Endoscopic toluidine blue dye spraying was carried out in 26 patients with gastric cancer. The cancer tissue with well differentiated adenocarcinoma showed positive metachromasia, but the cancer tissue with poorly differentiated adenocarcinoma showed negative metachromasia. The rate of correct diagnosis for the differentiation of gastric cancer was 96.2% by using the toluidine blue spraying.

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Clinical features of 80 cases of Mallory-Weiss syndrome were analyzed, especially regarding the associated lesions of the upper gastrointestinal tract. Sixty cases were accompanied with nausea or vomiting, and in 32 cases of them (53%) the causes of the prodromal symptoms were unclear. Forty cases were accompanied with the associated lesions and in 27 cases of them the causes of the prodromal symptoms were unclear. Twenty one cases of the 27 (78%) had the prodromal symptoms. It is supposed that the associated lesions may cause mucosal lacerations of Mallory-Weiss syndrome by inducing the prodromal symptoms. As to the number of mucosal laceration, there were a laceration in 52 cases, two lacerations in 13, three in 2. The lacerations were located straddling on the esophagus and the stomach in 29 cases, and were commonly seen on the lesser curvature and the posterior wall. In 40 cases, the lacerations got to the scarring stage endoscopically. In 32 of the 40 cases, the healing was shown within 3 weeks. Although 19 cases required blood transfusion, only 5 cases needed over 1000 ml of blood. The age of these 5 cases ranged from 51 to 72 with the mean age of 64.4. All were cured without operation.

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We carried out a comparative study of ultrasonic laparoscopy with the extracorporeal linear scanning in cases of the gallbladder diseases. We used the system which was developed in collaboration with Olympus Optical Co. and Aloka Co. When we compared ultrasonic laparoscopy with extracorporeal linear scanning, it could yield more fine and clear visuarization of the fuzzy thickened, ill-defined wall, small stones, polypoid lesions, biliary sludge and the surrounding area of the gallbladder. In addition, a clearly visuarized gallbladder could be obtained by this procedure in case of blurred or indistinct visualization of the gallbladder by the extracorporeal linear scanner overlying bowel or intrathoracic air. Furthermore, there were advantage of laparoscopic findings that could be obtained simultaneously. In conclusion, though we found out several problems which needed further improvement in this system, ultrasonic laparoscopy was considered to be of a great value in the diagnosis or the fine observation of the gallbladder disease.

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The diagnostic abilities of endoscopic ultrasonography (EUS), and conventional ultrasonography (US) have been compared in 18cases of chronic pancreatitis diagnosed by ERCP. The results were as follows. 1) EUS has givena more accurate diagnosis than US, because EUS demonstrated clearly pancreatic calculi and dilated pancreatic duct system, as main findings of chronic pancreatitis. 2) Irregularly dilated ducts, small stones, and slight changes of the margin or the parenchyma of the pancreas, has been also shown clearly by EUS. It was concluded that EUS was one of the best diagnostic methods of chronic pan-creatitis and it might become to be a diagnostic procedure of mild chronic pancreatits in the near future.

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In this paper, the evaluation of ERCP (Endoscopic Retrograde Cholangiopancreatography) findings, especially the shape of the obstruction in the main pancreatic duct, the status of the proximal part of the pancreatic duct and the cholangiographic findings were discussed for the differential diagnosis of the pancreatic diseases. The shape of the obstruction was classified into three types. Tapering, club-shape and irregularity. (1) Irregular obstruction was frequently observed in chronic pancreatitis and pancre-atic cancer. Tapering of the main pancreatic duct were characteristic of pancreatic cyst and pancreas divisum. (2) In almost all the cases of chronic pancreatitis and pancreatic cancer, proximal dilatation of the main pancreatic duct was also seen. However in pancreatic cancer, proximal dilatation was minimal, and of about 5-6 mm in diameter. (3) Visualization of branches at the site of the obstruction were characteristic of chronic pancreatitis. Although, they were sometimes seen in pancreatic cancer and pancreatic cyst. (4) Deviation, obstruction and stenosis of the common bile duct were frequently found in pancreatic cancer, especially in tumor localized in the head of pancreas. (5) Club-shape obstruction at the head of pancreas was not seen in pancreatic cyst and pancreatic cancer, and none of tapering obstruction in the head of pancereas was seen in chronic pancreatitis.

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The pH value of gastric juice and the endoscopic findings of the stomach were examined in 1, 129 patients. The gastric sample was obtained from the gastric fundus with a small tube via a biopsy channel during endoscopic examination. Among 353 patients without any pathological findings at endoscopic examination, 193 patients under age 50 showed a lower pH values than 160 patients over age 50. The pH distribution in 225 patients with gastric ulcer was simlar to that of non-pathologic group. On the other hand, the majority of 160 patients with duodenal ulcer showed lower pH values compared with gastric ulcer group. The pH values of the gastric samples were also compared in relation to the stage of ulceration. The gastric samples from patients with active stage of gastric and duodenal ulcer showed lower pH values and tended to show higher with its healing. However, even in the scar stage, the pH values in the duodenal ulcer group were apparently lower than those of the gastric ulcer or non-pathologic group.

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Acute obstructive cholangitis due to impaction of a stone is an extremely dangerous complication after endoscopic sphincterotomy, often leading to death. When immediate basket extraction has not been feasible or failed in patients with big stones that are not expected to pass spontaneously, we have to be constantly on guard against development of this condition. In 6 patients with big stones in the common bile duct, immediate extraction of the stones was not performed due to the presence of acute cholangitits, pancreatitis, hemorrhagic diathesis or frailty. To prevent acute cholangitis due to stone impaction in these patients, a double pig tail endoprosthesis was successfully placed in the common bile duct. The stones were safely removed using a basket catheter or after mechanical lithotripsy 7-15 days later with the endoprosthesis in place or after its retrieval.

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Because of elucidation of natural course of pancreatic cysts, especially pancreatic pseudocysts, by means of recently developed image-producing diagnostic aids, the thera-peutic guidelines for this disease have been changing. In this study, we compared 21 surgical and non-surgical cases of pancreatic cyst in our department and the affiliated institutions during the past 8 years to explore the possibilities of conservative therapy for this disease. It was found that the clinical course was favourable without surgery in 9 cases, including 2 cases in which the cyst disappeared spontaneously. From these results, it is considered that favourable results may be obtained in cases without surgery in which at one to two months observation malignancy can be ruled out, the patient is asymptomatic, the cyst is less than 4 cm in size with tendency to decrease, and there are no complications. Moreover, ERP findings suggest that a cyst linked to the main pancreatic duct, has a great possibility of decreasing and is, therefore, assumed to constitute an important factor in determining the therapy.

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We evaluated clinical and endoscopical features and of 29 patients with gastric anisakiasis which were encountered for past five years in N agato City. The results obtained were as follows. Gastric anisakiasis were frequently encountered in winter. Mackerel was the most attributable fish of this disease. In regard to the clinical symptoms, epigastric pain was always complained, and interestingly urticaria was appeared in some cases. The onset of this disease often followed 36 hours after eating of a causative fish. One third of the worms stinged in the midde body or lower body of the stomach in our study. Localized edema, redness and petechiae were often seen at the lesions which the worms stinged, but these features were rarely seen in such cases that endoscopy was performed early from the onset.

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Now endoscopic internal biliary drainage plays an important role as a decompression method of the biliary system. But it sometimes loses its effect by clogging of the stent because the diameter of the channel of duodenofiberscope limits the use of the stent that has wider diameter. In this paper we reported our experience to insert double or triple stents into obstructed bile duct for eight patients who had unresectable malignancies. We have gotten satisfactory results in all cases. To insert the stent into the left and right hepatic duct selectively, introducing catheter with specially formed tip was used. We used this catheter for four cases and the success rate was 75%. We regard this method as having advantages because it provides not only twice or three times as much width of the lumen as single stent has but also the assistance to maintain the patency of the stenosis making a gap between the stents and narrowed bile duct.

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The incidence of concurrence of cancer with malignant lymphoma is said to be 2-8%, the most frequent site of such complicating carcinomas being the stomach. In the case to be presented here, an attempt was made to treat multiple early cancer complicating malignant lymphoma with Nd-YAG lases under endoscopic control, with the attainment of complete disappearance of the gastric cancer as confirmed at autopsy. Cancerous lesions (III + IIc) at the gastric angulus on the lesser curvature and another situated on the posterior wall of the lower gastric body (IIc) were treated with laser, the former receiving non-contact irradiation and the latter non-contact and contact irradiation combined. A follow-up biopsy study revealed that the lesion site at the gastric angulus becoming negative for malignancy just after laser therapy, converted to positive 5 months later and then, after additional irradiation, became negative again with no further conversion to positivity thereafter. The lesion in the gastric body, which lay tangentially to laser beams and hence required combination of non-contact and contact irradiation, was totally obliter-ated by laser therapy with no later conversion to positivity on follow-up biopsy. The patient died of pneumonia despite VEP therapy while he was at the third hospitalization owing to a relapse of malignant lymphoma. At autopsy his stomach was confirmed to be entirely free of cancerous lesions with no evidence of lymph node metastasis. Endoscopic laser therapy seems to be a useful, less invasive therapeutic modality for such poor risk early stomach cancer patients as the present one.

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A 55-year-old man complaning of purpura in four extremities was diagnosed to have allergic granulomatous angiitis (AGA) according to his clinical course as well as his laboratory or histological findings. By colonoscopic examination multiple shallow ulcers surrounded by reddish mucosa were found in the entire colon. Histologically, vasculitis with marked eosinophilic infiltrations was observed in the biopsied colonic mucosa, although typical granuloma was not demonstrated. By administration of oral steroid, colonic ulcers showed complete healing as the generalized symptoms and abnormal laboratory data improved. In Japan, 54 cases of AGA including our case have been reported until 1984. Gastrointestinal or cardiac lesions are common causes of death. The gastrointestinal lesions were seen in 16 cases, while the lesions were demonstrated endoscopically during their clinical course in only 4 cases. Ulcer formation in the gastrointestinal tract in AGA seems due to ischemia by the occlusion of arterioles. However, the ulcers seldom lead to perforation as often as observed in polyarteritis nodosa (PN). It is concluded that examination of gastrointestinal tract is an essential procedure not only for diagnosing the disease but also for monitoring the clinical course.

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A case of Dubin-Johnson Syndrome associated with Idiopathic Portal Hypertension was reported, emphasizing charcteristic changes of both laparoscopic and histological appearances. A 43 year old woman was admitted because of general lassitude. Her serum transaminase values were within normal range, but hyperbilirubinemia and the characteristic pigmentation of the liver were present, and an extended bromsulphalein (BSP) test for 120 minutes showed a late re-rise curve. Besides, hepatosplenomegaly, pancytopenia, and portal hypertension without any cirrhotic patterns were recognized. So, she was diagnosed as a case of Dubin-Johnson Syndrome and Idiopathic Portal Hypertension, which was considered remarkably different from the ordinal Dubin-Johnson Syndrome in the following findings. Laparoscopically, the liver surface showed light black color and big rippling wavelike appearance with scattered small depressions. Histologically abundant Dubin-Johnson granules were observed in liver cells not only centrilobular but also in periportal area having dense fibers.

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A 53-year-old male was admitted to our clinic on December 9, 1982. He had recurrent fever, skin eruption, aphthous stomatitis and ulcerative tonsillitis. Non-spcific inflammation was suspected but various antibiotics were ineffective and oral lesions was progressive. Predonisolone 50 mg/day was started on December 30, 1982 for a presumptive diagnosis of Behcet's disease. After administration of steroid, aphthous stomatitis and oral ulcerative lesions remarkably improved. But he often complained abdominal pain and distension on February, 1983. Balium enema and endoscopic examination revealed a sigle and deep ulcer on the left side of the transverse colon. Treatment with steroid and salazopyrin was continued. The oral and abdominal symptoms resolved gradually. The patient discharged on March 18, 1983. The scar formation was comf irmed by X-ray examination done on November 19, 1984. He has remained well with administration of steroid and salazopyrin.

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This report described a case of 68-years-old female patient with early cancer in the 1st portion of the duodenum. An upper GI series and endoscopic examination showed a peduncular polypoid lesion in the 1st portion of the duodenum. Endoscopic polypectomy was performed and size of the resected tumor was 2.0×2.3×1.8cm. Histological finding were recognized well def f erentiated adenocarcinoma in adenoma. We thought it was the first case which we treated early cancer of the duodenum by only endoscopic polypectomy, because of depth of invasion in the mucasal layer. In addition, we collected cases of early duodenal cancer in the Japanese literatures and referred to the present state of early duodenal cancer.

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A 70-year-old man was born at Kakidomari-machi in Nagasaki-city, was hospitalized for treatment of watery diarrhea. Barium-enema examination of colon and colonofiber-scopic findings showed diffuse edematous lesions, "elevated as gyrus of the brain" from rectum to ceacum. Diarrhea was transient. On 60 th hospital day, rectal bleeding appeared, and abnormal T-cells were detected in peripheral blood. Furthermore, swelling of inguinal lymphnode was noticed as well. ATLL was diagnosed by histologically and surface marker analysis with lymphnode biopsy specimen. Diarrhea and rectal bleeding were rare as a manifestation of ATL. ATL with infiltration in gastro-intestinal mucosa was reviewed, and endoscopic findings were discussed.

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