In order to clarify the damage caused by the presence of Campylobacter pylori, a study was made on the detection of C. pylori from gastric mucosa in cases of chronic gastritis and peptic ulcer, and the relation between the stomach disease and C. pylori by developing simplified quantitative measurement. In addition, a study was made on the influence of ammonia which is thought to increase by the presence of C. pylori on gastric mucosa. As a result, a high detection rate of C. pylori was observed in duodenal ulcer compared to other disease. Also, there was a tendency to be detected in every gastric area in C. pylori positive cases. Furthermore we measured the bacterial number of C. pylori, using the endoscopic Congo red method. In closed type, a high bacterial number was observed in the antrum and in open type, a high bacterial number was observed significantly in the corpus. Therefore, it was suggested that the presence of C. pylori had relation to the progress of atrophic gastritis. In C. pylori positive cases, the concentration of ammonia in gastric juice was significantly higher compared to C. pylori negative cases. After the load of 0.02% ammonia to C. pylori negative case, a decreased gastric mucosal blood flow and an increased degree of inflammatory cell infiltration were observed. It was suggested that gastritis would be caused by ammonia that would be thought to increase in the presence of C. pylori.

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One hundred and twenty two cases with presumed hyperplastic polyp were followedor periods of five years to nineteen years and six months, with an average of seven years and ten months. The follow-up studies of the gastric polyps were made by radiological, gastroendoscopic and bioptic examinations.The results obtained were as follows : Among them, morphologic alterations of polyps had been observed in eighty seven cases (71.3%). 1. Length of polyp increased gradually in thirty three cases. 2. Diameter of polyp increased in forty four cases. 3. Twenty one cases had a decrease in its size, some of them spontaneously disappeared during the course of follow-up. 4. Twenty cases had an increase in its number. 5. Malignant transformation of gastric polyp was present in one case only. Therefore, the possibility of the transformation into gastric cancer seems to be very small. However, a coexisting gastric cancer was present in six cases. In conclusion, many cases with gastric hyperplastic polyp should also be followed carefully for the possibility of a coexisting carcinoma.

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Resection of early gastric cancers with strip biopsy were performed in 159 cases during the past 5 years (1983-1988) and 1042 cases were surgically resected during the past 13 years (1965-1988). Among them, 20 cases of well differentiated adenocarcinomas showed minute invasion of the submucosal layer. These twenty lesions were classified as 1(5), ha (4), IIa+IIc (3), IIc (6), and IIc+III(3 lesions) on the macroscopic classification of early gastric cancer. Te size of these lesions ranged from 7 to 60 mm in diameter. Consequently, the endoscopic findings of these 20 cases were not thought to be consistent with the macroscpic findings and the size of the lesions. However, the dissecting microscopic investigation of these lesions revealed that a clear depression of the surface of the ha lesions with minute submucosal invasion was related with histological minute submucosal invasion, that type I lesions showed broad erosion on the surface of the lesion and that depressed type cancers like IIc and IIc+III looked a wavy depressive appearance. Concerning the prognosis of the 20 patients with minute submucosal invasive lesions of which follow-up period was five years and eleven month, the fourteen cases without lymph nodes metastasis who had surgical resection, and the seven cases by strip biopsy, 19 patients are still alive as of March 1988. The cause of death of the one remaining case mentioned above was not due to gastric cancer, but was from another cause. According to these results, the prognosis of minute submucosal invasive cases is almost equal to that of intramucosal well and moderately differentiated adenocarcinoma.

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Since old times, the acupuncture has used for treatment in Japan. Above all, the Zusanli and Yanglingquan have frequently been used, but there has been no experimental medical study on these acupuncture treatment. The authors used gastrofiberscope to study changes in gastric secretion. The results indicated that the Zusanli loci stimulate gastric juice secretion and reduce pH, while the Yanglingquan loci have a weakly opposite effect. Concerning gastric hormones, stimulation of the Zusanli loci decreased gastrin and increased secretion levels, whereas the Yanglingquan loci decreased both. Furthermore, stimulation of the Zusanli loci resulted in elevation of the abdominal skin temperature and levels of 5-(hydroxytryptamine), whereas the yanglingquan loci resulted in a decrease in both of them.

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Observation of duodenal mucosa was made by using a magnifying endoscope (OLYMPUS, GIF-D10), and classification of three patterns was established, namely, the isolated pattern, the connected pattern and atrophic pattern. These magnifying endoscopic patterns are based on the shape of the duodenal villi, and also recognisable with an ordinary endoscope using the indigo-carmine dye contrast method. In our study, these magnified endoscopic duodenal mucosal patterns had asignificant relationship with the ordinary endoscopic picture of duodenitis. Sixty one and half percent of the normal control acses had an isolated pattern. In contrast, the isolated pattern decreased in number in hyperemic and erosive type duodenitis and none of the rough surfaced type duodenitis showed this pattern. On the other hand, 80.0 % of rough surfaced type duodenitis had the atrophic pattern. In bioptic study, inflammatory cells had significantly increased in hyperemic and erosive type duodenitis, and gastric metaplasia was characteristic in the rough surfaced type duodenitis. Amount of Cu-Zn super oxide dismutase in the duodenal mucosa of duodenitis was found to be in between the control and duodenal ulcer, except erosive type which showed low value as duodenal ulcer. In the cases of duodenitis, labellding index of duodenal mucosa of prolif erative zone was higher than that of the control.

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Patchy marking (PM) are frequently observed on the liver surface of chronic active type B hepatitis. As PM are considered to be the beginning of cirrhotic nodules, they are very important peritoneoscopic findings in recognizing the future progression of hepatitis. In this report the natural course of PM from early stage to cirrhotic nodules was morphologically investigated in addition to the influence of seroconversion from HBeAg to anti-HBe and the influence of surrounding findings arround PM such as reddish markings. The subjects of this study were 135 patients of chronic type B hepatitis diagnosed by liver biopsy under peritoneoscopy. In 32 patients, follow-up peritoneoscopy and biopsy were performed later. PM in early stage were pale red in color, flat and irregular in shape. They were sometimes indistinct but became more evident after intravenous injection of ICG. These PM in early stage gradually advanced to typical PM, which were dark red in color, slightly elevated and round in shape. And furthermore typical PM developed to cirrhotic nodules in many cases. In the 11 patients with early stage of PM at initial examinations, 6 patients (55%) showed no progression. On the other hand, all patients with typical PM developed to liver cirrhosis at later examinations. Incidence of PM in the patients with anti-HBe was not different from that with HBeAg. But the patients with HBeAg showed more frequent progression of PM (79%) than the patients with anti-HBe. The progression of PM were more frequently observed in the patients with reddish markings than in the patients without reddish markings. And moreover PM with reddish markings advanced to cirrhotic nodules even though in the patients with anti-HBe. It is concluded that the findings of PM and the surrounding reddish markings are important factors indicating the possibility of developing from chronic hepatitis to cirrhosis.

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Sixteen cases of ha and IIa+IIc type early colonic cancers were classified into three subtypes (Figure 1) according to Sano's subclassification of IIa+IIc type early gastric cancer, namely "polyp" type (P type), "erosion" type (E type), and "deep invasion" type (D type). And these cases were examined clinically, macroscopically, and pathologically.The results were summarized as follows ; 1) There were eleven cases of P type, one case of E type, and four cases of D type. Cancerous invasion was limited to the mucosal layer in seven cases of P type, and reached the submucosal layer in other nine cases (Table 1). 2) Adenomatous component was found in nine cases of P type, but was not found in other seven cases (Table 1). 3) The characteristic endoscopic finding common to P type and E type was disappearance of normal vascular pattern. The surface color was normal in three cases and slightly reddened in eight cases. 4) In cases of D type, the mucosa surrounding the depressed area showed normal color, and the depressed area was discolored or had white coat, endoscopically (Figure 8, 9). 5) Two cases of D type, cancer cells of which invaded the submucosa, were small, namely, within 1 cm in diameter. It is considered to be valuable for the diagnosis of early colonic cancer to classify ha and ha + IIc type early colonic cancers into the above-mentioned three subtypes.

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In rescent 7 years and 4 months, 24 cases of amebic colitis were experienced at our department. Conclusions which obtained by our examination are as follows. 1. The rate of male were 87.5%. Twenty five percent of our cases had a history of travelling foreign countries. Homosexual were 25% and positive of TPHA test were 29%. These suggested a part of the infection was related significantly to the sexual contact by homosexual men. 2. The commonest site of the lesion was the rectum (88%). 3. The characteristic colonoscopic findings were varioliform elevated lesion, and ulcers or erosions surrounded by a erythematous halo. 4. It is sometimes difficult to make a differential diagnosis from ulcerative colitis because of similarity on the commonest site and endoscopic findings. The therapeutic diagnosis of ulcerative colitis is risky because that salicylazosulf apyridine and corticosteroid are effective temporarily to some patients with amebic colitis. 5. To diagnose correctly amebic colitis, the characteristic endoscopic findings must be understood. We think that combination of biopsy and serologic test is most easy and effective method to final diagnosis.

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Three hundred ninty four patients who had 708 neoplastic polyps including 45 early carcinomas were followed by repeat colonoscopy. The median period of follow-up observation was 22 months. In 178 (45.2%) patients, 252 adenomatous polyps were newly found endoscopically during the whole follow-up period. The polyps in the initial polypectomy group were located in the sigmoid colon and rectum more commonly (52.4%). However, 252 newly detected polyps in follow-up group were distributed evenly in the entire colon and 88.2% of them were 6 mm or less than 6 mm in diameter. 216 patients had no polyps detected in follow-up examinations. 47 patients had a few polyps but they do not have any polyps finally because of the repeat polypectomy. As a result, endoscopic polypectomy was considered to have a great effect on the number, the anatomical distribution and the size of the polyps detected in follow-up observation. Therefore, endoscopic polypectomy for neoplastic polyps including carcinomas will be able to prevent from the occurrence of colorectal carcinomas.

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A considerable number of cases with Crohn's disease are now under tollow-up observation. During the last 15 years, enteroscopy using the sonde type enteoscopes has been carried out in 15 cases with Crohn's disease (including 9 males and 6 females) for diagnosis and follow-up observation. The enteroscopic findings were analysed, and compared with those of small bowel X-ray. Twenty-eight examinations were performed with these cases ; in 24 (85.7%), the scope could reach the involved area and observation was possible. In 13 case, the presence of small intestinal lesions were confirmed ; in the remaining two, the small intestine was not involved. Enteroscopy could reveal the characteristic findings of Crohn's disease, i. e. longitudinal ulcers, circular ulcers, irregular ulcers, aphthoid ulcers, cobble-stone appearance, inflammatory polyps, pseudo-diverticular formation, and stenosis. Enteroscopy was considered to have an advantage over X-ray in the detection of minute lesions ; however, X-ray was superior in the delineation of pseudo-diverticular formaiton. In cases under follow-up, fluctuation in the disease activity as well as the extention of the involved area were observed. However, the transition from aphthoid ulcers to longitudinal ones could not be observed.

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Fourteen colonic polyp cases were treated with endoscopic Nd-YAG laser contact method. Cases included polyp after piecemeal polypectomy in 8, flat elevation in 4, and pedunculated polyp in 2. The histological findings for the first 12 cases showed adenomas or adenocarcinoma localized in the mucosal layer before laser irradiation, so we treated them with endotip in order to perform a perfect excision, By microscopic investigation of the rectal mucosa we irradiated, optimum dosis for irradiation which were safe and effective were determined as 15W for 1 second. Polypectomies under laser irradiation were done in two pedunculated polyps, since electric snare polypectomy might injure the intestinal wall due to electric leakage. Coagulation of the stalks of the polyps were done initially with endorod with wide divergence for prevention of bleeding. After that, stalks were cut with endocutter and polyps were taken out. In all fourteen cases, we confirmed disappearance of all polyps and experienced no recurrences, no side effects. This method is considered to be effective and safe for treating polyps of the large intestine in which electric polypectomy is difficult to perform.

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The use of sliding tube during total colonoscopy has been well appreciated. But manipulation of the middle length fiberscope with sliding tube sometimes becomes troublesome. We have been using “hand-made sliding tube made of rolled-up X-ray film (13cm × 45cm size) with effective results as our expectation. This simple “ hand-made sliding tube” is strong and thin enough to insert easily after the tip of fiberscope passing through S-D junction. We used this tube without fluoroscopic control with no complications. It took 8minutes on the average to reach the ceccum after use of this sliding tube. Moreover, this tube made the removal of excised polyp easy arier poiypeuwli'y. Therefore, it has been proved quite advantageous to use this simple hand-made sliding tube during colonoscopy.

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A 48 years old male was admitted for the further evaluation of an elevated lesion of the stomach which was pointed out in a periodic health examination. Gastrofiberscopy revealed a submucosal tumor of one centimeter in size in the greater curvature of the lower gastric body and biopsy specimens obtained from the erosive surface of the tumor showed the histology of carcinoid. Remarkable hypergastrinemia (1, 500 pg/ml) was observed, whereas urine 5-HIAA and serum serotonin levels were within normal limits. Subtotal gastrectomy was performed and resected stomach showed no obvious elevated lesion macroscopically, whereas histological examination revealed the irregular atrophy of the fundic glands (consistent with type A gastritis, Strickland & Mackay) and multiple foci of carcinoids in the deeper lamina of propria mucosa to muscularis mucosa. Serum gastrin level returned to normal after the operation. This case suggests the close relationship among type A atrophic gastritis, hypergas-trinemia and multiple development of gastric carcinoids.

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A 28-year-old male was admitted to our service because of epigastric pain and vomitting. UGI series revealed irregular angulus and narrowing and shortening of the antrum of the stomach. Endoscopic examination revealed large and shallow irregular ulcers, erosions and edematous red mucosa mainly in the antrum up to the lower body of the stomach. The serological test for syphilis on admission was strongly positive. There was no healing tendency of the lesion by treatment with H₂ receptor antagonist, and microscopic findings of gastric biopsy specimen showed non-specific inflammatory changes. Consequently, Syphilis of the stomach was considered and he was successfully treated by antiluetic medication with complete cure. The pictures of serial endoscopic follow up studies were presented, and literature review for the past 10 years was also made.

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Two cases of eosinophilic gastroenteritis with hypereosinophilic ascites were reported. Case 1: A 27 year-old woman was admitted to the Iwate Prefectual Hukuoka Hospital complaining of recurrent epigastric pain, nausea and diarrhea after delivery and she had a past history of cold urticaria and gastritis. Examination of the peripheral blood disclosed 39, 200 of white blood cells with 79% eosinophils and there were many eosinophils in the ascites. Panendoscopy revealed multiple spotty and patcy redness in the gastric angulus and the lower gastric body, and laparoscopy revealed multiple redness in the serosa of the stomach and small bowel. The infiltration of the eosinophils was seen in the gastric mucosa of the biopsy specimens. After administration of predonisolone the ascites disappeared and the subjective symptoms were improved. Case 2 : A 37-year-old woman was admitted to the Iwate Medical University Hospital complaining of abdominal pain and she had a past history of food allergy, disorder of bowel movements and gastritis. At admission there were many eosinophils in the ascites. Examination of the peripheral blood disclosed normal count but eosinophils increased to 11.1%. Panendoscopy revealed normal findings of the stomach and duodenum but infiltration of eosinophils was seen in both gastric and duodenal mucosa. Ascites disappeared and the subjective symptoms were improved without specific therapy. The diagnosis of eosinophilic gastroenteritis is comparatively easy with history of allergy, subjective symptoms and an increase of eosinophils in the peripheral blood and GI tract mucosa. And observation of the serosa of the GI tract by laparoscopy is useful. Administration of steroid hormone may not always be needed and some cases of eosinophilic gastroenteritis with hypereosinophilic ascites may improve spontaneously without specific therapy.

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A 40 years old asymptomatic male patient was admitted because of calcified lesions in the upper abdomen which had been detected by a mass survey. Plain abdominal radiographs showed nodular calcification in the left upper abdomen. X-ray examination revealed an extragastric nodular mass with calcification. Endoscopic examination demonstrated a low protruded lesion with smooth surface covered by normal mucosa at the greater curvature of the upper body of the stomach. Biopsy specimen showed normal mucosa Gastric leiomyoma was suspected and distal gastrectomy was performed. The operat-ed specimen demonstrated nodular, solid, hard and intramural mass with size of 70 x 60 x 50mm. Histological findings showed gastric leiomyoma with massive calcification. Until now, only six cases of gastric leiomyoma with macroscopic calcification are reported in Japan.

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Two cases of pseudomelanosis duodeni were reported. First patient was 50 year old male. He had no underlying diseases and had no habit of taking particular drugs. Endoscopically black-brown spot were observed in the upper part of the duodenal bulb. Biopsied specimen revealed pigments in the lamina propria. The pigment was negative for PAS stain and iron stain, positive for Fontana-Masson stain. Result of electron microscopy showed that the pigment was located in the round lysosome as the fine electrondense particle. Second patient was 83 year old female with hypertension and anemia. Her medications included hydralazin, thiazide, reserpine and ferrous sulfate. Black-brown pigmentation was observed in the second portion of the duodenum as "peppered" like appearance endoscopically. Biopsied specimen revealed that pigments were negative for PAS stain, positive for iron stain and Fontana-Masson stain. Result of electron micro-scopy showed that the pigment was located in the irregular shaped lysosome as the electron-dense granule with lipid droplets. The second patient was a typical case of the pseudomelanosis duodeni, however the first patient was rather different from ever reported cases both in clinical and morphological aspects.

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A 32-year-old female was hospitalized in 1987 because of diarrhea and fever. Colonoscopy and roentogenographic examination showed longitudinal ulcers in the transverse colon. Biopsies of the colon revealed extensive inflammation and granulomas. These findings were consistent with the diagnosis of Crohn's disease. The patient was started on prednisone and sulfasalazine, and her symptoms resolved. The patient's mother, a 60-year -old housewife, developed ulcerative colitis in 1965, at the age of 38. She underwent a by -pass operation in 1970 under a diagnosis of ileus, and a further total colectomy for severe hematochezia in 1979. Postoperatively, she has been in satisfactory health. HLA-BW 52, DR 2 were found both in the mother and her daughter.It has been recongnized that Crohn's disease and ulcerative colitis tend to be familial in Western countries. Also, a great deal of English literature has also shown that both ulcerative colitis and Crohn's disease occur in the same families. Though the cause of inflammatory bowel disease (IBD) remains unknown, these investigations imply that a hereditary or environmental predisposition is important in the etiology of IBD. We present the above two cases because few had been reported of familial occurrences of IBD in Japan, especially both ulcerative colitis and Crohn's disease occuring in the same family.

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The first case is a 53-year-old man who was admitted because of a tarry stool. A barium enema revealed a smooth-surfaced polypoid lesion measuring 1.5 cm in the cecum. The tumor was quite flexible as it changed shape with compression and posture changes. Colonoscopy revealed that the surface was smooth and similar to the adjacent mucosa, although it was slightly transparent. In addition, the tumor was easily compressed with biopsy forceps. As these findings suggested lymphangioma, surgical polypectomy was performed. The second case is a 69-year-old woman was admitted because of lower abdominal pain. Colonoscopy revealed a submucosal tumor, similar to that in the first case, in the sigmoid colon. Lymphangioma was diagnosed with endoscopic polypectomy being subsequently performed. In both cases, histological findings confirmed the diagnosis of lymphangioma. Seventy-one cases of lymphangioma of the colon reported in the world were reviewed and the potential of endoscopic polypectomy as a preoperative diagnostic technique as well as a useful diagnostic treatment were discussed.

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Lymphoangioma is extremely rare even among benign non-epithelial colonic tumors. It is difficult to make a diagnosis preoperatively. Because of its cystic nature lymphan-gioma can, however, be suspected if a submucosal tumor readily changes its shape under palpation or mild compression We encountered one case of this rare condition. The patient was admitted to our hospital with severe diarrhoea and abdominal pain. A barium enema study revealed a submucosal lesion, which was diagnosed by colonoscopy as a cyst because of its really malleability under palpation and compression Since medical treatment brought about no relief of symptom, partial colectomy was performed including the site of the cyst in the descending colon. The lesion, measuring 1.7 x 2.5 x 2.0 cm, was septate, formed of fibrous connective tussue and lined with endoth-elium. It was diagnosed as lymphangioma of the descending colon.

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Lymphangioma is a rare tumor of the large intestine. We recently experienced two cases of lymphangioma of the large intestine. Case 1 is a 72-year-old male complaining of general fatigue. A semipedunculated tumor covered with normal mucosa was observed by barium enema and colonoscopy in the sigmoid colon. The 5×3×3mm tumor excised by endoscopic polypectomy was histologically diagnosed as cavernous lymphangioma Case 2 is a 51-year-old male who visited our hospital for precise examination of the large intestine. A semipedunculated tumor with cushion sign was observed by barium enema and colonoscopy in the ascending colon. The 18×14×12mm tumor excised by endoscopic polypectomy was diagnosed as cavernous lymphangioma. Sixty cases of lymphangioma of the large intestine have been reported in Japan, and fifteen cases of them, including our cases, were excised by endoscopic polypectomy. In view of the fact that no evidence of malignant degeneration has been reported as in lymphangioma, total biopsy by endoscopic polypectomy could be an efficient diagnostic and therapeutic treatment of this lesion in the large intestine.

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It has been known that it is difficult to make a diagnosis of intestinal endometriosis by endoscopic biopsy because the mucosal surface is intact in most cases with this disorder. Recently, a case of this disorder was experienced in which endometrial gland was histopathologically confirmed in the biopsied specimen obtained from rough reddish mucosa in the rectum. Moreover, intestinal endometriosis associated with an obstructive colitis has not been reported in Japan. Therefore, the case reported here is worth recording. A-35 year old woman was admitted to our hospital because of abdominal pain, rectal bleeding and complaining of constipation for 2 weeks. Barium enema revealed stenosis in the rectum, narrowing and thumb printing sign in the descending colon. Endoscopic findings showed an elevated lesion with smooth surface in the rectum, multiple ulcers and haemorrahgic erosions in the descending colon. Mucosa of the elevated lesion in the rectum became rough and reddish coincide with her menstral period. Endometrial gland was histopathologically in the biopsied specimen obtained from this lesion. Consequently, diagnosis of endomrtriosis in the rectum associated with an obstructive colitis was made. Soon after Danazol administration all symptoms as rectal bleeding and so on disappeared. She has been free from these symptoms after the discharge from the hospital.

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In order to simplify the procedure in endoscopic retrograde cholangiography, a new model of a duodenofiberscope, type DU-XL3 (Fujinon) was evaluated. This new fiberscope has a new advantage. The distance between the center of the image guide and the edge of the biopsy channel is designed to be shorter than the conventional type. This special arrangement enabled us to see the tip of the cannula near the center of the visual field through the endoscope even if the cannula was erected for selective cholangiography. This fiberscope was used in 27 ERCP examinations. A rate of visualization was 92.6% in selective cholangiography, and 100% in selective pancreatography. And EST was also successfully and safely carried out in two cases of choledochus stones with this fiberscope. Selective cholangiography could easily be obtained even by the docter of little experience on ERCP examination. This fiberscope was useful to shorten the time of ERCP examination and to prevent post-ERCP pancreatitis due to unskillfulness by avoiding excessive pancreatography.

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