After EIS was performed in 160 patients with liver cirrhosis, these patients were mainly examined with respect to post-treatment bleeding rates and survival curves. During the observation period for 23.5 months on average, post-treatment bleeding rates were found to be 30.3% in emergency cases, 18.0% in patients elective cases, 10.6% in prophylactic cases, while 8.7% in patients classified as child A, 17.6% in child B, 21.7% in child C and 16.3% on average ; 5 patients (3.1%) died from bleeding. Bleeding occured within 1 year in most cases, suggesting the importance of complete elimination of varices via a series of initial treatment. Four-year survival rates were calculated to range from 70 to 77% among all the patients. Patients classified as Child A or B were determined to have relatively good prognosis based on their survival curves ; however, satisfactory prognosis was seen only in prophylactic cases among patients classified as Child C, while many of emergency cases died within 3 months. Based on these results, it is suggested that EIS should be performed prophylactically if there is a possibility of bleeding.

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Remodeling electronic endoscopy and utilizing its delay circuit, image enhancement against signal of each R, G and B was carried out. This method is a kind of procedures by electronic signal, and can be proceded wide patterns, and has excellently laborious and economic advantages being performed at the real time. The effect of this method was evaluated in 32 cases with gastroduodenal ulcer, 40 cases with gastritis, 12 cases with gastric polyp, 8 cases with gastric cancer and other 47 cases. Excellent demonstration of uneven lesions was obtained by the image enhancement using the component of R, and patterns were effectively obtained due to the enhancement of shadow parts together with somewhat enhancenent of color tone keeping comparatively character of lesion. The excellent demonstration of micro-blood vessels and enhancement of margins of lesions and intragastric structures were obtained by the image enhancement using the component of G. This is concerned in a fact that G (green) itself has discrimina-tion area and visual sensitivity for eyes of human, in addition, structure informations such as lesions, ete., are largely controlled by the G component, and this was understood by the supplementary study due to convertible patterns of white black corresponding to the sigunal volume. Rough patterns are occasionaly obtained due to the change of color of pattern elements requiring for the image enhancement of each R, G and B, and increase of noise, while simple and practical image enhancement of each R, G and B is clinically useful for the acquisition of many patterns with further informations.

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We evaluated the peritoneoscope equipped with laser measurement, which utilized fiber grating. The measurement of liver surface was done by taking the photograph of diffraction beams emitted on the liver. Because each diffraction spot has a diameter of 50, u and the interval between the diffraction spots is 0.2 mm, the length and the height of lesions will be easily measured by counting and calculating the number of the spots. This system is very simple and the conventional peritoneoscope can be used, so we can measure the length and the height of lesions on the liver including the nodularities of liver cirrhosis easily and precisely. This system would be useful in the clinical study of the liver diseases.

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The liver surface fluorescence after fluorescein (F) injection was evaluated in rats treated with CCl₄ to produce acute and chronic liver damage. Fluorescent photography techniques were improved by the use of Olympus CLE_F10 instead of the usual light source apparatus for gastric fiberendoscopy. With this photographic improvement, sharp serial pictures were obtained. In the normal rat liver, fluorescence appeared in the periportal area 5 seconds after F injection and rapidly spread toward the pericentral area. In the acutely damaged liver with CCl₄, bright and coarse granular fluorescence corresponding to the pericentral necrosis was observed from 20 seconds to 5 minutes after F injection. In the chronically damaged liver treated with CCl₄ for 12 weeks, fluorescence of the surface of the liver revealed irregular in distribution and bright fluorescence showing mesh-like pattern, corresponding to the interstitial area surrounding the pseudolobules. These pictures were observed from 20 seconds untill 5 minutes after F injection. These observations suggest that the liver surface fluorescence at 5 seconds after F injection, to some degree, represents changes in the portal area, and fluorescence occuring from 20 seconds to 5 minutes after F injection represents changes in a necrotic or inter-stitial area. These results in the rat liver model suggest that the observation of liver surface fluorescence reflects the underlying pathophysiology and deserves further study.

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A new classification of endoscopic stage of duodenal ulcer healing based on the findings of regenerative mucosal patterns, was made by close-up observation using conven-tional fiberscopes. At first, it was divided into 2 stages ; stage of regeneration with white exudates and stage of scar without white exudates. The former was classified into RO without regenerative pattern, R1 with fine regenerative pattern and R2 with rough granular regenerative pattern. The latter was divided into Sa (Figure 2) with central depressed area, Sb (Figure 3) with rough granular regenerative pattern and Sc (Figure 4) with almost normal villi. As the result of morphological and functional studies, the duodenal mucosa where Sa pattern was observed was considered as the stage of insuf f icint recovery. The cases with Sb and Sc showed the well regenerated duodenal mucosa. On the other hand, the patient with duodenal ulcer, who always showed Sa pattern, had frequent ulcer relapses. However, the cases with Sb and Sc had no relapse in a prospective follow-up study for one year and a retrospective follow-up study over 10 years.

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Of 71 patients from whom Salmonella have been detected in stool culture in this hospital during these 6 years, 16 patients who were performed colonoscopy were studied mainly for endoscopic pictures. These 16 patients (12 males and 4 females) aged 25 to 66 years, averaging 49.3, and complained of diarrhea (16 cases), bloody stool (4 cases), abdominal pain (13 cases), fever (9 cases) and vomiting (5 cases). Of these 16 cases, 11 showed changes such as redness, bleeding, erosion and so on. Diffuse lesion, longitudinal lesion, and aphthoid lesions were noted in 3 cases, 3 cases and 2 cases, respectively. Lesions were observed in the whole colonic region in 2 cases, from sigmoid colon to deep colon in 2 cases, from ascending colon to terminal ileum in 2 cases, in sigmoid colon in 4 cases and in transverse colon in one case, respectively. Histological findings in 7 cases revealed high degree of inflammations in 2 cases, moderate in 3 cases, mild in 2 cases. Salmonella colitis, which shows various diversified endoscopic pictures, is often undif f erentiable from ulcera-tive colitis and other infectious colitis, and sometimes from drug associated colitis as well as ischemic colitis. Therefore, stool culture is essential inevitable for the diagnosis of Salmonella enterocolitis.

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Thirty three patients suffering from dysphagia caused by the stricture of cardiac region were treated with the Nd : YAG laser (laser group). Eighty five percent of the patients showed the improvement of the stricture, and 67% of patients showed clinical improvement of taking food and was discharged from the hospital. In order to study the quantitative and qualitative result of laser-treated patients, we picked up two non-historical control groups. One was a non-curative resection (NCR) group which consisted of 16 patients, and the other was a chemotherapy group in which there were 12 patients treated only with immunochemotherapy. As to the survival times and the lengths of time in which patients required no hospitalization (no hospitalization period), there was no difference between the laser and the NCR groups. As to characteristics of the patients, no difference was seen by the Quantification method II between the patients in both the groups as to each factor of characteristics such as age, Borrmann's type, stage of TNM, chemotherapy, complication and metastasis. On the other hand, the median survival time was 43 weeks in the laser group and 15 weeks in the chemotherapy group (p <0.001). In addition to that, the median value of no hospitalization period was 21 weeks in the former and only one week in the latter (p< 0.01). When the patient characteristics in these two groups were compared, there were proportionally more patients having categories of Borrmann's type 4, Tegafur as chemotherapy and no distant metastasis in the laser than in the chemotherapy group. Excluding the patients with those two to three categories, there was no difference as to each factor of the characteristics between the patients in the chemotherapy group and a modified laser group. The median survival time became 34 weeks in the modified laser group and 15 weeks in the chemotherapy group, revealing the statistical difference (p <0 .01). We conclude that Nd : YAG laser therapy is a useful palliative treatment for improving the stricture in cardiac region of gastric cancer. It could be said that the laser treatment should be applied as the first choice to a patient who is of poor risk or in whom the surgical procedure is considered to end in a non-curative resection.

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A TV-Peritoneoscope which incorporates a CCD (charge coupled device) in the distal tip of the scope is developed. We have tried to use this electronic endoscope for peritoneoscopy. In the prototype system (made by TOSHIBA-MACHIDA), an optical image of the objective lens is transformed to electronic signals by the CCD and displayed on a color monitor through a video processor. Clinical evaluation for this prototype TV-Peritoneoscope was performed in 10 cases, obtaining the following results: (1) The new system showed a clear and high resolution-image compared with an indirect video system, in which the CCD camera is coupled to the eyepiece of a conventional peritoneoscope. (2) Because of a side-viewing scope, it was capable of the surveying larger area, being easier to observe the surface of the liver more vertically. (3) A tube of the present TV-peritoneoscope was 10 mm in diameter, so being useable with the standard trocar. Therefore, this TV-system could be utilized as a part of a routine peritoneoscopy. With these results, the TV-Peritoneoscope showed possibilities for almost impossible an image processing and analysis, which were by a conventional peritoneoscope. This would surely be taste new field of peritoneoscopic diagnosis.

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Recently, endoscopic retrograde biliary drainage (ERBD) has become to be a common technique to relieve obstructive jaundice because of physiological one-step biliary decompression method. But ERBD has some demerits compared with external biliary drainage, such as percutaneous transhepatic biliary drainage (PTBD) and endoscopic naso-biliary drainage (ENBD). So we tried a new method, a combined method of ERBD and ENBD (ERBD+ENBD), in 13 patients with obstructive jaundice, and we performed successfully in all of the cases (Figure 1 describes the technique). Table 1 shows diseases we treated with ERBD and ERBD+ENBD. ERBD+ENBD established equivalent drainage effects (Table 2) and decreased serum bilirubin values after biliary decompression (Figure 2) compared with ERBD. In addition to those, we thought ERBD+ENBD is better than ERBD in three points ; (1) we can wash ERBD tube periodically without fiberscope, (2) we can investigate cytology and bacteriologic examination in bile juice frequently, and (3) we can get good X-ray pictures of dilated bile ducts when we needed. Complications were happened in 2 cases, one was falling off of ENBD tube, the other was bending of ENBD tube. In the cases, patients had no severe symptoms by pulling out ENBD tube. In conclusion, ERBD+ENBD will return to ERBD by simple procedure, namely, pulling out ENBD tube. Therefore, ERBD +ENBD is thought to be a improved technique remaining the merits of ERBD.

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For the purpose of reliable evaluation of cellular DNA content in endoscopic biopsy specimens by flow cytometry, we compared the DNA content in 3, 6, 10 biopsy specimens obtained from 16 colorectal cancer patients. At this time, DNA index (D. I) and coefficient of variation (C. V) were evaluated from these DNA histogram. As for cell harvest from specimens, we could obtain (3.45 ± 2.75) × 10⁴, (6.10 ± 4.49) × 10⁴ and (1.59 ± 0.94) × 10⁵ cells when 3, 6 and 10 biopsy specimens were taken from one sample material respectively. C. V and D. I were stabilized in all cases and the distribution of DNA histgram had not been changed in aneuploid cases, regardless of the different number of biopsy specimens. And also there were close correlation between D. I of biopsy specimens and that of the same resected tissue (r=0.997). In our study, it was indicated that a reliable D. I determination by flow cytometry can be estimated sufficiently with 3 specimens as biopsy material.

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An objective analysis of the color of the liver was performed using reflectance spectrophotometer system (MCPD-200, Ootuka Denshi). The materials studied were normal, ICG injected, cholestatic and CCl₄ treated rats. Each has 3 rats in a group. The color of the liver was measured by reflectance spectrum and expressed by three index : L*, a*, b*. The color of the normal liver was expressed as slight low lightness, red hue and dull saturation. The color of ICG injected liver was expressed as the lowest lightness, red hue and the most dull saturation. The cholestatic liver was expressed as high lightness, yellow-red hue and bright saturation. The CC1₄ treated liver was expressed as high lightness, red hue and bright saturation. The color of the liver measured by the reflectance spectrophotometer system was almost equal to the color macroscopically observed under peritoneoscopy. Reflectance spectrophotometer analysis is evaluated as highly useful for an objective expression of the color of the liver.

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Clinicopathological study was made on twenty nine cases with colorectal aphthoid lesion (twelve cases of drug-induced colitis and seventeen cases on unknown etiology). The results obtained were as follows. 1. The lesions were seen more frequently in female and in the third decade with a chief complaint of mucous bloody stool or diarrhea. 2. Lesions were located mainly in rectum and sigmoid colon and no cases localized in the upper part of large intestine. 3. Barium enema examination showed small radiolucent spots with a central barium fleck. 4. Pathological examination of biopsy specimen from the lesions revealed hyperplasia of lymphoid follicle surrounded by hyperemia and inflammatory cell infiltration. 5. Antibiotic-associated aphthoid colitis were similar in findings with early or mild stage of pseudomembranous colitis. 6. Viral infection was conceivable in some patients with unknown cause, but not proven.

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A case of esophageal mucosal bridge associated with benign esophageal stricture is reported. A 57-year-old man presented with a 4 month history of dysphagia in April 1986. Seven years previously, he underwent fistulectomy for a congenital esophagobronchial fistula. Over the last 2 years he had been suffering from recurrent pneumonia and given Ce-phalosporin capsules. A barium meal X-ray examination demonstrated a stricture in the mid-esophagus and irregularity of the mucosa proximal to the stricture. An endoscopic view disclosed a benign stricture about 5 mm in diameter at 35 cm from the incisors. The endoscope could not be advanced through the stricture. The proximal lumen revealed an irregular mucosa simulating multiple esophageal webs and a mucosal bridge was noticed at 10 cm proximal to the stenotic portion. The mucosal bridge was not observed 7 years ago at the operation. This patient had an esophageal stricture and was given Cephalospor-ins for recurrent pneumonia, which caused high acidity to have the possibility of damaging the esophageal mucosa. In this case, it is, therefore, hypothesized that the mucosal bridge was formed in the process of healing stage of drug-induced esophagitis although he did not have any symptoms of esophagitis in the past.

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Granular Cell Tumor of the stomach has been reported only 32cases previously. A case of granular cell tumor of the stomach in a 29-year-old man is reported. An upper gastrointestinal series showed the tumor with a bridging fold, and a Belle at the top, located in the cardia of the stomach. It was diagnosed as a submucosal tumor of the stomach. Contrast medium was injected into the submucosal space at the base of the lesion. The defect of the contrast medium showed the outline of the tumor. The tumor showed intraluminal type growth. Echoendoscopically, its internal echogram made a different impression from leiomyoma. The tumor was resected endoscopically, using high frequency currents. The cellular origin of granular cell tumor has been controversial. A recent review with electronmicroscopic and immunohistochemical study supports their schwann cell origin. In our case, the tumor showed positive reaction for S 100 protein, suggesting its neural origin. Much of them are submucosal, small and benign mass lesion. For this reason, we suggest that many of this tumor would be resected endoscopically.

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A case of gastric syphilis was reported. A 46-year-male patient was admitted to our hospital because of severe epigastric pain and hematemesis. On endoscopic examination, multiple huge ulcers with hemorrhage and mucosal edema in the body and angle were noted (Figure 3-a, b, c, d). These ulcers had no healing tendency despite the administration of H₂ -blocker and other anti-ulcer agents (Figure 5-a, b). Since biopsy specimens were negative for malignancy and serological tests for syphilis were positive, gastric syphilis was strongly suspected. After two weaks of anti-luetic therapy with penicillin-G, the lesions began to heal (Figure 6-a) and after nine weaks, completely healed (Figure 6-c, d). Gastric syphilis is relatively uncommon and is difficult to be dif f erenciated from cancer, malignant lymphoma or RLH. If anti-ulcer therapy is not effective, biopsy specimens are negative for malignancy and serological test for syphilis is positive, gastric syphilis should be suspected.

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A 62-yr-old Japanese man with end stage renal failure showed persistant anemia in the last 6 months. He had undergone Billroth-II partial gastrectomy for gastric ulcer 36 years ago. Endoscopic examination revealed polypoid lesions with an erosion around the gastrojejunostomy site, and biopsy from the erosion showed poorly differentiated adenocarcinoma. Because the patient refused operation, laser irradiation was performed under the diagnosis of gastric carcinoma in SPHG. Unfortunately, massive bleeding occurred thereafter and an emergency operation was done. Histologically, the resected specimen showed double early gastric carcinomas (III+IIc and IIc) which were situated on the SPHG. In the III+IIc type early gastric carcinoma, residual carcinoma around the laser-induced shallow ulcer and exposed distorted arteriole at the floor of the ulcer were found. We stressed the possibility of massive bleeding on endoscopic therapy of the carcinoma developed in the SPHG.

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A patient, 66 years old female, was admitted to our hospital for the evaluation of abdominal discomfort and loss of appetite. The barium enema (Figure 1-a, Figure 1-b) showed filling defect in the cecum, and colonoscopic examination (Figure 2-a, Figure 2-b) revealed multiple polyps at the same portion. Biopsy findings from the largest polyp were compatible with those of villous adenoma. However part of which showed the findings of suggestive of malignancy. The resected ileo-cecal specimen (Figure 3) revealed 3 polyps. Histologically, the largest polyp was mainly composed of villous adenoma with tubular feature, but in a part apparent cancerous focus was present (Figure 4-a, Figure 4-b and Figure 4-c). The schema of pathological reconstruction was shown in Figure 5-a and Figure 5-b. The uncommon case of polyp of cecum with focal cancer was reported.

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Peroral cholangioscopy (POCS) has been in clinical use but its facilities were not practical enough. There were various models of mother-baby system peroral cholangioscopy produced by Olympus. In 1986, practical baby scope (Type-J) which has 1.7 mm forceps channel, insufflation-water supply-suction system and 160° Up, 100° Down angulation was developed. We performed 63 cases of POCS and peroral pancreatoscopy by the scope mentioned above during May 1986 to Nov. 1987. Successful insertion into the choledochus reached 54 cases of 57(94.7%). Moreover, we could insert it into the gall bladder through a dilated cystic duct in all three cases because of the dilation more than 10 mm in diameter. It was suggested that a stone moved downwards to the choledochus in patients with cholecystolithiasis. In one case, a stone was successfully extracted by basket catheter, introduced through the channel of baby scope.

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Between 1977 and 1987, 13 small intestinal tumors (6 leiomyosarcomas, 3 leiomyomas, 2 adenocarcinomas and 2 malignant lymphomas) were subjected to operation in our hospital. The clinicopathological features and clinical diagnosis of the small intestinal tumors were examined. Small intestinal tumors were distributed about equally between jejunum and ileum at the same frequencies, and usually developed submucosally and may grow to a larger than 5 cm in diameter were found in 62%, and they were often histologically malignant. A clinical diagnosis of small intestinal tumors before operation was extremely difficult : a correct diagnosis could be made before operation in only 7 cases (54%), and the another 6 tumors were found at the time of laparotomy. For diagnosis of small bowel tumors, small intestinal endoscopy, selective visceral angiography and double contrast barium radiogra-phy were very useful. There are no specific symptoms for small intestinal neoplasms of any types. Therefore, patients with abdominal pain or gastrointestinal bleeding of un-known origin should be carefully examined to diagnose small interstinal tumors before operation.

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The experience with a new type of enteroscope, SIF-MS was reported; it is made up of two components, the master-and the sub-scope. The subscope has an outer diameter of 5.8 mm, its working length being 3, 425 mm; it is designed to be passed through the channel of the master-scope, whose outer diameter is 13.6 mm. The subscope has an angle mechanism of four directions, 130 degrees each. First, the master-scope was inserted up to the duodenojejunal junction. Then the subscope was advanced through the channel of the master-scope into the jejunum as far as possible. Enteroscopy with this scope was performed in three patients. The results showed that the depth of insertion was much the same as in push-type enteroscopy. The exmination was safe and not so painful ; it could be performed even for outpatients.

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