It is known that gastric mucosal redness, erosion and ulcer are frequently complicated in the patients with liver cirrhosis (LC). To know the mechanism of these appearance, gastric mucosal hemodynamics and aggressive factors were studied. At first, appearance rate of the mucosal redness was evaluated for the location and the form by endoscopy examination in LC patients and mass examinated group for stomach. The form of the redness was classified into 4 groups ; normal, comb-redness diffuse and flecky pattern. It was resulted that the appearance rate of redness was rather high in every parts of the stomach in LC group, espicially in the greater curvature of the body, the appearance of the flecky redness was most prominant finding. As the appearance rate of the redness was evaluated by the grade of the esophageal varices and liver dysfunction in LC patient, the result was that the more severe the grade, the higher the appearance rate was. Therefore, it was measured the gastric mucosal hemodynamics to study the relationship between the mucosal redness and the mucosal hemodynamic changes in LC group. Gastric mucosal blood flow (BF) was measured by H2 gas clearance method, and mucosal blood volume (BV) and O₂ saturation were measured by reflectance spectrophotometry during endo-scopy. In LC group, BF and O₂ saturation of the greater curvature of the gastric body were significantly decreased. In contrast, BV was slightly increased. These facts suggested that there was congestive state in the mucosal hemodynamics of the gastric body in LC group. BF and O₂ saturation of the gastric body more decreased in LC group complicated of mucosal redness than in the group not complicated of it. Moreover, as the grade of the varices and the liver dysfunction increased, BF of the gastric mucosa decreased. As mentioned above, it was suggested that the mucosal redness was caused by the congestion of the hemodynamics and that this state was aggravated in the higher grade of varices and liver dysfunction. On the other hand, acid secretion slightly decreased in LC group. Pepsin activity of the gastric juice, serum pepsinogen I significantly decreased compared with control group. But these increased in patients with LC complicated of peptic ulcer compared with those not complicated of it. As these results, it was suggested that the cause of the gastric mucosal changes in LC patients is due to both disorder of the gastric mucosal hemodynamics and aggressive factors.

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Endoscopic Injection Sclerotherapy (EIS) was carried out for esophageal varices in 181 cases with liver cirrhosis (emergency: 115, elective and prophylactic: 66). 3 of 66 cases were resistant to EIS. Thus, comparative clinical studies were made on the difference between successful EIS of 14 cases and 3 cases resistant to EIS concerning endoscopic findings, details of EIS, portographic findings and portal pressure. The resistant cases had endoscopically high grade varices fed by the coronary or short gastric vein without the collaterals other than esophageal varices and had a larger size of coronary vein with higher portal pressure. In addition they took a longer period, larger amount of EO and more sessions for EIS. In successful cases the esophageal varices were eradicated within 5 sessions, 36 ml of EO and 3 months on the average. When a case takes over these averages, we could predict that it would be a resistant case. In cases resistant to EIS, combination of PTO, different sclerosant or surgical procedures should be considered.

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Recent advances in image processing techniques are carrying the new era of endo-scopic diagnosis. An electronic endoscope is one of the newest instrument to contribute toward the progress in endoscopy. In this paper, we reported the usefulness of the electronic endoscopy in the analysis of gastric mucosal hemodynamics. The optical intensity of red or green obtained from the electronic endoscopic image depended on the distance from the object to the lens and the reflectance spectra of hemoglobin. Therefore, the index of hemoglobin concentration was extracted from the endoscopic image by processing of the ratio of red to green. This index had a good correlation with the concentration of mucosal hemoglobin measured by in vivo organ reflectance spectrophotometry. Using this method, the blood distribution of the gastric mucosa can be analyzed and displayed in animals. The electric image of this endoscope suited the imageprocesser. We concluded that the functional imaging using electronic endoscope would be important to the progress in endoscopic diagnosis.

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Duodenal and gastric mucosal hemodynamic changes in the healing process of duodenal ulcer were investigated by reflectance spectrophotometry under endoscopy. At the active stage of ulcer, the index of mucosal blood volume at the bulbus of duodenum increased significantly and returned at the healing and scarring stage of ulcer. Mucosal blood volume at the ulcer margin, however, decreased at the active stage as copared to that of the intact bulbar mucosa and it increased maximaly at the healing stage. The estimated mucosal hemoglobin SO₂ at the bulbus and ulcer margin did not change. The index of gastric mucosal blood volume was increased at the all stage of the duodenal ulcer. It was concluded that the mucosal hemodynamics changed in the course of healing process of ulcer and that an increased blood supply to the ulcer margin plays an important role in the healing of the ulcer.

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We have classified endoscopically the duodenitis into three types: hyperemic type (65 cases), erosive type (25 cases), and rough surfaced type (4 cases). In this report the differences of the mucosal function (ability of methylene blue absorption and mucosal enzyme activity) and the mucosal architecture (villous shape and histological features) between mucosa of the duodenitis and normal duodenal mucosa (200 cases) were studied. Results obtained were as follows; 1. Marked decrease of absorptive function of methylene blue and alkaline phosphatase activity was found in three types of duodenitis. On the other hand, normal duodenal mucosa showed high absorptive function of the dye and high activity of the enzyme. 2. The leaf shaped and ridge shaped villi were most frequently observed in normal duodenal mucosa by Bisecting microscope. On the other hand, the convoluted villi, and atrophic villi typel and type2, which were characterized by fusion or flattening of villi, were more frequently found in three types of the duodenitis. 3. The villous hight was lower in three types of the duodenitis than normal duodenum and the villous width was significantly widened in hyperemic type in comparison with other two types of duodenitis and normal control. 4. Higher incidence of gastric epithelial metaplasia was encounterd in all types of duodenitis. 5. The extent of infiltrating cells in lamina propria was increased in erosive and rough surfaced types. These findings suggest a validity of classifying the duodenitis into hyperemic, erosive, and rough surfaced types based on the endoscopic appearances.

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We have experienced 65 cases of vibrio parahaemolyticus enterocolitis in the recent 5 years and examined 13 cases of them by colonoscopy. This time, we mainly studied the endoscopic picture. Changes such as redness, bleeding and erosion were observed in 10 out of 13 cases. Morbidity in the ileocecal region such as the terminal ileum and Bauhin's valve was frequently observed in 7 out of 8 case and 6 out of 9 cases, respectively. In 2 cases, longitudinal bleeding and erosion were observed in the sigmoid and descending colon, and these findings were similar to ischemic colitis. Vibrio parahaemolyticus has no tissue-invasion property but produces heat-resistant hemolytic poison in the intestine. It was supposed that this poison brought on diarrhea and destroyed intestinal epithelial cells, and bleeding and erosion frequently observed in the ileocecal region was caused by this mechanism. In addition it was supposed that the longitudinal lesion in the sigmoid and descending colon was an exceptional case, and peristalsis promoted by exotoxin caused the ischemia in the intestine followed by causing the disease.

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Colonoscopy has become a widely-accepted procedure in the diagnosis and manage-ment of colonic disorders, mostly because of refined technique as well as improved equipements. For the colonoscopic examination of sufficient quality, adequate preparation is mandatory. Colonoscopy preparation should be theoretically rapid, effective, well-tolerable and safe, but the conventional method is not always satisfactory in this context. Recently-developed balanced electrolyte solution, containing polyethylene glycol and sodium sulfate, is associated with minimal absorption and secretion of water and electrolyte in the intestinal tract, when taken orally. In seventy patients who underwent total colonoscopy, we performed whole-gut lavage using this solution for the preparation, and prospectively evaluated its rapidity, effectiveness, patients' tolerance and safety. Preparation was accomplished within four hours in the majority of the patients on the same day of the examination, and was good to excellent in quality. The lavage method was preferred by the patients to the conventional method. No adverse effect was noted. We conclude the whole-gut lavage with nonabsorbable, nonsecretory balanced electro-lyte solution is a valuable method in preparation for colonoscopy.

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Moderate-sized polyps (adenoma and early cancer) ranged 6-5 mm in diameter were studied in order to evaluate the position and significance of early cancer. Among 337 polyps studied, adenoma was 239 and early cancer was 98 (29%) in number. Subdivision of early cancer was as follows: m cancer, 81 and sm cancer, 17 in number. A tendency that the larger their polyps the higher the ratio of lower-colon polyp was noticed. Early cancers existed at the rectum in the highest ratio, and the ratio of early cancer got lower at the right-sided colon. Polyps were divided into sessile and pedunculated according to their shape, the former accounted for one fifth (72 polyps) and the latter four fifths (265 polyps). Early cancer war 21% in sessile polyps and 31% in pedunculated polyps in all. In polyps larger than 1 cm the ratio of cancer cancer ratio was almost the same (ca 50%) among them. The number of m and sm cancer was almost the same in sessile polyp, while that of in cancer was 7 times larger than that of sm cancer in pedunculated polyps.

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To clarify the toxic effects of paraquat (1, 1'-dimethyl-4, 4'-dipyridylium dichloride) on upper gastrointestinal tracts, we examined seven patients with paraquat ingestion using panendoscopy. The results obtained were as follows: 1. The upper gastrointestinal lesions consisted of superficial inflammation, erosion and ulceration. 2. The corrosive changes were observed predominantly in the esophagus and the upper part of the stomach, while less markedly in the duodenum. The esophageal lesions were found in all patients. 3. The most severe derangement was observed in the lower portion of the esophagus. 4. The upper gastrointestinal damage healed within a few weeks. 5. There might be no relation between severity of the upper gastrointestinal lesions and serum paraquat concentration. From these endoscopic findings and clinical courses it was suggested that paraquat-induced upper gastrointestinal injury was produced by the direct and caustic intoxication of paraquat ion.

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Findings of endoscopic ultrasonography (EUS) have been examined in 37 cases of chronic pancreatitis diagnosed by ERCP (28 cases of the first group and 9 cases of the second group in Japanese Clinical Classification of chronic pancreatitis) and 21 cases without chronic pancreatitis. The accurate diagnostic rate of EUS was 93% and much better than that of conven-tional ultrasonography (US). Basecally, the pancreas in these cases was demonstrated as an ueneven echogenecity with more clearer irregular margin than US. The same findings of the pancreas were observed in the cases of the second group of chronic pancreatitis. These findings were differentiated clearly from the changes by aging. However, uneven internal echo was visualized also in some cases without chronic pancreatitis by EUS. Therefore, it is necessary to discuss further whether it is a specific finding in chronic pancreatitis or not.

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A case of esophageal mucosal denudation was reported.A 40-year-old male receiving hemodialysis for two years underwent endoscopic examination because of nausea and anemia. At the first examination, hematoma was observed in the middle portion of the esophagus. At the second examination four hours later, hematoma spread from the middle to the lower esophagus. When the endoscope was withdrawn, he vomited a small amount of blood. At the third examination on the next day, a longitudinal ulcer was observed on the area of the hematoma. Anti-ulcer drugs were administered and the ulcer healed four weeks later. Thereafter, his clinical course was uneventful without any stenotic symptoms. The esophageal mucosal denudation is very rare, and only 9 cases have been reported in Japan. The mechanical stimuli soch as snlid foods or the management of endoscope may cause this disease. In this case a bleeding tendency may have contributed to the onset of the disease. The all reported cases healed conservatively in about four weeks. At the time of endoscopic examination, we have to keep this, disease in mind.

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A case of intramural esophageal cyst was reported which were recently experienced.The patient was a 19-year-old male. The chief complaints were epigastric discomfort and loss of appetite. Upper GI series with barium and endoscopic examination of the esophagus showed submucosal tumor at the lower thoracic esophagus (Ei). Since no apparent tumor was found by the thoracic CT scan study, endoscopic ultrasonography was performed and the case was diagenosed as leiomyoma in the proper muscular layer of the esophagus. Through right thracotomy the esophageal tumor was enucleated.The tumor, located within the muscular layer of the esophagus, was a cyst with paste-like content. Pathologically the cyst wall consisted of proper smooth muscle with pseudostriated ciliated epithelium, but no cartilaginous tissue was found.It was considered that this intramural esophageal cyst was related to some abnormality of developmental process of the esophagus.

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Crohn's disease (CD) can originate in any part of the gastrointestinal tract from the mouth to the anorectum. We experienced a case of Crohn's disease developing an ulcer in the hypopharynx after operation of regional enteritis.This 37 year-old male patient has a past history of stomatitis at the age of 23, operation of regional enteritis (CD) at 24, ulcer formation in the hypopharynx at 25 and tonsillitis at 26. He developed sore throat in October, 1985, which aggravated in December. Therefore, he was hospitalized in our ENT ward until January, 1986. However, endoscopy after his discharge disclosed a giant ulcer in the hypopharynx, which was diagnosed as CD because biopsy revealed granuloma formation. So, he was re-admitted to our department and was placed on oral prednisolone. The ulcer and his general condition became better and he was discharged in good condition in March, 1986. He has been followed up in the outpatient clinic and his condition is well with medical treatment.he reported frequency of CD having oral lesions is 420%. To our knowledge, oral involvement of CD with histological evidence has been reported in only 10 until now. We herein presented this case and reviewed the literatures.

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A girl of 15 years of age with Wilson's disease was treated with D-penicillamine and examined by laparoscopy before and after treatment. Its finding showed the macronodular liver cirrhosis. Blue-gray colored nodules and copper in the liver tissue decreased after therapy, however, nodules still remained.

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A 54-year-old male with a chief complaint of pain in the right hypochondrium was referred to our hospital because of further evaluation of abdominal mass detected at a local hospital. Hypotonic duodenography revealed a large irregular ulcer showing the appear-ance of diverticulum in the third portion of duodenum. Endoscopic picture demonstrated that the third portion of duodenum was compressed by the tumor with bridging folds. The central portion of the tumor was communicated to the duodenum with a large ulceration. Histology of biopsy specimen obtained from the ulceration was strongly suspected to be the tumor of smooth muscle origin, probably leiomyoma, from the findings of proliferation of spindle-formed cells with funicular arrangement. Resected specimen demonstrated an encapsulated tumor (7×7×5.7 cm) with central necrosis communicating to the duodenum. Diagnosis of leiomyoblastoma was confirmed from the histological findings of the resected specimen demonstrating mainly epitheloid cells and well differentiated smooth muscle cells.

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A 31-year-old man was admitted to our hospital with complaints of abdominal pain, diarrhea, fever and 18 kg loss of body weight on March 7. 1984. Barium enema study revealed many irregular-shaped barium flecks from the cecum to the sigmoid colon mainly in the ascending colon (Figure 3). Barium meal study of the small intestine showed scattred small, irregular barium flecks with converging folds and girdle-form narrowings (Figure 6). A plain chest radiophotograph showed a tuberculous cavity on the left lung (Figure 1). Mycobacterium tuberculosis was cultured from the sputum. Soon after administration of antituberculosis drugs was started on March 24. 1984, his symptoms and clinical findings were markedly improved. The intestinal X-ray findings during the treatment were as follows: Slightly rough mucosal surface and disappearance of haustration of the colon were shown two and a half months after the initiation of therapy (Figure 4). Then, reappearance of haustration of the colon was recognized one year after the initiation of therapy (Figure 5). Barium meal examination of the small intestine three and a half months after the initiation of therapy showed remarkable improvement (Figure 7). This case was a rare life-threatening intestinal tuberculosis and was considered to be a valuable case to know the healing process of intestinal tuberculosis.

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A 51-year-old woman was admitted to our hospital. Her chief complaint was recur-rent right lower abdominal pain. A small granular polypoid lesion with mucosal conver-gence was shown by barium enema and colonoscopy. Operation was performed to confirm the diagnosis and ercluded the possibility of malignancy. On laparotomy, an appendix with inflammatory change adhered the cecum, also the cecum and the appendix adhered the retroperitoneum. A cecal tumor existed on the hidden side of the strongest inflammatory portion of the appendix. By histological examination, we concluded that the polypoid lesion was induced by appendicitis as the next sentences. The strongest inflammatory portion of the appendix penetrated into the cecum and formed a fistula. The fistula distrupted the muscle layer of the cecum, not the mucosa. The mucosa was retracted by strong fibrosis and contraction on the healing stage, and became a small granular polypoid lesion. This case is thought to give us a useful suggestion on the endoscopic differential diagnosis of cecal tumors.

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Recentry, we experienced a case of acute hemorrhagic rectal ulcer accompanied with the obstructive jaundice. A 75 year-old female admitted to our hospital with complaints of upper abdominal pain and jaundice. ERCP revealed choledocholithiasis (Figure 1). Then massive anal bleeding suddenly occured on the 8th hospital day. Endoscopic examination revealed the inflammatory changes and multiple ulcerations on the rectum (Figure 2). Mucous bloody stool was continued, and the transfused blood amounted to 1, 000 ml. Barium enema study showed a slight irregularity of the mucosa but failed to demonstrate the ulcerations (Figure 3). Healing of the rectal lesions were prolonged. Administration of SASP, steroid enema, and metronidazole were not effective. PTCD and PTC-lithotomy were performed for the choledocholithiasis. After that, the lesion of the rectum was improved and healed endoscopically on the 108th hospital day (Figure 4). This case is compatible with the so-called acute hemorrhagic rectal ulcer accompanied with serious illness, which has been disscussed in recent literature.

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A 50-year-old woman was admitted to our hospital in 1977 with a complaint of frequent mucobloody stools. Barium enema and colonoscopic studies showed typical ulcerative colitis. Predonisolone and salazosulfapyridine were administered with the diagnosis of active total colitis. During eight years after the initial attack she passed on her clinical course with remission and relapse of symptoms. In 1985, she was readmitted to our hospital because of bloody stools. Barium enema showed a loss of haustra in the total colon, spicular formation in the asscendig colon and a polypoid lesion in the rectum. On colonoscopy the polypid lesion in the rectum was found to be a ha-like elevation with irregular surface and bleeding. The biopsies taken from this lesion revealed a well differentiated adenocarcinoma. Wedge resection was performed in January 1986. The lesion was 1.5×1.0 cm in size and microscopic findings showed submucosal invasion. All the surrounding mucosa did not show epithelial dysplasia. Carcinoma of the colon in patient with ulcerative colitis is almost always advanced tumor but our case was early carcinoma of the rectum. Patient with ulcerative colitis must be followed up at regular intervals by barium enema and colonoscopy.

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Recent experience of fiberscopic examination in gastrointestinal tract performed to newborn patients is reported, together with the discussion about the technical detail and the indication of the endoscopy in this special age group. During the period between January 1979 and December 1980, 23 times of fiberscopic examinations were performed to 20 newborn patients, and this occupies 4.6% of 499 times of examinations in pediatric cases. The average age of the day in which the examination performed is 13.7 + 6.6 days after birth, and the average body weight was 3, 142.8±717.3 grams. The purpose of endoscopic examination was classified into five categories as follows. 1) diagnosis of congenital anomaly, 2) diagnosis of gastrointestinal bleeding, 3) endoscopic surgery, 4) functional evaluation of anorectum using VTR-endoscopy, and 5) others. As the size of gastrointestinal tract of newborn is extremely small and fragile, a very gentle manipulation is required to prevent injury. When the specificity of pathophysiology of newborn patient is taken into the considera-tion, the significance and the possibility of f iberscopy in this age group is not limited. When appropriately adapted, f iberscopy can be used, not only in diagnosis, but also in therapy and functional evaluation.

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