We studied on clinicopathological features of elevated type of gastric adenomas in 161 cases (190 lesions). The endoscopic characteristic features were evaluated on 36 lesions, followed-up for 6 months or more. Fifty-five resected lesions were investigated path-ologically. On endoscopic findings, elevated adenoma was observed as normocolored or discolored in comparison with the surrounding mucosa and elevated lesions with flat or nodular surface. The shape and size of followed-up lesions was unchanged in 80.6% and also unchanged in 6 lesions (16.7%) histologically changed in biopsy specimens. From these results, most gastric adenomas are unchanged macroscopically histologically and if the macroscopic form changed, it was considered that the changes might be very slight. In histopathological study, the size of carcinoma in adenoma was significant larger than that of adenoma. Six (42.9%) of 14 lesions over 21 mm in diameter were transformed to carcinoma. Intestinal metaplastic change was recognized in 52 lesions (94.5%), exsisting in full layer of the mucosa in the surrounding mucosa. However, it was only 4 lesions (7.2%) that intestinal metaplasia mainly exsisted in the deeper layer of adenomatous tissue. In addition, cystic dilatation occupied about 20% of full thickness of the mucosa throughout the adenoma. From these results, we presumed a growing pattern of elevated adenoma, namely, the initial form of suchlesion might be flat and afterwards, protruded by cystic dilatation originating in the deeper layer of adenomatous tissue.

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The possibility of the practical use of endoscopic ultrasound (EUS)-guided puncture technique was examined. The aim of this study was to establish the safety and reliability of fine needle aspiration biopsy (FNAB) via gastrointestinal lumen under realtime ultra-sound guidance. All studies were performed with Toshiba-Machida echoendoscope EPE-703FL (7.5 MHz) and EPB-503 FS (5 MHz) with linear transducers. The results were as follows; 1) EUS-guided puncture and FNAB was performed with a modified EIS needle gauge 23, 20 mm in length set up on the EUS fiber with the rising device. 2) A transesophageal puncture model was made and several lymph nodes resected from an adult mongrel dog embedded in an agar. The tissue material obtained from EUS-guided FNAB was satisfactory for cytological examination. 3) EUS-guided transesophageal puncture was performed in 2 dogs under general anesthesia with no complications. We conclude that EUS-guided puncture technique was expected to be a new diagnostic procedure.

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We devised a system for recording gastric motility and blood flow in which the numerical values of gastric mucosal blood flow and waveforms due to sequential changes obtained using electronic endoscopy (GIF-XV10) and a laser doppler blood flowmeter (PF3) were superimposed on an endoscopic monitor. To emphasize the relation between blood flow and motility, an attempt was made to induce changes in gastric mucosal blood flow by loading with cetraxate hydrochloride (CH). A dose form which can adhere to the mucosal surface endoscopically was prepared as a method of local application of a drug to the gastric mucosal surface. The subjects were five healthy male volunteers and one male patient with liver cirrhosis. The measured values in the volunteers rose from 95.8±13.0 PU before the CH load to 149.4±40.6 PU after 10 minutes, 232.5±66.7 PU after 15 minutes and 239.4±68.6 PU after 20 minutes with a peak of 338.1±34.6 PU in 16.0+2.5 minutes. A particularly interesting finding was a tendency of gradual increase in all of the volunteer with repeated cycles of transient decrease in blood flow every few minutes (Figure 4 & 5). Blood flow changes associated with peristalsis were observed in the liver cirrhosis patient (Figure 7). The method of simultaneous recording of the endoscopic images and blood flow appears to be useful for pathophysiological and clinico-phamacological studies in the stomach.

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In order to elucidate the clinical usefulness and problems of ERBD in malignant hepatic hilar stricture, 64 patients treated by ERBD were retrospectively studied. There were no relation of conventional liver function tests, origin of the tumor or type of stenosis in regard to drainage effect for jaundice. However, patients showed a tendency of poor drainage cases whose stents were inserted to the position "C". There was a high incidence of early cholangitis after ERBD in 23.4% of the patients within 1 week and in 37.3% within 1 month, however its incidence was not related to the type of stenosis, origin of the tumor or stent position. Nine patients died within 1 month of ERBD. However death within 1 month was not directly related to early cholangitis. All of them demonstrated type III strictures. The 50% survival time of the patients with type II and type III strictures was 155 and 119 days, respectively. There was a significant difference of survival rate in the age and drainage effect. Patients in whom a stent was inserted to the position "C", encountered more often recurrent cholangitis within 2 months after ERBD, which was sometimes treated by PTBD. These results indicate that ERBD should be recommended principally to the patients in whom a stent could be inserted to the position "A" or "B" instead of position "C". It is necessary to pay attention of the development of cholangitis.

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One thousand, five hundred and sixty patients underwent colonic fiberscopy ; of these, 40 were diagnosed as having 63 lesions of colonic xanthoma. In the present study, we investigated the following criteria : 1) Clinical symptoms and signs. 2) Observations on the surrounding mucosa of colonic xanthoma lesions in biopsy specimens. 3) Serum lipids, serum lipoprotein fraction, and serum apoprotein fraction. 4) Presence or absence of adipocytes in the feces : Thirteen patients who showed normal mucosa on total colonic endoscopy served as controls. The occurrence of colonic xanthoma was 2.6%. The patients had an average age of 56 years, and their sex distribution was approximately three men to one woman. The chief complaints at the time of fiberscopy were mostly a request for a workup, followed by bloody stools and a positive test for occult blood. With regard to the site of colonic xanthoma, 61 lesions (96.8%) were found in the rectum and sigmoid colon. Yamada's types 1 and 2 predominated in endoscopic morphologies. Moreover, the appearance of the surface was smooth and whitish in most cases. Colonic diseases associated with colonic xanthoma were detected in 22.5% of the patients, and adenoma was observed in most of the xanthoma cases. At the same time, colonic xanthoma was complicated with gastric xanthoma in 13.9% of the patients studied. There were no significant differences from the control group in terms of serum lipids (total cholesterol, neutral fat, non-esterified fatty acids, and HDL cholesterol in the serum), serum apoprotein fraction, and serum lipoprotein fraction. Nevertheless, a significant difference was noted between the control group and the patient group with respect to the presence or absence of adipocytes in the feces stained with Sudan (p<0.05).

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Peritoneoscopic and histological findings in four cases with sever acute hepatitis were studied. Patients in case 1, 2, 3 who recovered from acute liver failure rapidly had almost smooth liver surface and histological findings showing acute hepatitis with spotty and bridging necrosis. Their peritoneoscopic and histological findings were similar to those of fulminant hepatitis (acute type). Patient in case 4 who recovered from liver failure more slowly had potato like liver. His peritoneoscopic and histological findings were similar to those of fulminant hepatitis (subacute type). Peritoneoscopic and histological findings may suggest that two types with different mechanisms of hepatic necrosis and regeneration exist in severe acute hepatitis.

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We applied an endoscopic ultrasound probe system named "SONOPROBE SYSTEM" (Fuji photo optical Co., LTD. and Aloka Co.; LTD) for clinical cases. The subjects were 24 cases (42 times) of various gastrointestinal diseases and 6 resected materials of gastric and colonic cancer cases. During routine endoscopy, ultrasound images of five layer structure of gastric and colonic wall were clearly observed under endoscopic direct control with water immersion. And in vitro study an ultrasound frequency of 20MHz provided fine images of IIc type minute gastric cancer (invasion depth, m) as a hypoechoic lesion in the first and second layers. This system was useful in invasion depth diagnosis of small tomors, despite there were some mechanical problems to be solved in manual scanning.

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We have studied 13 cases of ischemic colitis in young adults under 40-years-old, and obtained the following results. 1. All of 13 cases were transient type in ischemic colitis and equivalent to 27.7% of all cases of transient ischemic colitis in our hospital. 2. Ratio of male and female was 1:3.3. 3. Affected sites distributed within the descending colon and the sigmoid colon in all cases. 4. No vascular factor were seen as underling desease. 5. Constipation was seen in about half of all case and increased intraluminal pressure and peristalsis were thought as a causative factor. 6. We considered that ischemic colitis was induced by increased intraluminal pressure and peristalsis or functional ischemia in young adults who had not something to do with vascular factor.

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Twenty five cases of the pancreatic cancer and fourteen cases of tumor forming pancreatitis were examined by endoscopic ultrasonography (EUS). The score evaluation of the characteristic findings by EUS was performed for the purpose of objective evalua-tion. Direct findings were as follows : (1) heterogeneity of the internal echo, (2) irregularity of the marginal echo, (3) clearness of the boundary echo. (4) ductal structure minus, (5) duct penetration sign minus, and indirect findings were (1) dilatation of the main pancreatic duct, (2) dilatation of the common bile duct, (3) swelling of the lymph nodes around the pancreas, (4) invasion to the vessels, (5) ascites. Each positive finding was added 1 point, and the points were accounted to the score among the direct and indirect findings. Regarding to direct findings, the score of pancreatic body and tail cancer was significantly higher than that of pancreatic head cancer (p<0.05). The reason was thoght that the incidence of tumor detection by EUS in the pancreatic head was lower than that in the pancreatic body and tail. Indirect findings had to be carefully observed in the pancreatic head cases with unclear tumor shadow. There was no correlation between the tumor size and the score. Both scores of direct and indirect findings in tumor forming pancreatitis were significantly smaller than those of pancreatic cancer (p<0.005), and the diagnostic standard evaluated by the score was useful.

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Two cases of cervical esophageal web were reported . The first case was a 46-yearold man with esophageal carcinoma and psoriasis vulgaris . The web was surgically removed as well as complicating carcinoma. The second case was a 58-year-old woman with Plummer-Vinson syndrome due to previous gastrectomy. Under fiberoptic endoscope, the web was cut by the high frequency knife, and the stricture was dilated by the balloon attached endoscope . After the procedure, her subjective symptoms improved without any complications . Endoscopic treatment for the esophageal web was supposed to be safe and useful.

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We experienced a rare case of the pedunculated submucosal heterotopia of gastric glands which was removed by endoscopic polypectomy with high frequency electric currents. A 57 years old female visited to our hospital because of epigastralgia. X-ray and endoscopic examination revealed a pedunculated polypoid lesion on the greater curvature of the upper corpus in the stomach, of which surface was smooth and slightly reddish. So endoscopic polypectomy was performed. The size of resected specimen was 14×13×9 mm (head) and 4×4 mm (stalk). Microscopically, ectopic glands consist of single layer of columner epithelium similar to the pyloric gland appeared in the submucosal layer. Intestinal metaplasia and atypical cells were nonexistent in it, and neither injury of musclaris mucosa nor inflammatory cell infiltration to the mucosal layer were seen. From these findings, we conclude that this case was a submucosal heterotopia of gastric glands arising from congenital aberration.

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A 60-year-old female was admitted for further examination of a large elevated lesion which looked submucosal tumor on mass screaning X-ray examination. Upper GI series as well as endoscopical examination revealed a round elevated lesion with mucosal bridge on the posterior wall of the gastric antrum. Simple gasterectomy was performed under the diagnosis of submucosal tumor. In the resected specimen, one large submucosal cyst measuring 40 × 30mm at the posterior wall of the antrum and two small submucosal cysts at the anterior wall of the antrum. Histologically, the lesions consisted of a large cyst with heterogenous glands and of the multiple simple retention cysts with a single layer of cells in the submucosal layer. Twenty-nine cases of submucosal cysts which were diagnosed as remarkable sub-mucosal tumors or cystic lesions preoperatively were reported in Japan since 1974. Multiple cysts were common, and most cysts were smaller than 3.0 cm in diameter. Chronic inframmation was complicated in 13 cases and cancer in 9.

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The patient was a 73-year-old woman who was admitted to our hospital because of melena and abdominal pain. Endoscopy performed on the third day after the onset of the symptoms revealed localized skip lesions located in the transverse colon and ascending colon. The lesion in the transverse colon was a hemicyclic and protuberant one with a large ulcer on the top, while the lesion in the ascending colon was a cyclic and protuberant one with hyperemia. Both lesions were diagnosed as colon cancer. On the seventh day after onset, the contrast enema was done ; the lesion in the ascending colon showed an apple core-like with constriction, while the lesion in the transverse colon showed a unilateral, large filling defect, and the same diagnosis of colon cancer was made. A surgical operation conducted on the 10th day after onset revealed only shallow ulcerative lesions, which were histologically diagnosed as ischemic colitis. This case was reported since the sites of lesions and the endoscopic features were rare.

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A 82-year-old man was admitted to Nagasaki University Hospital, complaining of bloody stool. Digital examination of rectum and barium enema revealed a protruding lesion with irregular surface and about 2.8 cm diameter in the lower rectum. Fiberoptic colonoscopic examination disclosed a subpedunculated protruding lesion with slight erosion and scattered black spot at 10 cm oral side from dental line. Microscopical examination of the biopsy specimen showed malignant cells, but it was not able to diagnose as malignant melanoma. Considering to patient's age, transsphincteric local excision for the protruding lesion was performed. Histopathological examination of the resected specimen revealed malignant melanoma. Despite adjuvant immuno-chemotherapy such as OK 432 and DAB after surgical treatment, local recurrence and multiple liver matastasis occurred after 5 months, and patient died after 13 months postoperatively. Retrospectively, several black spots were seen by endoscopic examination before surgery. This was a case that we felt keenly to be a difficulty of preoperative diagnosis.

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A 88-year-old woman was admitted to our hospital complaining of general fatigue and anorexia. Ultrasonographic examination and computed tomography demonstrated chole-cystocholedocholithiasis. Cholecystectomy, choledochotomy and T-tube drainage were performed. Cholangio-graphy through a T-tube was performed on the 38th days after operation and it demon-strated a filling defect of the distal common bile duct. As this filling defect was supposed to be a residual stone, cholangioscopic observation of the common bile duct was done through the fistula of T-tube. A polyp showing smooth surface and stalk was found. This was resected by biopsy forceps. Pathological findings showed inflammatory polyp. Experience of endoscopic resection for benign tumor in the extrahepatic bile duct had never reported in Japanese literatures. A possibility of existence of benign tumor should be considered, if a filling defect in the extrahepatic bile duct was seen.

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We reported in this paper a 58-yeaar-old female with autoimmune hepatitis presenting interesting peritoneoscopic findings. Physical examination revealed eruptions in her lower legs and icteric conjunctiva. On laboratory examinations, liver damage, hypergammag-lobulinemia, and antinuclear antibodies were noted. From these findings, we suspected autoimmune hepatitis and performed a peritoneoscopic examination. Peritoneoscopic picture showed an enlarged liver with a dull edge. The surface of the liver was overspread with various sizes of small yellowish nodules with obscure margins. The biopsied specimen showed that the portal area was remarkably dilated and was infiltrated with mononuclear cells. Focal necrotic lesions were found in many lobules. Although the peritoneoscopic findings of autoimmune hepatitis are typically characterized by reddish markings, wide-spread depressions, and gentle protrusions, the findings described above should be consid-ered to be an anomalous manifestation of autoimmune hepatitis.

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Recently, endoscopic examination of the biliary tract has been developed in diagnosis and therapy for biliary disease. The choledochoscope (XCHF-P 20 QY) equiped with a small caliber and 4 angles and its characteristics are demonstrated in this study. The choledochoscope (XCHF-P 20 QY) is equiped with 670 mm in length, and 380 mm of flexible part at the distal end of the fiberscope which can bend in four directions. The outer diameter of tip of fiberscope is only 4.1 mm. There was no problem of precise manupulation, although the range of vision narrowed slightly compared to the conventional scope. This scope was possible to insert through a narrow fistula, even 14Fr. in diameter. Therefore, this procedure using the scope made possible to dilate the fistula in a short term. Manipulation was improved in comparison with conventional model due to the equipment of 4 angles. In the future, it is expected to improve the managed equipment including EHL-probe.

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Recording, storage and effective utilization of endoscopic images has become possible by introduction of multiple endoscopic image filing system for electronic endoscopic system. The authors are using an analog optical disc for image recording and the systems are constructed with other peripheral equipments. Features of the system are as follows : (1) Images can be recorded in real time transfered from four independent electronic endoscope systems. (2) Images can be shown to patients on a TV monitor of the electronic endoscope system during examination. (3) Images can be played back and printed immediately after examination and the report can be made quickly. (4) Stored images cann be referred quickly from many points of view to be discussed with physicians. (5) Space for data storage can be saved. (6) Image processing can be performed in conjunction with a computer.

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