Cardiac forms were classified into seven types (CIto CVII) observed by inversionmethod with endoscope (Table 1). Lower esophageal remaining pressures, remaining gastric pressures and lower esophageal sphicter pressures were measured by transducer method with endoscope. There were negative correlations between age and these measured walues (Figure 2, Figure 3, Figure 4). As shown in Table 2, these pressures were lower in types CIV, CV, CVI (open type of the cardia) and type CVII (hiatal hernia) than in types CI, CII, namely closed type of the cardia. Negative correlation was obtained between age and height of peristaltic waves of the electromyographic examination induced at the esophago-gastric junction (Figure 5). As a result of the dyeing method using Congo red, open types of the cardia were observed more frequently in patients over 40 years old (Figure 6). This result was similar to the increase of type CIV, CV, CVI of the cardia. There were a little negative correlation between the pH of the middle and lower esophagus, esophago-gastric junction and age (Table 4). The pH of type CVII was lower than type CI, CII and type CIV, CVI (Table 5).

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Endoscopic forms of the cardia and the pylorus were studied. We classified cardiac forms into seven types observed by inversion-method with endoscope (Table 1). Endo-scopic forms of the pylorus were classified into six types (Table 2). There was no significat difference between intraluminal pressures of the antrum and the bulb measured by transducer method (Table 11). Pressures of the pyloric ring of type PI (closed type pyloric ring) and type PIT (open and close type pyloric ring) were significant-ly raised by secretin injection (Table 12). Cardiac form and pyloric form were analysed by 4mm and 16mm films in the same case (Figure 1, Figure 2). Further analysis was made on endoscopic forms of the cardia and the pylorus by film and endoscopic observation (Table 6, Table 10). There were no difference between these findings. On the other hand, we found a correlation between the cardiac form and the pyloric form in individual case (Table 13). Serum gastrin level and secretin level were studied in control group and in patients of gastric ulcer and in patients of duodenal ulcer. There were no correlation between age, cardiac forms and these hormone levels (Table 7, Table 8).

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One hundred and eighteen cases with various liver diseases who underwent laparo-scopy using intravenous injection of a large dose of ICG were studied. Of 118 cases, poor staining of liver surface with ICG were observed in 30 cases. The factors on poor staining were suspected as follows: 1) Severe cell infiltration within liver tissue (severe inflammatory activity within liver tissue), 2) severe fatty metamorphosis within liver tissue and 3) micronodular formation on liver surface. In experimental studies using rat model treated with carbon tetrachloride, choline-deficient diet and D-galactosamine, the factors contributing to poor staining states were studied. These results suggested as follows: 1) The more severe fatty metamorphosis existed within liver tissue, the poorer staining with ICG on liver surface, so the degree of fatty metamorphosis within liver tissue tended to correlate with the staining with ICG on liver surface laparoscopically observed, 2) in acute hepatic failure rat, poor staining of liver surface was observed, but the staining state was improved in accordance with improvement of hepatic failure. Thd degree and/or the distribution of 1) size of fatty droplet, 2) fatty metamorphosis and 3) fibrosis within liver tissue may contribute to irregular staining of the liver surface with ICG on laparoscopy.

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A histopathological study was made in ten autopsy cases after endoscopic injection sclerotherapy for esophageal varices (EIS) with intravariceal injection of 50% glucose, 1% Aethoxysklerol and human thrombin. Thrombi were observed in all ten cases. In two cases who died 12 and 24 hours after EIS, the thrombi revealed red thrombi. In three cases who died 1 to 2.5 months after EIS, organization of the thrombi was recognized. In three cases who survived 1 to 2 years after EIS, there was a increase in tissue fiber lenity in the thrombi. Microscopic recanalization developed 2.5 months after EIS. Cellular infiltration around the varices was present in the cases who died within 4 days after the last EIS. In the cases who survived more than 1 month, fibrosis was seen in the submucosal layer of the esophageal wall. These histopathological findings appear to support the effectiveness of EIS.

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In order to confirm the correct diagnosis of gastric malignancy, strip biopsy was performed in 73 gastric lesions diagnosed as Group III and IV histologically in the bite biopsy specimen. Then, some cancerous lesions were detected in these cases. In these cancer cases misdiagnosed as Group III lesions, the reason and background of false negative diagnosis were investigated pathologically. Moreover, endoscopic differencial findings between cancer and atypical epithelial lesion were studied in these cases based on the diagnosis by strip biopsy. 1) By the histological studies in strip biopsy specimen, 74.0% of these lesions were diagnosed as well differenciated adenocarcinoma, 9.6% as border line lesions and only 16.4% as adenoma. This paper deal with border line lesions and adenoma as atypical epithelial lesion. 2) In the newly diagnosed 54 cancer lesions, the cellular and structural atypism were investigated in strip biopsy specimen as compared with bite biopsy one. The histological pattern that the cellular atypism was moderate but the structural atypism was remarkable were observed in the local area of 28 out of 54 gastric cancer lesions. In these cases, it seemed that there was a tendency for these to be faultily diagnosed as Group III lesions and that it was difficult to differentiate such gastric cancers endoscopically from on atypical epithelial lesions. 3) In the retrospective endoscopic study on these lesions diagnosed by strip biopsy, the lesions that the surface was constituted by more than two curved demensions had a high possibility of cancer, but the lesions that the surface was constituted by one curved demension, in spite of many divisions, had a high possibility of atypical epithelial lesion. All lesions depressed in shape were cancer.

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In this report, the pyloric channel ulcer was defined as the peptic ulcer lying on the endoscopic pyloric ring, and retrospective studies were made on its clinical and endo-scopical features. Among 4, 509 cases of peptic ulcers, 77 cases of pyloric channel ulcer (1.7%) were diagnosed by endoscopic examinations in recent seven years. Clinical backgrounds such as sex ratio and age distribution of them were more closely allied to that of duodenal ulcers than gastric ulcers. Relatively small number of cases (30%) showed pyloric channel syndrome, such as early post prandial pain, nausea, vomiting, and loss of body weight. Endoscopic appearances were 54 cases of solitaly, 15 of linear, and 8 of kissing ulcers. They located frequently in the anterior wall (33.6%) and in the lesser curvature (30%). Gastric ulcers were associated at significantly high rate (54.5%) with pyloric channel ulcers, compared with that with duodenal ulcers (23.7%). On the other hand, duodenal ulcers unquestionably apart from the pyloric ring were associated only with 9.1% of pyloric channel ulcers. In follow up period within a year, 5 cases changed their appearance to ulcers or scars of the duodenal bulb. This finding suggests that duodenal ulcer may be misdiagnosed occasionally as pyloric channel ulcer due to edema and deformity of the pyloric ring and duodenal bulb.

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Many studies of the experimental hepatocarcinogenesis implicated the hyperplastic nodules as a premalignant lesion. In addition, it has been shown that all hyperplastic nodules do not always progress to the liver cell carcinomas. In the present study, the liver surface of rats fed with 0.005% diethylnitrosamine was studied laparoscopically with electroendoscope (EES-50 A, Toshiba-Machida Co.). The electroendoscope used in this study enabled us to analyze quantitatively the color of the liver surface, by RGB values and perceptual parameters-HSI. The laparoscopic examination revealed that the hyperplastic nodules were noted after 10 weeks and liver cell carcinomas after 13 weeks of DEN feeding. Both the hyperplastic nodules and liver cell carcinomas did not take up indocyanine green (ICG), while surrounding liver tissues did. But, the color analysis based on HSI signals showed that the capacity of ICG uptake in hyperplastic nodules had still been preserved, compared to the lack of ICG uptake in liver cell carcinomas. From these results, it was suggested that the hyperplastic nodules might be precancer-ous in the rat hepatocarcinogenesis.

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In endoscopic injection sclerotherapy (EIS) for esophageal varices, inflow of sclerosing solution into varices can be confirmed by fluororoentgenography. As this procedure is complicated, simpler method is needed. Therefore, we used fluorescein, a fluorescent contrast medium, and confirmed the exact inflow of sclerosing solution without roentgeno-graphy. The subjects consisted of 20 patients with esophageal varices who underwent EIS palliatively or preventively. According to our routine, 50% glucose solution, Aethoxyscler-ol, and human thrombin were directly injected into esophageal varices. In this procedure, 10% fluorescein was added to the 50% glucose solution. During EIS, injected varices changed yellowish green in color. Cardiac varices similary changed in some subjects. When local elevation of varices following color change at the site of injection, extravar-iceal injection was considered at the time the injection volume of sclerosant was dis-continued. This mininal volume of extravariceal injection resulted in a decrease in ulcers after EIS. When color change occurred in varices other than injected varix, demonstrating inflow of the sclerosing agent, varices without color change could be injected serially and effectively. No accidents were encountered in this procedure.

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Endoscopic removal of various foreign bodies in upper were performed to 33 cases gastrointestinal tract during a recent 5 years at the Second Department of Internal Medicine, Aichi Medical University. Excluding 6 cases of elimination by natural passage, endoscopic removal was tried in 27 cases ; removal was accomplished without any compli-cations in 24 cases, however there was a difficulty in other 3 cases where PTP (press-through-pack) pieces or dentures had lodged in the mucosa of the upper esophageal region. In those cases we prepared soft, elastic hood which was then attached to the open tip of the endoscope and, by encapsulating the sharp foreign body in the hood, the body was removed without injury to the mucosa, particularly on the oral side. Both sewing needles and PTP pieces were removed safely and without any complications. It is thought that, depending on the size and shape of the foreign body, simple and very safe endoscopic removal may be possible in cases of complications involving dangerous foreign bodies by using the hood-attachment method in addition to the selection of grasping forceps and positioning devices.

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An elevated type of gastric ulcer scars(EUS) in 8 patients treated with H₂-Blocker (A) were compared with that in 15 patients EUS, not treated with H₂-blocker (B). Moreover, a white elevated lesion (WEL) seen in 7 patients was compared with EUS and the difference was discussed. The incidence of EUS and the mean age of the patients were higher in A than B. EUS was seen throughout the stomach in A, and only in the antrum in B. EUS was an elevation with regenerated tissues and the histological appearance showed f oveolar hyperplasia. The period from detection of gastric ulcer to confirmation of EUS averaged 4 weeks. However, EUS still remains several months later. On the other hand, WEL was an elevation with white colour and the histological appearance showed granulation tissues. The period from detection of gastric ulcer to confirmation of WEL averaged 4 weeks, and several weeks later, WEL disappeared. Therefore, these elevated lesions have some differences in findings of endoscopy, histology and follow-up study. It seems that EUS and WEL were induced by rapid tissue regeneration due to the strong anti-ulcer effect of H₂-blocker on an ulcerated area.

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Using the relaxing effect of nitrate on the smooth muscle of the Oddi's sphincter, we were able to eliminate stones in four patients with common bile duct stones without endoscopic sphincterotomy (EST). This method employs intravenous injections of nitrate and uses a basket catheter endoscopically inserted into the bile duct to grasp the stone. Removal of the stone can also be accomplished by endoscopically inserting a balloon catheter into the bile duct and pulling out the stone with the catheter. There was no evidence of adverse side effects such as lowered blood pressure excessively. This method was used on a small stone in the bile duct, but is especially useful in cases where EST is contraindicated or inappropriate. The application of this method is also beneficial when catheter insertion is difficult due to strong tension of the Oddi's sphincter during ERCP or EST.

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A 8-year-old boy with esophageal varices in postoperative biliary atresia was pro-phylactically treated by endoscopic injection sclerotherapy (EIS) with 5% ethanolamine oleate including 46% iopamidol. A total of three EIS, two of which were employed under varicography, revealed complete disappearence of esophageal varices and ramarkable reduction of gastric varices. The complication during treatment was only a transient esophageal ulceration at the injection site and no other complications were observed in short-time follow-up. Although in adult EIS is estimated to be an effective approach for esophageal varices, its indication and efficacy in children remains to be established because of lack of controlled trials with surgical methods and limitation of follow-up period. However, we believe that EIS can be employed as the prophylactic treatment of choice as well as emergency procedure for esophageal varices in children.

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The patient was a 67-year-old man, who had been pointed out to have a small elevated lesion on the lesser curvature of the gastric f ornix in July 1978 (Figure 1). In April 1983, radiological and endoscopic examination revealed a broad-based flat elevated lesion on the same position (Figure 2, 3). It was suspected IIa+IIc type early gastric cancer. But, histological diagnosis of this lesion by means of endoscopic biopsy was group III, so he was agreed to have reexamination after six months, but he did not visited our hospital. In October 1985, when he visited our hospital with a complaint of diarrhea, radiological and endoscopic examination were performed. They revealed a great elevated lesion with central depression on the lesser curvature of the gastric f ornix, and diagnosis of this lesion by means of endoscopic biopsy was group V. Total gastrectomy was performed. The lesion was Borrmann I type gastric cancer on the lesser curvature at 1 cm from the cardia macroscopically (Figure 7). Pathological examination revealed moderately differentiated adenocarcinoma (Figure 8) in which cancerous depth of invasion was pm. The patient is alive for 19 months after the operation.

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A 52-year-old women who had received steroid for her Aplastic anemia underwent upper GI series, revealing the round elevated lesion, 1×1 cm in size, in the lesser curvature of the antrum (Figure 1). However, because of ber bleeding tendency, the patient did not have any treatment for this lesion. Approxinrately one year later the lesion grew twice in size (Figure 2). Therefore the polypectomy was performed. The histological findings of the polypectomized tissue were the proliferation of the connective tissue with massive infiltration of eosinophiles and the wavy bundle arrange-ment of spindle cells in the myxomatous part of the lesion. On the basis of these findings, the diagnosis of inflammatory fibroid polyp was made with characteristic of plexyform-neurofibroma (Figure 4, 5, 6). This case suggested that one of origins of inflammatory fibroid polyp may be neur-ogenic.

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Two cases of gastric carcinoma, which had been treated with repeated local injection of OK-432 (Hemolytic Strept-coccal preparation) via endoscope, were reported here for the remarkable effectiveness. Case 1 was a 67y/o female with advanced cancer of protruded type in the body of the stomach who was unresectable due to highly disturbed liver function. Case 2 was a 76y/o male with flat-elevated type of early gastric cancer in the body, who refused surgical treatment initially. In both of the cases, macroscopic disappearance of the tumors were noted after injection of 50 KE of OK-432 in total amount. Both, however, revealed to show minute residual cancer tubules in the mostly degenerated lesions histologically. Prominent lymphocytic as well as plasma cell infiltration to the parenchyma was observed in both cases. Immuno-chemical staining of the tumor-infiltrating lymphocytes showed large amount of OKT4, OKT8 and Leu7 positive cells in the specimen.

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This case report describes two patients of multiple lymphomatous polyposis (MLP). The first case was 73-year-old male who was admitted because of intractable diarrhea. X-ray and endoscopic examination of the GI tract revealed innumerable polypoid lesions in the stomach, small intestine, descending colon, sigmoid colon and rectum. The second case was 72-year-old male who was admitted because of epigastralgia. X-ray and endoscopic examination showed giant folds, a submucosal tumor of the stomach and innumerable polypoid lesions extending from the small intestine to the transverse colon. Biopsy specimens of the two cases revealed diffuse lymphoma, medium cell type. After chemotherapy (VEMP), the X-ray and endoscopic findings were markedly improved. Twelve cases of MLP in Japan were reviewed and their prognoses were reported to be better than those of primary gastric, small intestinal-or colorectal malignant lymphoma.

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A case of 54-year-old male who had liver disease for 10 years, was admitted to our hospital for the purpose of close examination of the liver. Physical examination revealed an abdominal mass and a space occupying lesion was seen in the left lobe of the liver on medical imagings. The specimens of liver biopsy and aspiration, each taken from the right lobe of the liver and tumor on the left lobe of the liver, defined liver cirrhosis and hepatocellular carcinoma. Barium meal examination revealed a filling defect in the antrum and duodenal bulb. Endoscopic examination of upper G. I. tract showed deformity, narrowing and multiple ulcers in the antrum and duodenal bulb. The biopsy specimen taken from the ulcer bottom on the anterior wall of the duodenal bulb revealed hepatocel-lular carcinoma. Reports on endoscopic findings of duodenal invasion from hepatocellular carcinoma were few in number, and therefore our report may be valuable on the endoscopic findings in patient with hepatocellular carcinoma.

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A 50-year-old female was referred to our hospital because of the presence of a tumor with marked extraventricular compression along the lesser curvature from the middle body of the stomach to the duodenal bulb which was found with upper gastrointestinal X-rays on a gastric mass survey. The findings of ultrasound and CT examinations were almost compatible with ones of the hepatic hemangioma. Selective hepatic arteriography, however, showed no "cotton wool-like" pooling of the contrast medium characteristic to the cavernous hemangioma. Displacement of intrahepatic arterial branches was only a positive finding. Peritoneoscopic examination revealed a hemangioma of the liver which grew extrahepatically out of the left hepatic lobe. This tumor was extirpated at surgical operation. Histological examination of this tumor showed typical features of cavernous hemangioma. It is common that hepatic hemangioma is discovered incidentally with recently developed imaging techniques. Peritoneoscopic examination is, however, sometimes indispensable for the correct diagnosis of hepatic hemangioma when imaging techniques are non-contributory or when hepatic hemangioma grew extrahepatically.

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A 43-year-old man referred to our hospital for close examination for complaining of repeased tarry stool and anemia. Radiological examination revealed small tumor shadow in the lower ileal loop. During laparotomy, large mass measuring 10×6×4cm in the mesentery including segment of the ileum was resected. Histologically this tumor was diagnosed as cavernous lymphangioma. Tumor tissue invaded the mucosal surface and caused erosion. Gastrointestinal bleeding is believed to be originated from this area. "Thd flat elevation with fine whitish granules" which we observed endoscopically is the distinctive feature of intestinal lymphangioma invading the mucosal surface. We feel it necessary to keep in mind that lymphangioma can be the cause of gastro-intestinal bleeding although it is very rare.

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A 52-year-old female with a history of ulcerative colitis over 25 years admitted to our hospital because of bloody stool. Barium enema and colonoscopic findings showed advanced cancer and early cancer in the rectum. Total coloprotectomy was performed. Histological examination revealed two carcinomas of well dif f erenciated adenocarcinoma in the rectum and two epithelial dysplasia in the cecum and the ascending colon. Dissecting microscopic study of the resected specimen was performed. There were several lesions. It was difficult to differentiate epithelial dysplasia from chronic inflammatory changes of longstanding ulcerative colitis.

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The results of nation-wide postal survey which was intended to provide information on experience with endoscopic treatments for tumor of the stomach in Japan are reported. Out of 143 institutions approached, 71 responded. Names of the institutions are listed in Table 18. Endoscopic treatment for early gastric cancer as a local curative procedure was investigated in 1653 patients at 61 institutions. Endoscopic treatment for advanced gastric cancer as a palliative procedure was attempted in 386 patients at 35 institutions. Nagative biopsy was obtained in 83 to 85% of patients with early gastric cancer in which snare ectomy was impractical or even hazardous, treated by laser therapy such as YAG and photodynamic therapy (PDT) and followed up for more than 1 year. Endoscopic double snare polypectomy, electrosurgical methods combined with intramucosal injection of solution such as strip-off biopsy (high frequency electrocurrent with injection of saline) and endoscopic resection with hypertonic saline and epinephrine yielded 97 to 100% of success rate. Tissue coagulation by microwave therapy was also attempted with good results. Effect of local injection of pure ethanol, picibanil (immunotherapeutic agent of streptococcal preparation) and anti-tumor agents were investigated in a small number of patients. Gastric adenomas are also candidate for endoscopic treatment and 945 patients were treated by various methods with good results. Palliative therapy for advanced gastric cancer was attempted for recanalization of malignant stenosis, tumor reduction and hemostasis of hamorrhagic tumor and overall success rates were 43%, 36% and 70%, respectively.

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