, type CF-10I, developing out of CF-IBW is designed from the standpoint of human engineering, and that it is advantageous for insertion, manipulation and observation, and gives good pictures. Moreover, it is easy to operate not only for experts but also for beginners having little experience in colonoscopy. Introducing this fiberscope, type CF-10I, colonoscopy is expected to become more popular as a routine examination, and to be widely applied to physiological examinations and emergency cases.

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