Clinical and Pathological studies were performed on 34 lesions of minute gastric cancer (less than 5 mm in the longest diameter) and 65 lesions of small gastric cancers (from 6 mm to 10 mm in the longest diameter). Macroscopically the depressed lesions were classified into 4 types, which were minute depression, malignant erosion, intermediate and IIc type. The elevated lesions were classified into 3 types, which were central depression, smooth surface and irregular surface type. All histological types of adenocarcinoma could be recognized in every depressed types and there were no particular histological differences in the surrounding mucosa among the four depressed types. Depressed minute gastric cancers showed either minute depression type or malignant erosion type and they were carcinomas of intramucosal cancerous invasion. Depressed small gastric cancers showed one of the three types, that is malignant erosion or intermediate or IIc type and some of them revealed cancerous invasion into the submucosal layer. Histologically all the elevated lesions were tubular adenocarcinomas of intramucosal cancerous invasion. Macroscopic type of elevated minute gastric cancers was central depression or smooth surface type. Intestinal metaplasia and atrophic gastritis existed in every mucosa sur-rounding the elevated lesions. Pressure by the cancer cells in the deeper part of the mucosal layer and proliferation of gastric glands and foveolar epithelium were thought to contribute much to the component of the elevation surrounding depressed lesion which was noticed in malignant erosion and intermediate type.

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Ninety-five cases of pancreatic tumors were analysed with special reference to relationship between pancreatograms and histlogical types. They were cathegolized into six types which were normal pancreatogram, stenosis of the main pancreatic duct (MPD), obstruction of the MPD, dilatation of the MPD, dislocation of the MPD, and abnormal pancreatic field. They were further divided into subtypes. The classification was well related to histological types of pancreatic tumors, especially fibrous stroma, mode of extension, cystic formation, ability of mucus production. Most of the pancreatic tumors were differentiated tubular adenocarcinomas which were scirrhous and infiltrative, and their pancreatograms showed tapering stenosis, tapering obstruction, and pancreatic field defect. In medullaly and expansive tumors such as islet cell tumors, papillary adenocar-cinomas, and mucinous cystic tumors, their pancreatograms showed obstruction of the MPD with compression, dislocation of the MPD, and dislocation of branches. Papillary tumors tended to grow intraductaly, and the pancreatograms demonstrated proliferative changes at the site of stenosis and obstruction. Proliferative cysts showed two different types of pancreatograms. One demonstrated abnormal accumulation of contrast medium with filling defect, and the other had a factor of compression, and showed obstruction of the MPD with compression, or dislocation of the MPD. Mucinous cystic neoplasms were thought to relate to mucus producing adenocarcinomas of which the pancreatograms showed dilatation of the MPD or branches. Papillary tumors had a tendency to extend intraductaly, and differentiated tubular adenocarcinomas of which most pancreatic tumors consisted to grow periductaly. We can speculate the histological types of pancreatic tumors by our classification. So our classifi-cation is useful to make the diagnosis of tumor extension within the pancreas. A small pancreatic cancer less than 2 cm in diameter, mucus producing adenocar-cinoma, mucinous cystic tumor, and small tumor occurring near the MPD is expected to have a good prognosis. Even these pancreatograms revealed changes of the MPD such as stenosis or obstruction. It is concluded that routine ERCP would be a way to give an effective diagnosis of early pancreatic cancers.

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To evaluate the ultrsonic findings of intrahepatic portal vein in liver diseases with diffuse lesion, abdominal ultrasonogram was retrospectively analyzed in 100 cases who underwent peritoneoscopy and liver biopsy. Peritoneoscopic findings were expressed using Shimada's code number system. Intrahe-patic portal echograms at left transverse and umbilical portion were demonstrated by the electric real time scanner and patterns of echogram were classified into three as follows. (1) Blurring (-): Echogram with thin and well defined portal vein wall and echo-free portal cavity. (2) Blurring (+): Echogram with thick and blurred portal vein wall and echo-free portal cavity. (3) Blurring (++) : Echogram with thick and blurred portal vein wall and portal cavity filled with dense echo spots. Results and conclusion: (1) All of echograms with normal liver were blurring (-), and all of liver cirrhosis were blurring (+) or (++). Especially in every case of code No. 500, dome-shaped nodular surface being observed peritoneoscopically, echo pattern was blurring (++). (2) Intrahepatic portal echogram had a tendency to change from blurring (-) to (+) and from (+) to (++) when cirrhotic nodule formation appeared and developed, respectively. (3) No fixed portal echo pattern was obtained in cases with acute hepatitis and fatty liver. Intrahepatic portal echogram was confirmed to be useful to diagnose chronic liver disease, especially liver cirrhosis.

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Non-contact beam irradiation by using cristal quartz fiber under an endoscope is very difficult to keep the constant distance of the beam irradiation between the end of the fiber and the aimed lesion as well as to get the constant photocoagulation. To overcome these disadvantages, the endoprobe which is directly connected with the quartz fiber was developed. We have studied the effects of Nd-YAG laser irradiation on the gastric mucosa by using a new contact type of endoprobe comparing to those of non-contact type of the cristal quartz fiber experimentally and clinically. The endoprobe was made of Al₂O₃ (artificial sapphire, ceramics) which transmit laser beam and have good characteristics of high transmission of laser beam, high mechanical strength, high hardness, no tissue adhesion and low thermal conductivity. Recently it became to change the shape of the endoprobe and made several kinds of laser beam pattern. On this studies, we used endotip type and endocutter type of the endoprobe. The advantages of contact beam irradiation by using endoprobe compared with non-contact beam irradiation were as follows; 1) it was easy to radiate toward aimed lesion 2) it was easy to get constant photocoagulation histologically with low power beam (10-35W) 3) it was able to change several kinds of laser beam pattern and to be expectedcutting, interstitial irradiation and local hyper-thermia 4) it was available to radiate gastric tumors clinically.

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In the liver surface of Non A, Non B hepatitis, reddish markings (RM) different from those in type B hepatitis are reported to be observed. For the characterization of these RM, we classified RM into subtypes; 1) periportal (pp) RM, centrilobular (cl) RM and multilobular (ml) RM from viewpoint of location, 2) hemorrhagic fleck-like, common redness and indistinct from viewpoint of color, and 3) dense, sparse and localized from viewpoint of distribution. Results: 1. In cases with acute hepatitis, RM was observed in about 10% both in type B and Non A, Non B. No specific findings were, however, given for characterizing protracted and/or chronic cases. 2. In cases with chronic hepatitis, some differences in RM were observed in type B and Non A, Non B; dense common reddish pp RM being a basic type in type B and sparse pp RM and localized hemorrhagic fleck-like ml RM being basic in Non A, Non B.

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The areae gastricae of the antral mucosa were examined on 143 cases with and without gastro-duodenal diseases by dye spraying endoscopy. Areae gastricae of the antral mucosa, called pyloric type area, were classified into 4 types: Po is the smallest area arranged closely to each other. P₁ is small in size, uniform and arranged regularly. P₂ is irregular in form and arrangement. P₃ is the most irregular in size, form and arrangement. Pb is like P3 but not so tall and is seen on the lesser curvature of the gastric body. P₀ and P₁ were seen in the antrum of the stomach with large fundic mucosa, and P₂ and P₃ (Pb) were with small fundic mucosa. The amount of parietal cells in the gland, atrophy of the gland, foveolar hyperplasia, intestinal metaplasia, cellular infiltration and lymph follicle of biopsied specimen were examined. Many parietal cells were seen in the P₀ type mucosa. In addition, mild or no changes in the other factors were seen in P₀. More severe atrophic changes were observed in the order of P₁, P₂ and P₃ (Pb). Considering the patterns of areae gastricae and histologic findings, we can make the following conclusions. 1) Our classification of pyloric type area corresponds to the histologic findings of antral pyloric mucosa. 2) Atrophic changes of the pyloric mucosa progress in parallel with those of fundic mucosa. 3) Pyloric gland consisted of mucous and parietal cells is a form of normal structures of non-atrophic antral mucosa. These parietal cells may be the manifestation of latent capacity of the stem cells in the antrum.

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We performed a mass survey using a thin forward-viewing gastrointestinal f iberscope (Olympus GIF-P2) as a direct examination of 624 persons in 1983, comparing these results obtained by using photofluorography and lateral-viewing gastrocamera (Olympus GIF-PF) simultaneously, as a direct examination of 706 persons in 1982, and endoscopy was employed in 1982 (or 1983) for the second step of the screening in 595 (or 690) of 4, 165 (or 4, 595) persons examined in "A" worklace. Furthermore, comparing these results with those obtained in the mass surveys of 1980 and 1981 (or 1982 and 1983) in which a thin forward-viewing gastrointestinal f iberscope, GIF-P2 (or GIF-P3), was employed for the second step of the screening in 583 (or 528) of 3, 276 (or 3, 663) persons examined in "B" workplace. We arrived at the following conclusions : (1) the thin forward-viewing gastrointestinal f oberscope for mass survey permits acculate diagnosis not only of gastric lesions but also of bulbar lesions. (2) there was no significant difference in the rate of discovery of gastric lesions requiring treatment between the two mass surveys in which using the photofluorography and lateral-viewing gastrocamera simultaneously, and in which using the thin forward-viewing gastrointestinal f iberscope, however, less gastric ulcer scars and more duodenal lesions were detected when using the thin forward-viewing gastrointestinal fiberscope. (3) there was a higher discovery rate of upper gastroiotestinal lesions by using the gastrointestinal endoscopy directly than by using it as a secondary step of the examination. (4) there was no significant difference between the two instruments, GIF-P2 and GIF-P3, in the discovery rate of upper gastrointestinal lesions. (5) there was no significant influence by the methods of premedication such as the injection of anti-cholinergic drug or not, and the posture of the examination such as supine position or lateral position. We reconfirmed that the most important factor for performing a mass survey was the mastering of the instruments by the doctor and paramedical staff.

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The effect of endoscopic mechanical lithotripsy (EML) of biliary tract stones was clinically evaluated by using a mechanical basket-tipped lithotriptor which was specially made by Olympus Optical Co. of Tokyo. The instrument consists of an intensive basket -tipped catheter incorporated within a stainless steel sheath and a handle manipulator with a clamping screw rack. In our experimental studies, biliary tract stones caught by the basket were easily crushed by this instrument with its strong clamping power. Endoscopic mechanical lithotripsy (EML) was attempted in 12 patients with choledo-cholithiasis following endoscopic sphincterotomy (EST). A newly developed side-viewing duodenoscope (Olympus, TJF-10) with a larger instrument channel of 4.2 mm in diameter was also employed in this procedure. The EML was successfully accomplished in 11 of 12 patients with complete removal of stones and without any complications. In the remaining one, the procedure failed because of unsuccessful catching of a stone by the basket probe. The results apparently show that the EML is a safe and effective procedure and makes it possible to retrieve huge stones within the common bile duct. The technique can eliminate the limitation of noninvasive endoscopic removal of biliary tract stones and can enlarge the indications for EST.

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The ulcers in the upper portion of the stomach in which acid secretion is usually low have been considered to be better treated with agents which exert their anti-ulcer effect through mucosal protection. This study was undertaken to assess the effect of cimetidine on the treatment of the ulcers in the upper portion of the stomach. We also examined mucosal prostaglandins and mucosal blood flow in such cases. Cimetidine, unexpectedly, tended to accelerate healing rate compared with that in cases treated with conventional antiulcer agents. Acid secretion in patients with ulcers in the upper portion of the stomach was low in both basal and tetragastrin-stimulated condition. Mucosal PGE2 and PGI2 were also low especially in the corpus in such cases. Furthermore, mucosal blood flow in the corpus tended to be low. These results suggest that hypoacidic condition and low activity of mucosal protection exist in patients with ulcers in the upper portion of the stomach. Therefore, gastric mucosal damages is likely to be induced even in hypoacidic conditions in such cases. In these reasons, strong inhibition of acid secretion (by cimetidine) is thought to be very important in the manage-ment of ulcers even in the upper portion of the stomach.

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SUMMARY : A 54 year-old man with IIc type early gastric cancer is reported. In September 1972, he visited to a clinic because of epigastric pain, and was diagnosed as early gastric cancer by upper GI-series and endoscopic examination with biopsy. Surgical treatment was advised, but he did not accept it. About 11 years later, he visited to our hospital with a complaint of recurrent epigastric pain after meals. Radiographic and endoscopic examinations revealed IIc type early gastric cancer at the posterior wall of the gastric angulus, and biopsy specimen revealed signet ring cell carcinoma. Subtotal gastrectomy was performed in January 1984. Histological examination of the resected stomach showed the cancerous involvement limited to the superficial zone of the mucosa, measuring 15 x 10 mm in size, and associated with Ul-IV scar. Although depressed types of early gastric cancer, generally, should show slow growth, it is extremely rare that gastric cancer should be in situ during such a long term as more than 11 years.

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A case of spontaneous cholecystogastric fistula was reported. A 43 year old man complaining of right hypochondralgia and diarrhea was diagnosed as sepsis due to acute cholecystitis and admitted to the hospital. Abdominal ultrasonogra-phy on the 2nd day revealed distended gall bladder with a stone impacted in the neck of bladder. Although initial treatment was successful with medical improvement of the general condidions, surgical operateion was postponed because of the patients refusal and serial ultrasonography was performed to follow up the clinical course vigously. Ultrasono-graphy in the 11th hospital week revealed a low echogenic mass nearby collapsed gall bladder. Barium fluoroscopy of the stomach showed a protruded lesion at the greater curvature of the antrum. Spontaneous cholecystogastric fistula was suspected and gas-troendoscopy revealed an elevated lesion like a submucosal tumor at the same location with the orifice of fistula at the top of the lesion. Cholecystogastric fistula was confirmed by fistulography via catheter inserted endoscopically into the orifice. Cholecystestomy and closure of the fistula was performed and the patient was discharged with good hospital course.

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A 51 year-old female was admitted to our hospital because of severe watery diarrhea and loss of appetite, On admission, she had alopecia, skin pigmentation and onychodystrophy. X-ray and endoscopic examinations of the gastrointestinal tract showed generalized or multiple polyposis of the stomach, duodenum and colon. Biopsy study of the gastric polyps revealed hyperplasia, cystic dilatation of the glands and edematous changes of the interstitium. Diagnosis of Cronkhite-Canada syndrome was consequently made. Although hypoalbuminemia was present, protein-losing gastroenteropathy was not found by Gordon's test. On the basis of hospitalization with intravenous hyperalimentation and palliative treatments, she was closely followed up for a month, without any improvement of clinical manifestations. Prednisolone 40mg per day was given afterward in the course of 6 months hospitalization. Her ectodermal abnormalities gradually improved. Polyposis of the stomach apparently decreased in number, and polyposis of the colon almost disappeared. In comparison of gastrointestinal angiographic studies before and after the treatment, enlarged size of the inferior mesenteric artery was found in the former and it returned to normal size in the latter. This is the predonine-effective case of Cronkhite-Canada syndrome.

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A 68-year-old woman was admitted with obstructive jaundice. PTC revealed a large tumor in the hepatic hilum, and transhepatic biliary drainage was performed through the bilateral intrahepatic ducts. After dilating the sinus tract of the catheter, PTCS was carried out. A yellow tumor with bleeding was found in the bile duct, and diagnosed as hepatocellular carcinoma (clear cell type) by cholangioscopic biopsy. It was safe and easy to make the external and internal drainage by PTCS. Autopsy disclosed a hepatocellular carcinoma, 50×50mm in size, developing in the left caudal lobe of non-cirrhotic liver, which extended to the extrahepatic bile duct through the caudal branch.

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A case of a large duodenal leiomyoma removed by endoscopic polypectomy is reported. A 36-year-old female was admitted to our hospital, complaining of epigastric colic. A diagnosis of cholecystolithiasis was made by ultrasonography, and cholecystectomy was carried out. However, the complaint persisted after the operation. Upper gastro-intestinal radiography performed again demonstrated a large duodenal tumor. Duodenoscopy revealed a giant, spherical tumor possessing a short, broad pedicle, a small ulcer at the top, and was covered with smooth mucosa. For the purpose of histopathological diagnosis and treatment, the tumor was removed by endoscopic polypectomy. The polypectomy was carried out twice, taking 30 minutes each time and being careful not to burn the duodenum. A part of the tumor remained but no massive hemorrhage was encountered, and the complaint disappeared. Histopathologically, the tumor was benign leiomyoma. The patient is at present being kept under close medical observation.

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Two cases of Crohn's disease which was difficult in a differential diagnosis from ulcerative colitis (UC) were presented. Case 1 was a 28-year-old man who complained of frequent diarrhea and anal fistula. Barium enema showed continuous involvement of the colon. Diffuse inflammatory changes were endoscopically detected in the sigmoid colon. Later, the diagnosis of Crohn's disease was confirmed by typical endonscopic features of Crohn's disease such as longitudinal ulcer of the colon and especially of the terminal ileum, and by uneven involvement of the colon shown by barium enema. Case 2 was a 21-year-old man who complained of mucobloody diarrhea. Barium enema showed continuous involvement of the left sided colon. Diffuse inflammatory changes were endoscopically detected in the sigmoid colon. Later, the diagnosis of Crohn's disease was confirmed by the development of anal fistula and typical endoscopic features of Crohn's disease such as longitudinal ulcer and cobblestone appearance. Although both cases were longstanding inflammatory bowel disease and showed some conflicts in symptoms and clinical features, the diagnostic re-evaluation revealed heterogeneous and uneven alterations of the colon, and led to the certain diagnosis of Crohn's disease.

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A twenty-six-year old female who had been well and had no serious disease developed pseudomembranous colitis after ampicillin and cloxacillin (Viccillin-S) therapy for acute tonsilitis. Barium enema examination revealed a loss of haustration and a marked narrowing of the colon and colonoscopy showed maculae-like pseudomembrane extensive-ly. A relap:;e occurred after cessation of metronidazole (Flagyl) and it was successfully treated with Vancomycin. A possible role of allergic reaction to Viccillen S in the case was evaluated. All tests including skin reaction, rectal mucosa reaction and lymphocyte transformation to Viccillin S were negative. Laboratory findings revealed no elevation of eosinophil, I gE or immune complex in the peripheral blood. From these, it was concluded that the case developed pseudomembranous colitis without relation to allergic mechanism with Viccillin S.

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This is a report of newly developed OES Endoscopy System which comprises OES-fiberscope, light sourse CLV-10, data imprinting device DS, and endoscopic camera SC 16-10. As to CLV-10, exposure light intensity is increased, automatic exposure improved, and emergency lamp provided. DS enables input, memory, and imprinting of patient data by local mode, and indication of various imprintable data in the view finder of SC 16-10 by remote mode, SC 16-10 is reduced in weight and mount adaptors are available for image magnification. Usefulness of this system is summerized as follows : (1) Operation of the apparatus is facilitated. (2) Image magnification and improved automatic exposure yield better picture for diagnosis. (3) Data imprinting makes endoscopic data more objective.

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We had been performing removal of bile duct stones following endoscopic papillotomy since 1982, but it has been proved impossible to remove large concretions using conven-tional methods. Therefore, such cases had undergone operative therapy. This time, in concert with Olympus optical Co, we succeeded in removal of common bile duct stones in 11 of 14 cases, using new duodenofiberscope (TJF-10) and newly developped basket catheter. We consider our new basket catheter is very useful for medical treatment of common bile duct stones, yet there might be several points to be improved.

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