The endoscopic examination with biopsy and both levels of pepsinogen I, II (PG I, PG II) in the serum (S) and mucosa (M) were performed in 187 subjects. Ninety-five cases of them received the endoscopic Congo red test and 84 cases received gastric analyses on another day. The results were obtained as follows :1) Compared with the endoscopically normal cases (NOR), the gastric ulcer cases (UV) had significantly lower values of SPGI/ SPGII (P <0.05) and a low tendency of SPGI, CPGI, CPGII, APGII, CPGI/CPGII and values of gastric acid-pepsin outputs. The duodenal ulcer cases (UD) had significantly higher values of SPGI, CPGI and the maximum acid output (MAO) (P<0.05-0.01) and a high tendency of SPG II, SPGI/SPGII, basic acid output (BAO), basic pepsin output (BPO) and stimulated pepsin output (SPO), while the gastric cancer cases (CA) had significantly lower values of SPGI, SPGI/SPGII and CPG I (P <0.01-0.001) and a low tendency of CPG II, CPGI/CPGII, CPGII/APGII and values of gastric acid-pepsin outputs. 2) In the study of the histological findings in the mucosa of the corpus, there were 14.7% of atrophic gastritis (AG) and 5.9% of metaplasia (M) found in NOR group, while there were 50.0% of AG and 17.5% of M found in UV group, 11.5% of AG and 3.8% of M found in UD group, 83.3% of AG and 27.8% of M found in CA group. Compared with the NOR group, UV and CA groups had a significantly higher rate of AG (P <0.05) and a high tendency of M. 3) In the study of types of glandular border determined by the endoscopic Congo red test, there were 80.0% of closed type found in NOR group, while 64.3%, 94.2% and 33.3% found in UV, UD and CA groups, respectively. 4) A significant correlation was found among the levels of serum pepsinogen, the levels of mucosa pepsinogen and the gastric secretion. In conclusion, different states of the gastric mucosa were observed in various gas-troduodenal disorders and close relationships were found among morphological, biochemi-cal and physiological changes of the gastric mucosa.

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To investigate the relationship between tongue coating and gastric mucosa, we performed both gastroscopic and photographic inspection of the stomach and tongue in 198 cases (165 persons) aged 27-76 years (mean age 50). The tongue was photographed with ringflash, and then given scores for both thickness and color of coating. Endoscopic findings were also given scores for erosion, superficial gastritis, atrophic gastritis. In addition, the presence or absence of gastric ulcer was diagnosed. Correlations between the scores of tongue coating and those of endoscopic findings were calculated by using the qui square technique. In 31 subjects receiving endscopic and tongue examinations twice or more, their initial and subsequent scores of tongue coating and erosion of gastric mucosa were investigated in order to establish the relationship between these two factors and their changes over the course of time. The results indicated that tongue coating became thicker and more yellowish, as gastric erosion and superficial gastritis became severer. On the other hand, tongue coating became thinner and more whitish with the increase in seventies of atrophic gastritis. These result suggests that tongue coating is related to acute changes of gastric mucosa.

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In Fukui Prefectual Hospital from 1971 to 1985, 3 cases of early gastric cancer of remnant stomach which coexsited with Gastritis cystica polyposa (GCP) were treated. All cancerous lesions exsisted on GCP at the anastomosis site. Macroscopically, the resected specimens showed type I early cancer in 2 cases and type IIa + IIc in 1 case. H istologically, 2 case were tubular adenocarcioma and 1 case was sigent ring cell carcinoma. By immunohistochemical study, not only cancerous lesion but also GCP were positively stained with CEA and CA-19-9. It is concluded that Gastritis cystica polyposa is probably related to gastric cancer of remnant stomach.

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We applied the laser Doppler velocimetry through a gastrofiberscope to investigate the human gastric microcirculation in normal subjects (n=30) and in patients with gastric ulcer (n=47). We simultaneously examined mucosal blood flow at the regions of corpus, antrum and angle of the stomach and, at the edge and the surrounding mucosa of the ulcer. In normal subjects, mucosal blood flow (MBF), which expressed Laser Doppler flow, of the antrum was significantly lower than that of the corpus (p<0.01), and MBF of lesser curvature was significantly lower compared with that of the greater curvature (p <0.01). In the course of ulcer healing, MBF of ulcer margins was the highest in the healing stage, and it was decreased in the scarring stage. There was no difference between MBF of the ulcer margin and that of the surrounding mucosa, irrespective of active or scarring stage, but MBF of the ulcer margin was significantly greater compared to that of the surrounding mucosa (p <0. 05) in the healing stage. It is suggested that measurement of gastric mucosal blood flow may be a useful method for studying pathophysiology of gastric microcirculation in patients with gastric ulcer.

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Cholescintigraphic evaluation of choledocho-duodenal bile flow using Tc-99 m-E-HIDA was performed for patients after endoscopic sphincterotomy (EST) or operative transduodenal sphincteroplasty. Regions of interest (ROT) were chosen on the duodenum, distal part of choledochus and gallbladder. Time-activity (T-A) curves were constructed by each ROT. Utilizing T-A curves obtained following subjects were studied ;1. Patterns of T-A curves. 2. The time required to reach maximum counts on the distal part of choledochus and the duodenum (Tmax). 3. The transit time from biliary maximum counts to duodenal maximum counts (Tc.D). 4. Rate of decrease (ROD) in the gallbladder area. 5. Reflux of radioisotope (R. I.) activity from duodenum to choledochus. The results obtained suggested the followings; 1. The patterns of T-A curves in both groups were similar, and demonstrated gradual increase of the R. I. activity, and no evident peak as compared with the T-A curve in healthy subjects. 2. T-A curve analysis of the distal part of the choledochus gave a mean (±standard deviation) value for Tmax of 34.9±9.5 min (EST, cholecystectomized), 32.6+9.7 min (EST, non-cholecystectomized) and 30.6±9.8 min (sphincteroplasty). Tmax of the duodenum were 40.6±11.8 min (EST, cholecystectom-ized), 46.2 ± 9.6 min (EST, non-cholecystectomized) and 36.9±10.7 min (sphincteroplasty). There were no significant difference. 3. The mean (±standard deviation) value of TC±D were 6.9±5.1 min (EST, cholecystectomized), 8.2±5.3 min (EST, non-cholecystectomized) and 6.3 ± 8.0 min (sphincteroplasty). There were no significant difference. 4. ROD of R. I. activity on the gallbladder in control group was 38.5±12.4 (mean±S. D.) (n = 5) and that in EST was 29.7±17.8 (n= 4). And there were no significant difference. 5. No reflux of R. I. activity from the duodenum to choledochus was recognized. The cholescintigraphy using Tc-99m-E-HIDA demonstrated some features of EST. The first is that the narrow distal segment of the common bile duct is not incised completely by EST and so the bile may accumulate easier in the distal part of choledochus than in the case of transduodenal sphincteroplasty. The second is that the destructive effect on the sphincteric function is obtained by this procedure. The third is that the function of the gallbladder would be partly preserved even after EST in cases with functioning gallbladder. Thus, cholescintigraphy is one of the useful methods to evaluate the effect of EST.

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Irregular vessels in bile duct mucosa are characteristic findings of carcinoma of percutaneous transhepatic cholangioscopy (PTCS). In order to elucidate this phenomenon, stereoscopic studies were performed on bile duct mucosa of 35 resected specimen. Thirty-five cases are divided into three groups : benign desease and carcinoma without bile duct involvement (Group A, 13 cases), bile duct carcinoma (Group B, 14 cases) and pancreas carcinoma and gallbladder carcinoma involving the bile duct (Group C, 8 cases). Irregular vessels were observed on bile duct mucosa involved by carcinoma in 13 cases (93%) of group B and 6 (75%) of group C. In group A, however, irregular vessels were not found. Distribution of irregular vessels on the tumor was classified into 3 types : entire, marginal and central. Sixteen cases (84%) were entire or marginal type, which was easy to recognize irregular vessels under PTCS. Irregular vessels are observed only in bile duct mucosa involved by carcinoma. Therefore, irregular vessels are tumor vessels and regarded as one of the basic findings of malignancy in PTCS.

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We usually carry out total colonoscopies by a single examiner without pre-medication and fluoroscopy. We conveniently call this method "Simple total colonoscopy". We evaluated 4, 651 total colonoscopies in 3, 629 patients taking general health check-up including screening for cob-rectal diseases during 4 years from April, 1983 to March, 1987. We tried to evaluate the merits and demerits of our method through this study. We easily succeeded 4, 540 complete total colonoscopies (97.6%) in a short time, proving the usefulness of our method. Pain on examination (74 cases, 66.7%), insufficient length of fiberscope (26 cases, 23.4%), massive feces in the large bowel (5 cases, 4.5%), cancerous stricture (2 cases, 1.8%) and others prevented 111 cases from complete examination. We carried out barium enema for incompletely examined cases to diminish the false negatives of examination on the same day. Although simple total colonoscopy has such problems that it showed false negative in a few cases of incomplete examinations, the procedure is non-invasive. Therefore, we think that simple total colonoscopy is an appropriate procedure for routine use in screening of colorectal diseases in adults who have abdominal complaints.

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Kammrötung (viz, comb-like redness, KR), regarded as a sign of superficial gastritis was studied in detail by endoscopy. During recent 6 years, there were 211 cases with KR among 3443 patients examined by endoscopy in our hospital and its frequency was 6.1%. KR was seen not only in the corpus but also in the antrum. KR was sometimes observed in both the corpus and antrum. Almost all of the cases with KR were noted in the stomach with a closed type of atrophic pattern of the fundic gland mucosa. That is, we think KR occurs in the stomach without atrophic change. Various erosions-linear, varioliform and linear depression, were observed where KR existed. Surrounding gastric mucosa showed irregular gastric areae. It was supposed that some kind of superficial change occurred in the surrounding gastric mucosa as well as in the mucosa where KR existed.

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This study purposed to gain image enhancement to the picture of the peptic ulcer at the prepylorus of the stomach obtained by the electronic endoscope (TGS-50 D, ToshibaMachida) by edge enhancement using one of primitive image processing approaches. Methods of image processing we attemped were analogical processing approach, namely by record enhancer, and digital processing approach including differential method, unsharp masking (high-pass filter) and grey scale trasformation. The processed picture by record enhancer or unsharp masking revealed thin line clearly and, therefore showed detailed pattern of regenerative epithelia around gastric ulcer. After processed by differential method, edges were enhanced as thick lines so gastric mucosal surface were drawn as detailed spotty patterns. This method was not suitable for clarifying thin lines. The processed picture taken by grey scale transformation was good visually, but did not satisfy our purpose. Color can be separated to the three color components namely Red, Green and Blue (RGB) or the three color qualities, namely, Hue, Saturation and Intensity (HSI). These digital image processing approaches were perform-ed by RGB transformation. In addition, differential method and unsharp masking were processed by HSI transformation. Comparing the image processing between RGB transformation and HSI transformation, there was no appreciable difference in edge enhancement, but the color tone was more enhanced in some degree with HSI transformation than that with RGB transformation.

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The therapeutic effects of H2-blockers in 64 patients with gastric ulcer were compared with those in 81 gastric ulcer patients receiving conventional antiulcer drugs (control group). Factors causing gastric ulcer to be refractory to H2-blockers were also analyzed. In the control group, healing of the ulcer was affected by age, sex, alcohol consumption, and smoking. The shape, size, and number of the ulcers were also related. In the H2-blocker group, however, these factors were revealed to have much less influence. When 6 patients for whom more than 3 months was required to heal their ulcers were compared with 7 patients in whom ulcer healing never occurred, the only significant differing factors were the duration of the illness and the number of occasions of ulcer recurrence. In our study, the factors of which ulcers became intractable were duration of illness for more than 10 years and recurrences of the ulcer over than 3 times.

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Among various colonic cleansing methods in preparation for colonoscopy, whole gut lavage with balanced electrolyte solution containing polyethylene glycol (PEG) is considered a most successful one in its simplicity, efficacy, and patients' tolerance. In experimental animals, very large dose of PEG is known to produce toxicity. Although absorption of orally administered PEG from the human gastrointestinal tract is considered to be poor, it should be critically evaluated in order to confirm safety of this colonoscopy prepartion. We measured serum concentration of PEG 4000 in 7 subjects and urinary excretion of the same substance in 13 subjects who ingested up to 240 g of PEG 4000 for colonoscopy preparation. Blood samples were obtained before, immediately after, 1, 3, and 12 hours after ingestion of PEG 4000. In all samples collected from 6 subjects, PEG 4000 could not be detected, as it was below the quantitation limit (10 μg/ml). In one subject with hyperlipidemia, measurement was not possible due to cross reaction to serum lipids. Urine specimens were collected for 48 hours after the initiation of ingestion. Mean urinary excretion of PEG 4000 in 13 subject was 0.09%. These results indicate that absorption of PEG 4000 from the human gastrointestinal tract is minimal and that PEG 4000 is unlikely to produce toxicity at its ordinary usual dosage for colonoscopy preparation.

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There are a number of reports on the failed fusion of the ventral and dorsal pancreatic ducts as the pancreas divisum. We discuss the responsibility for incomplete fusion as well as failed fusion for the development of pancreatitis. The incomplete fusion is classified into stenosing type at the site of fusion and branch fusion type. In the stenosing type at the site of fusion, the main pancreatic duct is narrowed at the site of fusion of the ventral and dorsal ducts. In the branch fusion sype, the main pancreatic duct made of one duct, either the ventral or the dorsal duct, is fused with the other duct. We had four cases of stenosing type at the site of fusion, all of which had pancreatitis and six cases of branch fusion type, four of which had pancreatitis.

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This case report describes a patient with tuberculosis of the esophagus. A 52-year-old man complaining of dysphagia was admitted to our hospital in February 13th, 1986. On gastrointestinal roentgenogram, an ulcer was recognized in the middle esophagus. The lesion was 2.1×1.1 cm in size. Endoscopical examination of the esophagus showed an ulcer at 31 cm from the incisors, which ulcer was irregular and the surrounding area was elevated and covered by normal mucosa. Biopsy specimen was obtained endoscopically. Histological examination of the biopsied specimen revealed caseating granulomas. The culture of the biopsied specimen revealed mycobacterium tuberculosis. He was given antituberculous drugs. One month later, endoscopical examination showed an ulcer scar with slight deformity. Seventeen cases of tuberculosis of the esophagus have been reported so far in Japan. In Japan, our case is first which was established a definite diagnosis of tuberculosis of the esophagus by both histological examination and culture of the biopsied specimen taken from a lesion.

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A rare case of early esophageal carcinoma, which is histochemically CEA positive, is reported. The patient was a 59-year-old male with a long history of heavy alcoholic intake and also of cigarette smoking, who complained epigastric pain. Double contrast barium study of the esophagus revealed no abnormal lesion, although endoscopy revealed a superficial depressed lesion in the lower esophagus, which was diagnosed as superficial esophageal carcinoma of erosive type. The necessity of endoscopy for the early detection of esophageal carcinoma is emphasized. Histological study of the resected specimen revealed that the depth invasion of carcinoma sized longitudinally 1.0 cm in length was limited to the muscularis mucosa with no lymph node metastasis, and was accompanied by lymphreticular infiltration. A small focus of severe dysplasia was detected 2.0 cm distal to the main tumor, and was also accompanied by lymphreticular infiltration. Immunohistochemical study on the resected specimen revealed that the main tumor was, in part, CEA positive whereas the focus of severe dysplasia was CEA negative. From these findings, it is considered that severe dysplastic epithelium might be premalignant, and also that immunohistochemically detect-ed CEA could be a useful marker of esophageal malignancy.

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A 64 year old woman without complaints was pointed out to have slight elevated lesion on the body of gallbladder by ultrasound. On endoscopic ultrasonography a thickened mucosal layer was recognized. Percutaneous transhepatic cholecystoscopy revealed that the surface of the lesion was irregular and papillary with dilated capillary veins. The neck of the gallbladder had a regular arranged granular mucosal patten. Furthermore, the double contrast study of gallbladder demonstrated that the cystic duct had normal mucosa. Biopsies from the elevated lesion showed the atypical epithelia. We diagnosed the lesion as a cancer of gallbladder on the basis of overall imaging tequniques. Extended cholecys-tectomy was performed. Cancer invaded mainly in the mucosal layer, but partially in the proper muscular layer and subserosal layer of the body of gallbladder. Atypical epithelia were noted around the cancerous lesion. No cancer cell was observed in the cystic duct.

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A 50-year-old male complained of right lower quadurant abdominal pain. Guaiac test of stool was positive. Barium-enema study demonstrated an elevated lesion with smooth surface and partial lobulation in the ascending colon. Shape of the mass changed on compression. Colonoscopy revealed a pale yellow coloured tumor with smooth surface in the ascending colon. The tumor looked as if it had hanged down from near the ileocecal valve. The resected specimen was a 4.0×4.0×0.8 cm sized soft tumor with fluctuation. The surface of the tumor was covered by normal smooth mucosa. Microscopically, the tumor was diagnosed as cystic lymphangioma. Lymphangioma is a rare benign lesion in the colon and rectum. Thirty-two cases of lymphangioma of the colon and rectum have been reported in Europe and America, and 29 cases including our case have been reported in Japan. For diagnosis of lymphangioma it is important to notice transparancy, fluctation and transformation on compression endoscopically.

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Colonic cytomegalovirus inclusion bodies indicating CMV infection were detected in three of 58 patients with ulcerative colitis. The immunohistological studies of biopsied specimens enabled diagnosis of CMV infection in the patients with uc. All three patients with cytomegalovirus infection had a long duration of symptoms and took severe courses. They were all treated with oral predonisolone and two of them were also administered to azathiopurine. Cytomegalic inclusion bodies appeared to confined to perivascular cells beneath the areas of mucosal ulceration of the colon, and were rarely seen in the epithelial cells. This infection appeared to alter the course of ulcerative colitis.

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Amoebic dysentery is recognized as a disease to show a good prognosis. According to the previous reports, there are some dead cases who took fuluminant course. We reported a 68 year-old female with fuluminant amoebic colitis. She was admitted to our hospital because of pleural effusion and dyspnea. She had had a history of radiation therapy (6, 000 rad in total) for esophgeal cancer, but never traveling to foreign country. On the 26th hospital day she had bloody stool, and stool became strawberry jam like, gradually. She was diagnosed of amoebic colitis by colonoscopic examination and biopsy specimen. Colonoscopy disclosed many polypoid lesions with erosions, ulcers and hemorrhage. In spite of administration of Metronidazole and some medications, she died on the 36th hospital day. Through post-mortem examination, colitis was observed from transverse colon to rectum, while perforation, peritonitis and liver abscess were not recognized at all. We should keep in mind that some patients of amoebic colitis take a fuluminant course like this case.

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A case of intussusception caused by early colonic cancer was reported. A 35 year-old female was admitted to our hospital in January 1983 with chief complaints of lower abdominal pain and bloody stool. Physical examination on admission revealed a hen's egg sized tumor in the left lower abdomen. Plain abdominal X-ray film showed an accumula-tion of much colon gas from ascending colon to descending colon. A colonoscopic examina-tion disclosed a large tumor at the site 20 cm distant from anal ring. The top of the tumor was coverd with irregular and nodular mucosa, whereas mucosa of the base of that had reddend and smooth figure which suggested submucosal tumor. Colonic X-ray examina-tion showed complete obstruction at the S-D junction. Claws-like shadow and coiled spring sign were seen at the edge of obstruction. Therefore, the lesion was diagnosed as intussusception caused by colonic cancer and the operation was performed. The tumor showing sessile feature was 60×35×20 mm in size and diagnosed as mucosal carcinoma. It was considered that the smooth mucosa of the base of the tumor observed endoscopically was related to the intussusceptive state of the colon.

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Three cases of bile duct stones are reported. In each case the stones were removed after being broken to pieces using electrohydraulic shock wave lithotripsy at the time of percutaneous transhepatic choledochoscopy (PTCS). Case 1: 53-year-old male. Percutaneous transhepatic cholangio drainage (PTCD) was performed because of purulent cholangitis due to impacted stones in the common bile duct and revealed a number of stones in the left intrahepatic bile duct as well as the choledochus. The choledochoscope was inserted into the bile duct through a PTCD fistula, and Nd-YAG laser was irradiated 17 times (66, 000 Joule). However, not all of the stones were broken into fragments and failed to be removed. We have recently attempted to crush the stones using electrohydraulic shock wave lithotripsy, and successfully crushed and removed the big stones without any complications. Case 2 : 47-year-old male. He had had cholecystectomy due to gallbladder stones one year ago. PTCD was performed because of incarceration of a stone (2 x 2cm) in the common bile duct. Using the electrohydraulic shock wave technique, the stone was crushed and removed. Case 3 : 54-year-old female. She had complaints of Charcot's trias and PTCD was performed. PTCS revealed an impacted stone (1.5 x 1.5 cm) in the choledochus. We removed the stone completely after 4 sessions of electrohydraulic shock wave lithotripsy. This electrohydraulic shock wave technique will be valid for the choledochoscopic lithotripsy of bile duct stone disease.

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Three patients with massive colorectal bleeding which was successfully treated by endoscopic local injection of hypertonic sodium epinephrine "HS-E solution" were report-ed. The first case was a 79-year-old-male with postoperative colonic stenosis after sigmoidectomy, which was attempted to treat by endoscopic balloon dilatation. Six hours after the dilatation massive anal bleeding occurred. The second case was a 51-year-old-male in whom hot biopsy was performed for a small flat polyp of ascending colon. Six days after the biopsy massive anal bleeding occurred. The third case was a 43-year- old-female with amyloidosis. Six days after rectal biopsy to confirm the disease of GI tract massive anal bleeding occurred. Endoscopic local injection of HS-E solution can control massive colorectal bleeding as safely and effectively as in upper GI bleeding.

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