We found subepithelial longitudinal vessels at the lower esophagus in all 844 cases but 21 cases in which we could not find them because of mucosal thickening by inflammation. We measured endoscopically their length by using the silk thread marked at intervals of 5 mm, then 90% of them ranged from 2 cm to 3 cm. The "indentation", which corresponded to the angle of His, was observed at the junction with the tubular esophagus and the saccular stomach by both radiological and endoscopical examination. We made the investigation on positional relationship between the "indentation", squamo-columnar junction, and longitudinal vessels. We found no cases in which the longitudinal vessels were observed under the gastric mucosa beyond the "indentation". Therefore it is the finding peculiar to the esophagus to be able to observe subepithelial longitudinal vessels in the vicinity of the esophago-gastric junction. On 21.4% of 884 cases, longitudinal vessels were found under the columnar epithelium at the oral side over the "indentation" from the stomach. This columnar epithlium located at the esophagus because the longitudinal vessels were observed only at the esophagus, therefore it should be the Barrett's epithelium. Thus the definite diagnosis of the Barrett's epithelium can be made by endoscopic examination.

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Comparative studies were made on laparoscopic features of the liver surface and concentration of stainable copper granules in liver biopsy specimens of untreated patients with Wilson's disease. Nine cases (eight males and one female) including cases of the two siblings were studied. According to the uneveness and coloration of the liver surface, laparoscopic findings were classified into four types as follows, type I : smooth surface with yellowish brown coloration, type II: granular surface with whitish brown coloration, type III: nodular surface with dark brown or dark purple-blue coloration, and type IV : hemispherical nodular formation with dark purple-blue coloration. On the basis of our classification, it may be suggested that the nodular formation of the liver in Wilson's disease coincides with advance of dark coloration. Copper granules stained by Rhodanine in biopsy specimens were estimated by their size and distribution. As dark colorations and nodular formation of the liver surface advanced, concentration of stainable copper granules increased. We propose that laparoscopic findings of the liver surface in untreated Wilson's disease play an important role in the advancement of Wilson's disease.

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It has been well known that the activity of alkaline phosphatase (ALP) is detected in the wall of blood vessel. To determine good condition for mucosal staining based on ALP activity, studies on fixation time and observational method were carried out. As a result, capillary network in gastric mucosa could be clearly observed. Abnormal findings of capillaries were classified into 5 patterns, such as hemorrhagic, diminished, shortening, proliferative and irregular pattern. With respect to a density of capillaries, the former 3 patterns were termed as a low-density capillary group, and the latter two as a high-density capillary group. In the cases of mucosal redness found by gastroendoscopical examination, 58.9% of those was shown to be low-density capillary group and 45.1% to be high-density group. In the low-density capillary group, mucosal redness was demonstrated to be due to inflammatory cell infiltration. Several gastric glands and surrounding vascular proliferation were observed as single unit in the cases of hyperplastic polyp. Gastric mucosa involved by intestinal metaplasia had a tendency to be diminished in capillary density.

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Ten cases of Schistosomiasis Japonicum (SJ) with colonic lesions were experienced. All of them are patient from Kofu basin which is known as prevalent area of the disease. The distribution of the lesions was as the following : diffuse (total colitis 2, proctosigmoiditis 3) 5 cases, segmental sigmoiditis 2 cases, patchy proctitis 2 cases and mixed type 1 cases. Abdominal ultrasonography revealed liver fibrosis typical for SJ in seven among nine. Colonoscopy showed that the following findings were typical for SJ : (1) atrophic and smooth mucosa, (2) irregular yellow fleck which coincided the nest of eggs. (3) abnormal vascular pattern (4) teleangiectatic spots. Barium enema were performed for 5 patients. Two were diffuse total colitis, two were segmental colitis and one was mixed type. Diffuse lesions were very similar to that of ulcerative colitis in remission. The lack of episodes of bloody diarrhea and the existence of irregular yellow spots in case of SJ were the main differentrating points between the two conditions.

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Peritoneoscopic features of five severe cases of acute viral hepatitis with prolonged jaundice, ascites and intensive coagulopathy were investigated. Whereas two cases which showed local necrotic change on the liver had good prognosis, two of three cases which showed diffuse necrotic change resulted in chronic hepatitis and liver cirrhosis, and the remained one died on gastrointestinal bleeding. Peritoneoscopy for the cases such as severe form of acute viral hepatitis is useful at foreseeing the prognosis. Liver biopsy in such cases should be performed peritoneoscopically to prevent a sampling error.

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The colonoscopic results of the past 15 years (1970-1984) were reviewed. The total number of the colonoscopy in the 15 years was 9820 for 6077 patients. The following results were obtained. (1) Ulcerative colitis (uc) was the most popular inflammatory bowel disease from the start (1970). Although rapid increase was expected, no marked change in the number of the new ucpatients was observed. (2) Crohn's colitis was very rare at the earlier days of this study. Gradual increase in the following years, resulted in the recent explosive increase. (3) Ischemic colitis, antibiotics-associated colitis and amebic colitis (amebiasis) are known as conditions which showed rapid increase in the recent years. (4) As for neoplastic conditions cancers and adenomas have increased gradually. It was revealed that adenomas and early cancers are abundant in the spectrum of morphology. (5) Formerly, most adenomas and early cancers were either domeshaped (small ones) or pedunculated (larger ones). However, flat, IIb-like, creeping or even depressed type tumors have come to be known to exist.

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During the fluorescence analysis for colon cancer, we coincidently found extremely specific fluorescence of Schistosomiasis Japonica of the colon. In this article, we reported the method for examination of the fluorescence and discussed the significance of this method for the diagnosis of Schistosomiasis Japonica of the colon. By examining the location of the aggs in the colon wall, we also studied how deep the fluorescin material in the colon wall can be detected by this apparatus. An examined specimen was a surgically resceted colon with 5 cancers and multiple egg nests of Schistosomiasis Japonica (Figure 1). Excited laser used for fluorescence examination was 514.5 nm of argon laser, and fluorescence spectrometer was OMA-2 system. After observation of the fluorescence of the colon (Figure 2), fluorescence spectra of small area of colon mucosa with 2 mm, in diameter was examined using a contact method, which was followed by histological examination. The results showed that the egg nests of Schistosomiasis Japonica in the colon had extremely specific fluorescence with orange-red color (Figure 4), which was 612 nm in wavelength (Figure 9). Because this specific fluorescence coexisted with the location of egg nest, we expected this fluorescence examination can offer a good method for the diagnosis of Schistosomiasis Japonica. Furthermore, because most of these detected egg nests located in or near the submucosal layer (Figure 8), we suppose that this apparatus can detecte fluorescin in the submucosal layer of gastrointestinal tract.

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Sixteen cases of ischemic colitis (IC), consisting of 14 cases of transient type and z cases of stenotic type, were presented. The course of the disease were endoscopically observed. The results were as follows : 1) IC was seen mainly in the elderly persons. Abdominal pain and bloody diarrhea were typical clinical symptoms. 2) The colonoscopic findings of IC of transient type were characteristic and diagnostic. Four stages were recognized according to the endoscopical features. (a) Stage I : (Within 3 days after the onset). Nodular edematous-reddish mucosa due to edema and/or hemorrhage in the submucosa was the earliest change. (b) Stage II: (4-7 days after the onset). Edematous-reddish areas seen in the stage I were fused longitudinaly, followed by formation of linear ulcers. (c) Stage III : (8-14 days after the onset). The linear ulcers and/or linear ulcer scars were seen in all cases. (d) Stage IV : (15-54 days after the onset). Only linear ulcer scars were seen. 3) Gross pathology had proved that linear ulcers were seen along the teniae coli which formed three seperate bands. Endoscopical findings of this investigation also proved this. However, it is obscure why the linear ulcers were seen along the teniae coli. 4) Repeated colonoscopical examination in the early stage were very helpful in the observation of the course of these characteristic lesions. 5) Two cases of stricture formation were recognized to diminish the grade of stenosis by examinations performed on the 56th and 87th day after the onset, respectively. In one case, a barium enema a year after the onset disclosed no evidence of stricture.

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Two cases of IFP in the stomach were reported. One patient was a 45 year-old female. IFP was diagnosed pleoperatively by endoscopic findings showing a characteristic shape mimicking (human) glans penis. The other patient was a 69 year-old male. Histopathological findings in each case showed onion-skin like lesions around arterioles and infiltration of eosinophilic leucocytes, which were compatible findings with IFP. No fragments of parasites were detected. The laboratory findings before resection of IFP showed elevated level of IgE. Radio-Allergo-Sorbent Test (RAST) specific for soluble antigen extracted from anisakis type I was positive. In one patient Leukocyte Migration Inhibition Test (LMT) to this antigen was positive. After resection of IFP, the IgE titer decreased and LMT became negative. These findings suggested that immunological reaction to Anisakis type I played an important role in the pathogenesis in some cases, of IFP.

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A 75-year-old male was admitted to our hospital complaining of dark skin pigmentation of the whole body. Papillomatous and verrucous protrusions with hyperpigmentation were noted in the face, neck, hands, feet, axillae, and external genitalia. Striking hyperkeratosis and papillary hypertrophy without hyperpigmentation were noted on the palmar and plantar surface. The lips, tongue and oral mucosa were also involved with papillomatous thickening. Radiographic and endoscopic examinations of the upper gastrointestinal tract showed an advanced gastric cancer (Borr. type III) at the cardia and numerous granular changes of the esophagopharyngeal mucosa. Endoscopical biopsy taken from the pharynx and esophagus revealed the papillary hyperplasia of the squamous epithelium without malignancy. And, the lesion of the stomach was also histologically confirmed as moderately differentiated tubular adenocarcinoma.

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A 41-year-old man visited our clinic with complaints of edematous erythema on the face, scalp and upper chest. He also had muscle weakness and dysphagia in addition to the above complaints. Laboratory examination showed anemia and remarkable elevation of CPK, GOT, LDH and aldolase. Biopsied specimens obtained from the erythema of his face presented atrophic epidermis, liquesf action degeneneration and edema in the upper part of the corium. There was not proteinuria nor M-proteinemia. Radiographs of bones failed to find any deposits. Endoscopic examinations revealed a saucer-shaped flat elevation with a wide central depression in an area from the gastric body to the antrum and verrucous lesions on the anterior wall of the antrum. Based on these clinical findings, we diagnosed this case as malignant gastric lymphoma with dermatomyositis. Emergent total gastrectomy was performed because of hematemesis. The resected stomach exhibited the same findings as observed endoscopically. Histologically plasmoid cells which had abundant cytoplasma and eccentric nuclei infiltrated massively into the submucosal layer and partly into the subserosal layer. The lesion was IgG positive, λ positive and x negative stained by PAP method. This case was finally diagnosed as gastric plasmacytoma associated with dermatomyositis. The patient died four months after operation in spite of careful treatment including the administration of predonisolon.

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A 67-year-old man without any symptoms was admitted to our hospital for further investigation after an abnormality of the duodenal bulb was pointed out elsewhere. Hypotonic duodenogram showed a polypoid lesion in the duodenal bulb, and endoscopic examination disclosed that it was whitish, nodular and pedunculated. Although the histological diagnosis of biopsy (specimen) was adenoma, carcinoma was strongly suspected by both of x-ray and endoscopic examination. Therefore, endoscopic biopsy using a snarewire was performed to differentiate adenoma from carcinoma. The large biopsy specimens obtained by this method revealed papillotubular adenocarcinoma. Gastrectomy, partial duodenectomy and lymph node dissection were performed. A nodular, pedunculated tumor with broad base, 2.8 × 1.9 cm in diameter and 1.2 cm in height, was found in the duodenal bulb. Histological examination of the resected specimen proved papillotubular adenocar-cinoma partially invading the muscularis mucosae. In this case, the big snare biopsy was very useful for the diagnosis of the duodenal polypoid lesion.

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A case of chronic alcoholic pancreatitis with persistent duodenal stenosis is reported. A 66-year-old man complaining nausea and vomiting was admitted. He had been treated for chronic alcoholic pancreatitis and diabetes melitus for fifteen years. Dilatation of the stomach and long stricture of the second portion of the duodenum were revealed by upper GI seriese. Multiple polyps were found by endoscopy. The common bile duct was dilated 2 cm in diameter by ultrasonography. The serum levels of amylase, lypase and bilirubin were not elevated. CA-19-9 level in the serum was within normal range. Surgery was performed after 7-weeks of medical treatments with total parenteral nutrition because of persistent duodenal stenosis. The distal stomach and the stricture segment of the duodenum were resected and a Billroth II gastrojejunostomy was made with the duodenal stump anastomosed by Roux en Y duodenojejunostomy and choledochojejunostomy was added with Roux en Y loop. Microscopy of subserial sections through the portion of the duodenum revealed marked thickning of the external muscle layer and inflammatory polyps in the mucosa. A abnormal duct which run parallel with the duodenal submucosal layer, however it was not identfied what it is, was found. The duct was severe inflammed and the inflammation extended into the surrounding submucosal layer and external muscle layer. In this case, duodenal stenosis is thought to be caused by severe duodenal inflammation which might be related to the abnormal duct.

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A case of adult asymptomatic annular pancreas was reported whose body of the pancreas was observed through peritoneoscope without special techniques or equipments. The patient was a 50-year-old female who suffered from liver cirrhosis with persistent hepatitis B virus infection. Endoscopic retrograde pancreatography revealed that the configuration of the duct was compatible with the type-IV of Yumura's classification on the annular pancreas. Since the body of the pancreas was hypertrophied and protruded toward the abdominal wall, we . were peritoneoscopically able to observe the body through the lessure omentum between the left lobe the liver and lessure carvature of the stomach.

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A 40-year-old man was admitted to our hospital with jaundice. Laboratory tests showed slight jaundice and liver dysfunction. We diagnosed it as a case of Dubin-Johnson syndrome (D-J synd) because in the BSP test, after 45 minutes, dye retention in the serum had mildly increased and a secondary rise in the BSP excretion curve was evident. Laparoscopic examination showed a gray discoloration of the hepatic surface. Biopsy specimens showed that the quantity of pigments had decreased. Other cases of D-J synd complicated by hepatitis have been reported. In those cases also, the liver was discolored and there was a decrease in the accumulation of pigments in the hepatocytes. In this case, it was not possible to diagnose hepatitis because of a lack of histological evidence. However, the similarities between this case and above-mentioned reports indicate that the D-J synd was complicated by some type of hepatic injury.

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This case report describes a patient with cavernous hemangioma of the rectum and sigmoid colon. A 49-year-old male was admitted to our hospital with a long-standing history of intermittent rectal bleeding and anemia. Plain roentgenogram of the abdomen showed multiple small calcifications within the pelvis (Figure 1). Roentgenogram (barium enema) of the rectum revealed deformity caused by an extraluminal mass and multiple filling defects with thum-printing (Figure 2). Colonoscopy revealed a soft dark brown mucosa of the rectum bulging into the lumen circularly from anal verge to approximately 20 cm (Figure 3) and hyperemic mucosa of the sigmoid colon (Figure 4). Computed tomogram of the pelvis showed thick wall of the rectum and multiple small calcifications (Figure 5). Selective inferior mesenteric arteriogram with delayed venous phase showed venous pooling in the region of the rectum and sigmoid colon (Figure 6). These findings led to a diagnosis of hemangioma of the rectum and sigmoid colon. No other hemangiomas were found in the remainder of the gastrointestinal tract, pancreas, spleen, kidney and skin. The affected rectosigmoid segment was resected surgically. At operation, hemangiomas of the liver and cystis were found out. The resected specimen showed thick wall of the rectum and sigmoid colon (Figure 7). Histological finding of the specimen disclosed cavernous hemangioma (Figure 8).

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A 66-year-old man was admitted to our hospital due to an episode of syncope attack. He had severe anemia. Upper gastrointestinal endoscopy revealed an ulcer on the posterior wall of the middle body of the stomach. By medication, the gastric ulcer had healed, but occult blood of the stool had continued to be positive. Although barium enema study revealed no lesion, colonoscopic examination showed multiple gatherings of abnormally dilated vessels on the splenic flexure, hepatic flexuer, ascending colon and cecum. Superior mesenteric arteriography confirmed the presence of arteiovenous malformation supplied by ileocolic and right colic branches, showing dilated vessels and poolings of the contrast medium in the peripheral arteries. The changes were also detected by inferior mesenteric arteriography. 42 cases of arteriovenous malformation of the gastrointestinal tract have been reported in the Japanease literature.

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This syndrome is a rare condition, which affects young adults, which causes problem in diagnosis. In the present study solitary ulcer of the rectum and rectal prolapse are regarded as identical disorders which overt or occult prolapse is common underlying pathogenetic mechanism. Therefore, du Boulay proposes to use a common clinicopathological term "mucosal prolapse syndrome" to solitary ulcer of the rectum, hamartomatous inverted polyp, colitis cystica profunda and same conditions. For earlier diagnosis, it is important to recognize a spectrum of this syndrome. Our two cases of this syndrome are reported, discussing on clinical and histological features. Case 1: An 8-year-old female with a complaint of mucous bloody stool first visited our hospital in February, 1978. Subsequently, though she had been relatively well, she visited again because of the increase of the symptom in November, 1980. Endoscopy showed semi-spherical and irregular shaped flat elevations covered with white coat in the lower rectum. Trans-anal excision was performed. Case 2 : An 11-year-old male, complaining of fresh bloody stool visited our hospital in December, 1978. Endoscopy showed grouped polypoid lesions and mucosal erythema in the lower rectum. Trans-anal excision was performed. Histological specimens of both cases revealed fibro-muscular obliteration of the lamina propria which is most characteristic of this syndrome.

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We had a chance to use a prototype of VideoColonoscope that has no optic-fiber bundle for imaging. The tip is set in the distal tip of the instrument and it electronically transport the image to the videoprocesser and display it on the T. V, monitor. We examined 27 patients with the VideoColonoscope or VideoSigmoidscope. The image on the T. V, monitor was excellent. Successful insertion rate to the cecum was 81.8%. There are still some weak points for the clinical use, but seemed very hopeful.

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Not only laboratory data and blind biopsy of the liver but Peritoneoscopic examination is necessary for understanding the pathological conditions during clinical course of chronic hepatitis more accurately and in details. This is because peritoneoscopic examination has already been evaluated to be indispensable for morphological and patho-physiological diagnoses of liver diseases, especially chronic hepatitis, although some kinds of invasion such as pain for about one hour at peritoneoscopy really exist. Present conditions of peritoneoscopic examination in clinical practice, mainly in diagnosis of chronic liver diseases, are presented in this paper.

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The aim of emergency laparoscopy lie in the prompt and adequate identification of pathologic conditions of abdominal cavity and determination of indication of surgical operation, and performance of laparoscopic treatment if possible. For the past 17 years 4, 40C patients have undergone laparoscopy, while 907 (20.6%) have undergone emergency laparoscopy. As to those undergoing emergency laparoscopy 65.8% suffered from inflammatory diseases, 8.9% perforative diseases 23.2% obstructive diseases and 1.9% hemorrhagic diseases. Out of 140 cases of acute pancreatitis 7.1% underwent emergency operation, 15.7% laparoscopic drainage, 77.1% conservative treatment, and 92.8% recovered without emergency operation. The mortality rate was 2.1%. Out of 137 cases of acute peritonitis the operation rate was 61.3% and mortality rate was 1.4%, while 54.2% recovered without emergency operation. Out of 7 cases of mesenteric arterial occlusion the operation rate was 43.0% and mortality rate was also 43.0%. Out of 2 patients of mesenteric venous occlusion one died. Out of 56 cases of acute appendecitis the operation rate was 84%. Conclusion : Emergency laparoscopy is effective in prompt diagnosis and determination of indication of surgical operation in acute abdomen. Especially laparoscopic drainage in acute pancreatitis and laparoscopic treatment using electro knife in intestinal obstruction help patients to recover without surgical operation.

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Recent improvement of image fiber bundle and development of endoscope of fine diameter made use of panendoscope popular in endoscopic examination of upper GI series. Panendoscopy underwent case number in our department was 3, 111; 88.4% in total examined 3, 520 cases in last 5 years (from June, 1980 to May, 1985). On the other hand, endoscopic examination in use of side-viewing scope was underwent in about 10% of cases, almost of whose diagnosis being early gastric cancer. This fact indicates significance of endoscopy in use of side-viewing scope in endoscopic diagnosis of early gastric cancer. Visual diagnosis is important in endoscopic examination in use of front-viewing scope and examiner must observe and take a picture in excellent visual field at an optimal distance. Diagnosis of fine change such as one of early gastric cancer or stage diagnosis of peptic ulcer may depend on diagnostic ability in endoscopy of examiners. Cases with discrepancy of visual diagnosis and photodiagnosis should be, therefore, carefully judged.

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