Using the general rules for recording endoscopic findings on esophageal varices by Japanese Research Society for Portal Hypertension, clinical and histopathological studies were undergone in 170 clinical cases and 27 autopsy cases with portal hypertensionconcerning the endoscopic findings of esophageal varices . 1. There was a significant correlation between bleeding and grades in "Form" or "Location" of esophageal varices. Furthermore, frequency of bleeding was especially higher in cases with "Red-Color sign" (R-C sign) . 2. Cases of "Form 1" had little danger of bleeding and they need a follow-up examination by endoscopic studies. 3. In cases of "Form 2 or 3 with R-C sign", the main cause of death was gastrointestinal bleeding in untreated group . "R-C sign" seemed to be a signal for rupture from histopathological studies and thus, they need prophylactic treatment . 4. Prophylactic surgery for varices of I . P. H. group showed a satisfactory result. 5. Histopathological studies revealed that esophageal varices was mainly formed by submucosal veins. In higher degree of variceal form, higher degree of a pile of varices was seen, and larger space of the tissue was occupied by varices . 6. "Cherry Red Spot" (C.R.S.) and "Red Wale Marking" (R.W.M.) seem to be composed of varices located at the propria mucosae just beneath the thinned esophageal epithlium located on the top of piled varices . Endoscopic difference of C. R. S. and R. W. M. seems to be due to difference of running manner of blood vessels forming varices . 7. "Diffuse Redness" seems to be formed by increased blood flow into the variceal network of the propria mucosae just beneath the esophageal epithelium and into the intrapapillary vessels of esophgeal epithelium derived vertically form the variceal network .

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Purpose of this study was to make it sure that gastric mucosal blood flow played an important role in suppression of ulcer formation. Wister rats (250-300g of body weight) were used for this study. Each rat was restrainted in water at 21°C for eight hours. During the restraint and water immersion, endoscopy was performed with a small-calibered forward-viewing f iberscope of Olympus made. Bleeding spots appeared within three-hours restraint, water-immersion. Bleeding and erosions were recognized endoscopically in eight-hours restraint, water-immersion in every cases. Gastric mucosal blood flow of each rat was measured by electrochemically generated hydrogen gas clearance method in the course of the restraint and water immersion . Gastric mucosal blood flow decreased with the lapse of time, from 60.48±5 .38ml/min/100g (before the beginning of restraint and water immersion) to 22.12±5.67ml/min/100g (eight hours after), which was a decreasing rate of 63.4%. After administration of 5mg/kg of nifedipine (Ca++ antagonist, vasopressor) to the rats, gastric mucosal blood flow temporarily increased. When 5mg/kg of nif edipine was administered to restraint, water-immersion rats every 30 minutes, gastric mucosal blood flow did not decrease, but was kept as high as the initial blood flow level even in eighthourswater immersion. The higher the gastric blood flow was kept, the smaller was ulcer index after eighthours restraint and water immersion. Ulcer indexes of nifedipine-administered rats in each hour after the beginning of restraint and water immersion were obviously smaller than those of control groups. Even if ulcerative lesions had appeared in a course of restraint and water immersion, when nifedipine was administered, the subsequent appearance of ulcerative lesions were well suppressed by nif edipine. On the other hand, gastric secretion was examined in Shay rats both with and withoutnif edipine administration in restraint, water immersion. But no relationship was found between the administration of nifedipine and gastric secreation. As a conclusion, nifedipine increased gastric mucosal blood flow, as a result of which, ulcer formation in restraint, water-immersion rats was suppressed. It suggested that suppression of ulcer formation was closely related with gastric mucosal blood flow.

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We have evaluated the significance of magnifying endoscopic observation in comparison with usual colonoscopical observation and barium enema study. The materials were 40 cases (46 lesions) which had been experienced in our hospital from 1971 to 1982. We excluded the cases of familial polyposis and villous tumors. The results were as follows : 1) The frequency of the early colonic carcinoma was 12.4% in all the resected colonic carcinomas. 2) The location of the early colonic carcinomas were at the rectum and sigmoid colon in 67% and at the right side colon in 26%. This made us emphasize the necessity of total colonoscopy. 3) Detection rate of the lesion of early colonic carcinoma by barium enema study was 83% but the rate of accurate qualitative diagnosis was 37%. 4) The rate of correct diagnosis for mucosal carcinoma by usual endoscopic observation with biopsy was 50% and that for the carcinoma with submucosal invasion was 67%. On the other hand, the rate of correct diagnosis for mucosal carcinoma by magnifying endoscopic observation with biopsy was 63% and that for the carcinoma with submucosal invasion was 100%. 5) Magnifying endoscopic observation was most useful for diagnosis of the lesions which were sub-pedunculated and / or sessile polyps. We concluded that magnifying endoscopy for the early colonic carcinoma was more useful than the usual endoscopy.

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Analysis of endoscopic appearance is a basic procedure in endoscopic diagnosis. But such analysis has depended exclusively on diagnostic criterion introduced by subjective recognition of endoscopic appearance. It seems very important to express and evaluate objectively an endoscopic appearance. We studied the possibility of the objective expression of the color of the endoscopoic image. The endoscope (MT-I and II, Machida) which can be connected to the spectrometric colorimeter (CMS-1000, Murakami) was newly manufactured. The mechanicalcharacteristics of this endoscopic instrument are summerized as follows. 1. The color of the endoscopic image is expressed into numerical value of trichromatic specification (Yxy) by the spectrometric colorimeter. 2. Observation of endoscopic appearance and color measurement can be performed simultaneously. 3. Only a central part of the endoscopic visual field (2.1X2.1 mm) is measured by the spectrometric colorimeter. 4. The endoscopicaly magnified appearance can be observed. The efficiency of this endoscopic instrument was investigated. The test specimens from the "Munsell Book of Color" were measured by this endoscopic instrument. The measured values of the luminous reflectance (Y) and the chromaticity coordinates (xy) were converted to Munsell color notation (hue, value and chroma) by referring to "Designation; D 1535-80" in Munsell Book of Color. No significant difference of Munsell color notation value was recognized between the value which was printed in the test specimen and the measured value of the same test specimen. The luminous reflectance value and the chromaticity coordinate value were altered by changing the observational endoscopic condition of distance and angle. The same alteration was seen by changing the light reflection by the addition of an oil layer to the surface of the object. These alterations could be prevented by using a metal pipe fitting at the tip of the scope. These results indicate that the newly manufactured endoscopic instrument has a great efficiency in discrimination and numerical expression of color. In conclusion, objective expression of the color of the endoscopic image is possible.

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Three hundred patients with diabetes mellitus (insulin dependent) were investigated on peptic ulcer, and compared with three hundred non-diabetic subjects without gastrointestinal problems, all who were hospitalized at about same time. In the latter, patients who had either liver or pancreatic disease were excluded because of the possibility of their gastrointestinal involvement. The incidence of peptic ulcer in diabetics was 5%, and the same rate as those in non-diabetics. Out of 300 subjects with diabetes mellitus, 6 patients with gastric ulcer (s), 8 patients with duodenal ulcer (s) and 2 patients with gastroduodenal ulcers were found, but there were no characteristic features endoscopically. Peptic ulcer was more commoncy found in patients with neuropathy than those without it. Active ulceration was more predominant in patients with poorly controlled diabetics. In conclusion, these results indicate that there is no difference on the incidence of peptic ulcer and its clinical features between diabetics and non-diabetics.

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Total colonoscopy was carried out in 927 cases during the past year with the "Shinya Technique". There are three main method of insertion : "Hooking the fold" (28.3%), " right turn shortning" (65.5%) and the "alpha-loop" (4.5%). Dr. Shinya's technique is characterized as a "one man technique", utilizing coordinated motions between the right & left hand in withdrawing and rotating the scope. This helps in telescoping and straightening the bowel as the scope is being advanced. The scope was successfully introduced into the descending colon in most cases (99.7%). The "alpha loop maneuver" has been commonly used by most Japanese colonoscopist. However, Dr. Shinya's method has proved to be effective in not only the short sigmoid but the redundant sigmoid colon as well. Total colonoscopy was carried out succesfully with the use of the CF-IBW scope (Olympus) and FC-38 (Pentax) in 345 of 359 cases (96.1%). Comparative studies of the insertion succes rate, time required and insertion technique through the sigmoid was made between the two instruments. Abdominal manipulations were required less frequently with the FC-38 scope probably due to the increased rigidity of the instrument. From Dr. Shinya's point of view, a scope with a slight increase in stiffness of the shaft is more desirable. Our study indicates that total colonoscope can be carried out, in most cases, within as short a period of time as an upper GI endoscopy.

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In order to make clear the problems pertaining to the estimation of vertical invasion in the recent cases of depressed type of early gastric carcinoma, endoscopic pictures of 489 patients with solitary lesion were reviewed and the results were compared chronologically. The 489 patients underwent gastrectomy during the period from 1972 to 1980 and they included 367 of early carcinoma (m:199, sm:168) and 122 of IIc-like advanced carcinoma. According to the convetional diagnostic criteria, endoscopic findings in these lesions were evaluated on the following four parts of the cancerous lesions ; converging folds (F), depressed area (D), elevated component of the marginal area (E) and stiffness of gastric wall arround the lesion (S). To quantify the endoscopic malignancy, we gave marks to the finding in the four parts, respectively, that is to say, point-0 (underectable of malignant finding), point-1 (detectable of only superficial malignant finding), point-2 (in addition to point-1, detectable of conventional submucosal invasive finding) and point-3 (detectable of much more advanced finding). The points obtained from each of the four parts were summed up in each case and we treated this total point as the malignant score in endoscopic appearance. The results obtained were as follows : 1. Score-distribution of the subjects showed that the malignant score was closely related to the degree of vertical invasion. And according to their scores obtained, endoscopic appearance of the subjects could be classified into following three groups ; "low score group", whose score ranged from 0 to 1, "middle score group" from 2 to 4, and "high score group" more than 5. In low score group 73% were musosal and 26% submucosal carcinomas. In middle score group, 46% were mucosal, 41% submucosal and the rest 13% advanced carcinomas. In high score group, only 7% were mucosal, 27% submucosal andthe rest 66% advanced carcinomas. 2. Comparing the malignant score of early cancer by every three years, low score group had been markedly increasing (16 to 38%) and high score group decreasing (19 to 7%) in the last three years. In advanced cancers, however, no such chronological trend was observed in the period of nine years. 3. In the early cancer detected during the last three years, conventional diagnostic criteria for estimation of vertical invasion were quite less frequently observed endoscopically, especially on the tip of converging folds (F), surrounding area (E) and gastric wall arround the lesion (S). Only the mucosal pattern of cancerous depression, however, showed different score-distribution between mucosal and submucosal carcinomas. That is to say, most (over 70%) of the cases whose point on that area was 0 or 1 were mucosal and those of 2 or 3 mostly (over 70%) submucosal carcinomas.

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A two-channeled small-intestinal endoscope for the "ropeway" method (FIS-W) has been developed, intending improvement for endoscopic diagnosis of small intestine, especially of localized changes. Improved specifications are as follows. 1) Shorter working length 2) Two channels for introducing forceps 3) Angle wire mitigator 4) Increased capacity of transmitting light from the light-source 5) Angle deflection in four directions 6) Wider angle of vision 7) Automatic operation system of air/water supply and suction This FIS-W has much higher efficiency than the former small-intestinal endoscope (FIS-BII) and has almost equal efficiency to a gastroendoscope or a colonoscope.

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We examined the depth of the cancerous invasion in 15 cases of gastric cancer patients by means of the 3rd. type of Ultrasonic Endoscopy (U. S. E.) made by cooperation of Olympus Co. and Aloka Co. In addition to the scanning of the gastric wall by U. S. E. inserted into the stomach filled with water, resected stomachs were scanned in the water bath by the same instrument. Comparing the echogram of the gastric wall with the histological findings of the resected stomach specimen, we could obtain the following results. (1) Gastric wall was analyzed into 5 layers echographically. The echogenicity of the proper muscle layer was lower than those of the submucosl layer. (2) Proper muscle layer was destructed or discontinued in the majority of our advanced cancer cases. It was difficult, however, to visualize the destruction of the p. m. layer in some advanced cases in which cancer invaded not expansively but diffusely. Hence, the ability of U. S. E. to prove destruction of the proper muscle (p. m.) layer may be influenced by the mode of infiltration throughout the p. m. layer. (3) Characteristic echogram of Borrmann IV type of gastric cancer reveals homogenous thickening of gastric wall in comparison with the normal gastric wall.

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The patient was 61-year-old female. Abnormality in the prepyloric region was indicated by gastric mass survey. She visited our hospital, wanting further examination. Roentgenographic and endoscopic examination revealed IIc on the posterior wall of the antrum. Abnormal folds existed on the anterior and posterior wall of the prepyloric region. The anterior ones were suspected of forming a mucosal bridge. Resected stomach showed IIc lesion sized 1.5X1.5cm on the posterior wall of the antrum. Pathologically, IIc lesion showed signet-ring cell carcinoma. Carcinoma infiltration of the lesion was limited to the mucosa. In the part of mucosal bridge, muscularis mucosa was very thick and abounded with smooth muscle elements, but rupture or separation of them was not recognized. By these findings, the mucosal bridge was thought to be caused by congenital factor. Our case was probably the first case of the mucosal bridge of stomach co-existing with early gastric cancer. We reported our case and reviewed other reports of the mucosal bridge of the stomach.

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A patient, 75 years old female was admitted to our hospital on March 8, 1982, with hematemesis. On the second hospital day, endoscopy was done. Slight protruded lesion with central depression and small white coating was demonstrated at the posterior wall of the gastric fornix. It was suggested to be hemangiomatous lesion because of showing projecting bleeding right after contacting by biopsy forceps. Surgical specimen showed slight uneven and dark red mucosal lesion, 2.5X2.5 cm in size, and dilated vein at the serosa of the gastric fornix. Histological specimen revealed irregularly dilated and tortous vein with irregular thickening of the media and adjacent small artery. From these findings, arteriovenous malformation of the stomach was diagnosed.

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Although infestation by Strongyloides stercoralis is usually milb, it can be severe and even fatal. We experienced one case of infestation by Strongyloides stercoralis. The patient was admitted to our hospital for massive gastrointestinal bleeding which was proved to be from the descending part of the duodenum by fiberoptic gastroscopy. Emergent operation was done. Larvae and eggs of Strongyloides stercoralis were identified in the mucosa of the descending part of the duodenum in the biopsy specimen obtainedat operation. The patient had a long history of diarrhea, abdominal discomfort, general fatigue and weight loss of several years' duration. We suspect that these symptoms were caused by its autoinf ection. Massive duodenal bleeding due to Strongyloides stercoralis is rare.

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