Hyperemic erosive duodenitis was observed in 96 (3.8%) out of 2, 560 patients by duodenofiberscopy. This type of duodenitis showed hyperacidity of gastric juice and were often combined with erosive gastritis as duodenal ulcer does. The duodenitis had slighter dyspeptic symptoms and a higher rate of complication of liver injury than duodenal ulcer. Duodenitis did not seem an important precursor of duodenal ulceration, as only one of 21 patients of duodenitis subsequently developed duodenal ulcer. Electron microscopy demonstrated various alterations from minimum changes of absorptive epithelial cells to gastric metaplasia in the duodenal mucosa of duodenitis. These altered epithelial cells seemed to be resistant to hyperchlorhydria.

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The chromoendoscopic features of healed gastric ulcers and the accuracy of diagnosis of histological repair of gastric ulcers were investigated by the endoscopic Congo redmethylene blue test. Histological repair of gastric ulcers was graded by Murakami and Koide's scale, as follows: Ul¹, Ul², Ul³ and Ul⁴. Endoscopically, Ul⁴ scar is observed as a flat granular area without any depression, sometimes associated with redness. Ul3 scar is observed as a distinct depression in the surrounding normal mucosal surface, usually associated with homogenous redness. In contrast, Ul³⁺¹ or Ul³⁺² scar are seen as a distinct depression with irregulary-patchy redness. A correct diagnosis of histological repair of gastric ulcer was made in 82.6% of the lesions by chromoendoscopy. Histological repair of gastric ulcers located in normal oxyntic gland mucosa could also be accuratly diagnosed by chromoendoscopic examination. Ul⁴ scar are observed as discolored areas, but Ul³ scar are seen as nondiscolored areas surrounded by discolored areas. Follow-up studies of patients with Ul⁴, Ul³ and Ul³⁺¹ or Ul³⁺² lesions showed that recurrence was significantly rare in patients with Ul4 lesion than in patients with Ul³ and Ul³⁺¹ or Ul³⁺² lesions. Therefore, we conclude that1) chromoendoscopic examination is useful for diagnosing the histological repair of gastric ulcer and 2) healing of gastric ulcer should be defined clinically as disappearance of ulcer fur.

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To date it was considered that the endoscopical differential diagnosis of the ischemic colitis and antibiotics-induced hemorrhagic colitis were difficult. The study about the differential diagnosis with endoscopy and/or biopsy of these colitis soon after the onset had not been reported. In this paper the study on the endoscopical and histopathological differentiation of these two colitis within 7 days after the onset was carried out. The materials were 15 cases of ischemic colitis and 11 cases of antibiotics-induced hemorrhagic colitis. Our results were as follows: Endoscopically, in the patients with ischemic colitis were seen frequently longitudinal ulcer with necrotic debris. Histologically, they were the degeneration and necrosis of the mucosa as well as ghost-like appearance of the glands. Mucosal bleeding were seen diffusely throughout the lamina propria. On the otherhand, endoscopically, in the patients with the antibiotics-induced hemorrhagic colitis were seen brightly reddened mucosa with slight necrotic debris. Histopathologically, the mucosal structure remained with slight degeneration and necrosis. The bleeding was seen in the superficial layer of the mucosa. Histological differential diagnosis of the ischemic colitis from the antibiotics-induced hemorrhagic colitis within 3 days after the onset were easy. But it was quite difficult to differentiate them over 7 days after the onset endoscopically as well as histopathologically. We concluded that the endoscopical examination and biopsy, especially within 3 days after the onset, were useful to diagnose those acute hemorrhagic colitis.

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Endoscopic ultrasonography (EUS) was examined in 80 patients with pancreatic and biliary diseases including 33 cases of tumorous lesions, and the diagnostic accuracy of the method was examined especially in the small lesions of the pancreato-biliary tract. Ultrasonic scanning was made through the wall of the digestive tract using an echo-endoscope (Sector type, Olympus and Aloka Co. Ltd.) mainly with a balloon attached to the end of the scanner (balloon method). The head of the pancreas and the biliary tract were scanned via the postbulbar region or the descending portion of the duodenum, and the body and tail of the pancreas via the posterior wall of the gastric body. Clear ultrasonographic images of the lesions were obtained in all 33 patients with pancreatic and biliary tumors including 13 small lesions with diameters of 30 mm or less (10 of them with diameters of 20 mm or less). These small lesions included 11 malignant tumors (4 in the pancreas, 4 in the biliary tract, and in the papilla vater) and 2 benign tumors (a focal pancreatitis and an adenoma in the common bile duct). The high demonstrability of EUS was recognized by comparison with other body imaging diagnostics such as US, ERCP, CT and angiography. With improvement of the scope and establishment of appropriate scanning technique, this method is expected to be effective in the diagnosis of small pancreatic and biliary tumors.

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An endoscopic observation of the hypopharynx and the cervical esophagus seems to be rather difficult because of it's anatomical and physiological circumstances against instruments. In our series of 1, 307 cases, various types of panendoscopes were used for the observation of these area. At routine works, an examiner used to observe these areas on pulling a fiberscope up in cooperation with an assistant having a gastroviewer scope. At a precise examination, in addition to this, an examiner oberves these areas on inserting it slowly with the help of an assistant. A gentle and careful manuever should be taken on especially angling a tip of a fiberscope or suctioning saliva. A sufficient air feeding is also necessary for the observation and taking pictures. In cases of stenotic lesion in these areas, a finer GIF-XP or a bronchofiberscope was preferably chosen. On an endoscopic intervention in these areas, monitor TV seems to be especially useful for the prevention of an unexpected accident. According to the method mentioned above, forty three lesions or abnormalities were found endoscopically in these areas for recent six years. In this study, these lesions were retrospectively analyzed. Benign lesions or abnormalities were 16 (1.2%) and malignant lesions were 27 (2.1%). Among benignancies esophageal webs were seen at highest incidence of 6 while hypopharyngeal cancers were observed at highest occurrence of 19 among malignancies. Four out of 6 cases of eso-phageal web were concurrent with the malignancies, such as hypopharyngeal or esophageal cancers. Three cases of the web located at anal site of the cancer, but one located at both anal and oral sites of the cancer. In our cases, there was no case in which the malignancy appeared clearly in follow-up of the web. Furthermore, patho-histologic examination of resected cases previously irradiated revealed no distinct proof which these esophageal webs had some pathogenetic signif icances to the genesis of the malignancies. Three out of 19 cases (15.8%) of the hypopharyngeal cancer had another synchronous cancer in the esophagus or/and the stomach. From these results, this study suggests that a careful and periodical observation for these areas through a panendoscope is mandatory for the detection of the malignancy which concurrently exists or may occur especially during follow-up of benign lesions in these areas.

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Standard endoscopic retrograde pancreatography (ERP) sometimes fails to fill the peripheral ducts mainly due to a back flow of the injected contrast medium. ERP with a balloon catheter was performed in twenty one patients (five with pancreatic cancer, seven with chronic pancreatitis, nine with others) to improve filling of the perpheral branches of the pancreatic ducts. In most cases, filling of more than third branches of the pancreatic duct was possible by this procedure. Selective pancreatography of the pancreatic duct was also made feasible by inserting the balloon catheter as far as the distal portion of the duct. No serious complications were encountered. Thus, the balloon catheter . procedure will improve visualization of the peripheral pancreatic ducts and hence facilitate the diagnosis of pancreatic diseases.

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During the last five and a half years, total colonoscopy and/or endoscopic polypectomy was carried out to 90 children in our clinic. The bowel preparations employed were as follows; (1) For children under one year of age, enema using 60ml of glycerin or 200-400ml of saline was repeated three or four times before the examination, without dietry control or oral administration of laxative. (2) For children aged 1-6, low residue diet and lactulose was given on the previous day of colonoscopy, supplemented by enema repeated several times two or three hours before the examination, using saline or glycerin. (3) For children aged 7-10, low residue diet, 100-200ml magnesium citrate and 24mg contact laxative (sennoside) were given on the previous day of colonoscopy. (4) For children aged 11-14, the same preparation as in adults (so called Brown's regimen) was employed. By means of the protocols listed above, cleansing of the bowel was satisfactory for colonoscopic observation, insertion and manipulation in children under one year, and above seven years of age. While, in some of the children aged 1-6 satisfactory cleansing could not be obtained ; poor preparation of the rectosigmoid in 22%, of the middle colon in 9%, and of the right colon in 12% of cases. Children, especially aged 1-6, cannot understand the importance of the examination, and do not follow the strict dietry control or administration of laxative, resulting in unsatsfactory bowel preparation. Further effective regi-men should be used in younger children.

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A 55-year-old man who had been under 2 years of medical treatment for alcoholic liver injury was admitted with ascites on August 13, 1983. Gastroscopy demonstrated an early gastric cancer of type ha on the lesser curvature of the gastric angle. The histrogical examination showed signet ring cell carcinoma. We had pure ethanol injection therapy due to serious liver disfunction. Since liver biopsy under laparoscopy revealed hepatic fibrosis, the patient underwent subtotal gas-trectomy. In the resected specimen, an early gastric cancer (m) of IIb type was found around the injectional area, and finally a diagnosis of early gastric cancer, IIa+IIb type was made. The region injected with pure ethanol was ulcerated without residual cancer cells. A elevated lesion of signet ring cell carcinoma has been rarely reported, and we could obtain a good result by the ethanol injection therapy for treatment of a case of early gastric cancer (IIa+IIb).

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A 57 years old woman was admitted to our hospital with 3 months history of bitter taste. In upper gastrointestinal series, the polypoid lesion was seen in the anterior wall of corpus of the stomach. Gastroendoscopy findings appeared atrophic with small sessile polypoid lesion, approximately 1.0cm in diameter, high on anterior wall. Multiple biopsies of this lesion and of the normal mucosa were taken. Histological examination showed chronic atrophy and the presence of a carcinoid tumor. In the laboratory findings, serum gastrin level was raised at 730pg/ml (normal ≤ 200pg/ml). The remainders of laboratory finding were within normal limit. A subtotal gastrectomy was done. A IIa+IIc like protruded tumor in 7mm in diameter was identified in corpus of the stomach. Histologically, this tumor was identical with the carcinoid tumor consisting of nest of small round cells showing little pleomorphism with occasional medullary formation. Grimelius staining revealed aboundant argyrophilic granules in the tumor cells, which were present in the mucosal layer, not extending into the submucocae. Electron microscopy showed numerous small secretory granules within tumor cells. Serum gastrin level was remarkably decreased following surgery. From this case history, we discussed that it is important to bear in mind the tumor's multipotential endocrine properties.

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A 54-year-old woman was admitted because of epigastralgia. Ultrasonographic examination and laboratory findings revealed evidence of acute cholecystitis and pancreatitis. After improvement of clinical signs, ERCP was carried out. It showed cystic dilatation in the lower part of the common bile duct with stenosis at the junction of the lesion and the bile duct, and small stones in the gallbladder. The diagnosis of cholecystolithiasis and anomaly of the common bile duct were made, so operation was performed. Histological study of the resected bile duct revealed irregular proliferation of accessory gland, smooth muslce and collagen fibers tissue. A rare congenital anomaly of the common bile duct was confirmed clinicopathologically.

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A case of blue rubber bleb nevus syndrome (BRBNS) which is characterized by bluish rubber nipple like hemangiomas on the skin and gastrointestinal tract was reported. A 60-year-old man was admitted to our hospital because of bluish polypoid lesions in the stomach. History of chronic anemia was continuing more than forty years. He noticed skin blue bleb like tumors over the trunk and lower extremities at age 40. The histopathological specimen obtained from the right inguinal region showed "cavernous heman-gioma". Findings of the X-ray and the endoscopic examinations of the GI tract showed multiple polypoid lesions. These lesions existed in the esophagus, stomach, small intestine and colon. The color of polypoid lesions was blue and those lesions were thought to be hemangiomas. We speculated that chronic anemia would be caused by continuous minimal bleeding from hemangiomas locating throughout the GI tract. Hemangiomas were not found in any other organs. Family history was normal. We reported a typical case of BRBNS as Bean had reported. Clinical importance of BRBNS is gastrointestinal bleeding. In a patient with skin hemangiomas and gastrointesti-nal bleeding, BRBNS should be considered at diagnosis.

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A 35-year-old man visited our hospital with a complaint of mild abdominal pain. Barium enema and colonoscopy revealed a baseball bad like polyp with smooth surface and lemon yellow color at 10 cm distal to the ileocecal valve. The polyp excised by endoscopic polypectomy was 12 × 4 × 3 mm in size. Histologicaly, bundles of nervefibers were present in the submucosa with connective and vascular tissue proliferation and a number of ganglion cells was present in the mucosa with bundles of nervef ibers. This polyp, therefore, was diagnosed as ganglioneuroma of the ascending colon. Gastrointestinal ganglioneuroma is very rare. 5 cases have been reported in Japanese literature and 30 cases in English. This is the second case of gastrointesitinal ganglioneur-oma excised endoscopically.

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A 66-year-old male was firstly admitted to the Institute because of mucosanguineus stool. Ulcerative colitis was the most probable diagnosis except for the fact that barium enema and colonoscopy with biopsy revealed segmental lesions in the large intestine. Six years after the remission, the patient developed typical ulceretive colitis, which strongly indicated that the first attack should also be a form of ulceretive colitis. One of the essentials of ulceretive colitis is continuous inflammation originating from the rectum. A hypothesis was proposed here; i. e. in the first attack of this patient the inflammation might originally be continuous, and as the speed of the remission could differ from part to part the seemingly segmental lesions appeared. The inflammation might not be severe enough to leave histological evedence of the past inflammatory process.

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The forward-viewing upper gastrointestinal fiberscope (Olympus GIF-Q10) developed on the basis of a new Olympus Endoscopy System was applied to 1, 380 cases of upper gastrointestinal endoscopy and its facility in manipulation, observation and others were evaluated. Owing to the improvement of image guide, increased ocular magnifying power, an extra wide visual field and stronger upward f lection of the tip (210°), manipulation, observation and recording ability were improved and there were no blind areas for observation. And it is easy to observe in detail because of increased ocular magnifying power. Moreover, a forcep's channel is set at the lower end of the manipulation part of this scope for protection of facial contamination by gush of dirt. It can be operated by a left hand only because of a shutter lever incorporated in the camera (SC-16) for a progress in manipulation. Otherwise, from the aspect of protection against infection of hepatitis virus and others, this scope is improved to be waterproof and can be immersed all of the scope in water, including the manipulation part to the universal cord parts, and this scope, therefore, tolerates enough against some chemicals (such as Hibitane gluconate, Sterihide). After all, this scope is evaluated clinically to be a more excellent upper gastrointestinal endoscope than former fiberscopes.

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