Intragastric pressure was measured by a telemetering method ; gastric blood flow was measured by 133Xe and Hydrogen clearance methods. The relations among the intragastric pressure, gastric blood flow and atrophic gastritis were studied. The objects were 122 cases without localized lesions in the stomach. The results were as follows; 1) The intragastric pressure measured by the telemetering method, can be shown as an absolute value with atmosphere pressure 0cmH₂O as its basis. Therefore, the intragastric pressure of each case can be compared, furthermore the remaining intragastric pressure can be measured correctly. The mean value of the remaining pressure was 8.6cmH₂O. The remaining pressure slightly decreased according to the advance of age (Table 1). The mean value of the maximal intragastric pressure was approximately 25cmH₂O. There was no correlation between the maximal pressure and the age (Table 1, 2). The appropriate intragastric pressure during endoscopical examination was 15-20cmH₂O. 2) The results of both 133Xe and Hydrogen clearance method at the intragastric pressure of 15-20cmH₂O were similar. That is, the mean value of blood flow in the lower gastric body was 63.3ml/min/100g (133Xe-method, n=38) and 65.ml/min/100g (H₂-method, n=30). The blood flow slightly decreased according to the advance of age (Figure 11). In all of the 14 cases by 133Xe-clearance method, the blood flow decreased due to the increase of intragastric pressure. 3) Slight negative correlation between atrophic gastritis and remaining pressure was found (Figure 13). However, there was no correlation between atrophic gastritis and maximal pressure. Evident negative correlation between atrophic gastritis and gastric blood flow was found (Figure 14, 15, 16). The rate of coincidence between endoscopical diagnosis and histological degree of atrophic gastritis was 86.7%.

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In our Department, endoscopic polypectomy was carried out in 82 colonic lesions including 74 cases of adenoma during the past four years. The author investigated the possibility of cancer transformation of colonic adenoma with use of these materials. Seventy-four adenomas were investigated hisologically according to the Mutoh and Morson's classification. The analysis revealed that there were 17 lesions (23%) of early cancer; 15 lesions of carcinoma in situ (m cancer) and 2 lesions of cancer involving submucosal invasion(sm cancer). The size of early cancer was over 10 mm in diameter in 16 lesions out of the 17 lesions and only one lesion was under 10 mm in diameter. The subpedunculated polyps of 10-20mm in diameter mostly showed cancerous alterations. The both two lesions of sm cancer were also subpedunculated type with the diameter over 20mm. These results seem to indicate that the possibility of malignant transformation is significantly high in the subpedunculated adenoma over 10mm in diameter. The histochemical nature of the mucin contained in the goblet cells was studied in relation to the degree of atypism of the colonic adenoma. Many cases of mild dysplasia were shown to contain both sialomucin and sulfomucin by HID-AB stain. The sialomucindominant goblet cell type was found in 40% of the moderete dysplasia cases. In the early cancer cases, the proportion of the sialomucin-dominant goblet cell type reached 64.7%. It is suggested that this goblet cell mucin pattern might be the change characteristic to the malignant transformation of colonic adenoma.

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An endoscopic embolization treatment (EET) was employed in 151 patients with esophageal varices (emergent : 71, elective : 42, prophylactic : 38), utilizing intravascular injection of 50% glucose, thrombin and 1 % Aethoxysclerol. All of the patients were followed up and the results were summarized. 1. In 55 cases (87.3%) out of 63 patients in emergency (except 8 patients with hepatic failure within 2 weeks), bleeding wa;s successfully controlled. Eight cases out of those 55 patients underwent elective surgery from 1 to 2 months after EET. 2. Percentage of emergent operation for esophageal varices decreased from 18.6% to 4.2% following an introduction of EET. 3. Cases with elective and prophylactic treatment were followed up endoscopically. In some cases, varices completely disappeared. In a majority of cases, Red-Colour sign became less remarkable and formation of variceal thrombosis was seen. 4. In 9 patients, percutaneous transhepatic measurement of portal pressure and portography were performed before and after EET. Portal pressure increased by 6.4cmH₂O on an average. Portography suggested an increased flow through porto-systemic shunt except through esophageal varices. 5. In autopsy cases, variceal thrombosis was found in lower esophagus and cardia of the stomach. 6. As complications of EET, 1 patient with blood aspiration among emergency cases and 6 patients with bleeding from the site of injection among elective and prophylactic cases were seen. None of other major complications were encountered in our series.

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Upper gastro-intestinal endoscopy in pediatrics, aged from 18 months to 15 years, was performed on 66 occasions in 33 cases. Premedications, as a rule, were given in the same way as adult with injection of anti-spasmodics and oral anesthesia in patients aged 4 years and older. However, five of them were examined under general anesthesia with inhalation of Nitrous Oxide or injection of Ketalar, and four were under the age of 3. All patients were safely and fully examined by using the ordinary f iberscopic instruments for adult, and no hazard was experienced during and after the procedures. Main troubles in 33 cases required the examination were abdominal pain in 11, anemia in 9, hematemesis and melena in 6 and foreign body swallowing in 3 cases in order. Pathologic changes in the upper GI tract were found in 20 of 33 cases (61%). Ulcerative lesions were detected in 4, 3 and 2 of the patients with abdominal pain, anemia and GI bleeding sequentially. In our present study, the endoscopic survey of the upper GI tract in an early stage of diseases should be considered in pediatric patients, particularly in patients without apparent abdominal complaints.

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Many reports have been made about "steroid ulcer" or "drug induced ulcer" and the ulcers in the patients of collagen diseases. But the concepts of such ulcers are overlapped, and the location of the ulcers is not yet determined. The relation of the ulcers and the acid-secretion border has also been unclarified yet. We studied, by endoscopy, 56 cases of upper G. I, tract ulcers which have occured during the treatment for collagen diseases (group A) and 516 cases as control group (group B). The control group included the cases of the ordinary upper G. I . tract ulcers without any involvements of collagen diseases and not receiving any anti-inflamatory drugs . Group A were deviled into three groups. The group 1; administered only with steroid drugs. The group 2; administered only with non-steroidal anti-inflamatory drugs. The group 3; administered with both type of drugs.Acid-secretion-borders were determined by the endoscopic Congo-Red method. The incidences of prepyloric ulcers in these three groups were outstandingly high in contrast to control group. The respective incidences were the following ; group 1; 6 cases out of 7 (85.7%), group 2 ; 8 cases out of 11(72.7%), and group 3 ; 33 cases out of 38 (86.8%). On the other hand, the incidence of prepyloric ulcers in control group was very small(3.7%). The prepyloric ulcers found in group A were so distinctively unusual that the lesions were apart from the acid-secretion-borders determined by the endoscopic Congo Red method. It was thought from our further evidences that prepyloric ulcers are not specific to RA or collagen diseases. We conclude, therefore, the feature of such region is characteristic of gastric ulcers induced with anti-inf lamatory drugs during the treatment for collagen diseases (especially for a long period).

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Extreme difficulties were experienced in establishing histological diagnosis of submucosal tumors clinically except for the cases showing ulceration or special cases. It was rare that tumorous tissue including the gastric mucosa covering the tumor could be collected by use of ordinary biopsy forceps. Even in cases showing ulceration, biopsy of the exposed tumorous tissue was associated with a risk of bleeding. In exploration for a technique with which tumorous tissue can be collected safely and accurately in hospitalized patients, we deviced a method ultilizing topical infusion of pure ethanol which has been used by us as a method to stop bleeding from the gastrointestinal tract. By our method, an ulcer is produced artificially on the surface of tumor and biopsy was made of the tumor exposed in the ulcer base. Using this method, a total of 20 biopsies were made in 12 cases and 100 bioptic preparations could be collected. Of these, 64 preparations (64%) were regarded as good. Biopsies by our method caused little or no bleeding in any of the cases. Our method which is safe and simple is useful for biopsies from submucosal tumors. However, in order to prevent massive bleeding or perforation, it is important to exclude vascular tumors or compressions from extra-gastric tumors using submucosography.

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Basic studies were carried out on the utility and the ssafety of the Palliative treatment for esophagogastric malignant stenosis by positioning of the plastic prosthesis. We transplantated the VX2 carcinoma endoscopically into the esophagus of 36 male rabbits. Eleven of them, “tube (+) group”, were positioned the plastic tube when the VX2 carcinoma was enlarged more than the half round of the esophagus, and 10 of them, “tube (-) group”, were not positioned the plastic tube. Amount of oral intake of the “tube (+) group” was statistically greater than that of the “tube (-) group” (P <0.01). Changes of the body weight and the survival days of both group were not different statistically. Side effects of the plastic tube were, perforation (9.1%), pressure necrosis (18.2%), obstructin (9.1%), and tube migration (18.2%). Therefore, it is considered that endoscopic treatment for malignant stenosis by positioning of the plastic prosthesis would give the patient the joy of eating and social life, when the the complications can be controlled.

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We have carried out the endoscopic hemostasis with Nd-YAG laserphotocoagulation, local injection of pure ethanol and microwave-tissue-coagulation in 38 cases of upper gastrointestinal hemorrhage. Hemostasis succeeded in 30 of 38 cases at the first procedure. In 8 cases in which the complete hemostasis was also observed in combination with other hemostatic procedures. Effectiveness of hemostasis in Nd-YAG laserphotocoagulation, lacal injection of pure ethanol and micro-tissuecoagulation were 83%, 86% and 100%, respectively. Three endoscopic procedures all revealed good effectiveness for the cases of the slight or moderate bleeding. In the cases of the severe bleeding, local injection of pure ethanol and microwavetissue-coagulation seemed to be most effective for the arterial bleeding. On the other hand, Nd-YAG laserphotocoagulation appeared to be most effective for the venous or capillary bleeding covering a wide range.

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Laparoscopic examination is indispensable to make a diagnosis or to detect pathophysiology of liver diseases. But it is difficult to train young doctors for laparoscopic examination with several reasons. We have thought that endoscopic color TV system would be useful for observation and education of laparoscopic examination . However, the previous TV camera system was too heavy and big to handle. This time we studied on the usefulness of a very light and small TV camera system, SK-1057 made by Shinko Kohki Co. This TV camera system was very easy to operate and handle at the examination. With RJ-500 made by Machida Co., we could get enough light for surveying the whole abdominal cavity. Furthemore, color and resolving power was enough in observing minute changes of liver surface. SK-1057 made an important role in educating young doctors and in training experts. From the experience mentioned abore, we thought that this camera system would be useful for education as well as dynamic observation.

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Clinical findings with reference to x-ray and endoscopic features of twelve cases with ischemic colitis were evaluated. 1) The lesions of ischemic colitis were mainly descending and sigmoid colon. It tended to occur with the older age. 2) According to classification of ischemic colitis by the Marston, stricture type, then transient type were common in our cases. We did not encounter any cases of gangrenous type of ischemic colitis. 3) X-ray feature was thumb-printing in the early stage of ischemic colitis. Sacculation was demonstrated in any stage of ischemic colitis. 4) Hyperemia of the involved mucosa in the whole cases and longitudinal ulcer in most of the cases were demonstrated on endoscopic examination. It was necessary to perform colonof iberscopic examinations in the early stage in order to detect those findings.

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A 79-year-old male was hospitalized for epigastric pain and hematemesis. Urgent esophagogastroduodenoscopy demonstrated a thumb tip-sized tumor with peduncle on the opposite side of the papilla of Vater. The tumor head had reddish and granular surface with partial erosion and bleeding. This tumor was divided into two parts by magnifying endoscopy combined with methylene blue (M. B.) staining method. At the upper part, flattened villous tips, fused villi and narrow intervillous spaces were observed. The mucosal surface of this part was poorly stained by M. B. On the other hand, the lower lateral part showed wide villous tips and gyrus like villi. The mucosal surface of this part was deeply stained by M. B. Histochemical study revealed no activity of alkaline phosphatase at the mucosal surface of the upper part of the tumor. On the contrary, high activity of this enzyme was recognized at the lower lateral part of the tumor. The former part of this tumor was diagnosed to be adenocarcinoma and the latter part to be adenoma through histopathological examination. Cancer cells invaded into the submucosal layer, but did not extend to the muscle layer. Endoscopic differential diagnosis of duodenal tumor has not been fully investigated. Twenty-one cases of early duodenal cancer have been reported in Japan. However, none of these 21 cases has been differentiated from duodenal adenoma by means of endoscopic observation. We could make clear the difference of the villous architecture and the grade of M. B. staining effects endoscopically between duodenal cancer and duodenal adenoma by means of magnifying endoscopy combined with M. B. staining method. This procedure seems to be useful in endoscopic diagnosis of duodenal cancer.

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A 64 years old man visited to the Institute of Adult Disease, Tokyo Womens' Medical College for regular health checkup. Laboratory examination was almost normal, and fecal occult blood test was negative. Barium enema study was recognized diverticulosis in the ascending colon, but there is no remarkable lesion suggestive of the polypoid lesion in the rectum. Flat polypoid lesion was recognized in the rectum with colonoscopy. Biopsy specimens demonstrated well differentiated adenocarcinoma. In the resected specimen, early colon cancer of IIa is like IIb type, 1.2cm × 1.0cm in size, was located in the rectum. Histologically, well differentiated adenocarcinoma was found in the mucosa without adenoma. For the reason mentioned above, this case is presume “de novo” origin. Author emphasized that colonoscopy was useful discovery of the early colon cancer.

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