The pictorial images oberved by the wide-and narrow-band infrared rays, loaded by indocianine green (I. C. G.) were studied by the infrared videoendoscope illuminating directly inside of the stomach. Under the wide-band infrared rays, fine structure were entirely dismissed except the fold and characteristic appearance of the deep layers' vessels were observed in the antrum. Appearances of vessels were observed under the narrow-band infrared rays more eminently than under the wide-band ones. Besides this, the appearance of fine branches of the vessels was emphasized by the intravenous injection of I. C. G.. At the greater curvature in the lower body of the stomach, appearances of deeper layers' vessels' were recognized as a network pattern in 82.2 per cent of the subjects and as a longitudinal pattern in 17.7 per cent of them with the infrared videoendoscope. In atrophic gastritis cases, mucosal fine vessels' appearance was not recognized by the infrared videoendoscope. In gastric ulcer, vessles were not observed around the swelling ulcer margin on active stage, and deeper layers' vessels were observed to run toward the ulcer margin on healing stage. On scarring stage, vessels tended to run to the center of the scar and were ceased around the scar margin while vessels were not observed at the center of the scar. From these facts, the infrared videoendoscope was useful to make diagnosis of the range and depth of gastric ulcer. The author is expecting that the videoendoscope will be useful for prospecting the prognose of various diseases on upper gastrointestinal tract as well as making the diagnosis of them.

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The effects of endoscopic injection sclerotherapy (EIS) were evaluated in 26 patients with esophageal varices by using color Doppler endoscopic ultrasonography (CDEUS). Of these, 21 patients underwent CDEUS before and after EIS. The color Doppler flow mapping before EIS revealed that esophageal varices were mainly located in the sub-mucosa and the blood flow was characteristically turbulent and hepatofugal. CDEUS just after EIS showed that the varices changed to echogenic, and the blood flow was not detected. CDEUS 2 weeks after EIS showed thickness of the esophageal wall with a mild echogenic pattern. Four weeks after EIS, the esophageal varices were completely disappeared without any blood flow, and a 5-layer structure just like the normal eso-phageal wall was observed. Besides, CDEUS 4 weeks after EIS also revealed the complete resolusion of varices. Therefore, CDEUS after 4 weeks is suitable to evaluate the effect of EIS. EIS resulted in incomplete disappearance of the varices in 10 patients and complete disappearance in 16. Of these 10 patients with incomplete disappearance, 6 patients with paraesophageal collateral veins recurred within 13 months, while those with complete disappearance who had no paraesophageal collateral veins did not recur within 13 months except for one patient. These results suggested that the existence of paraesophageal collateral veins may play a crucial role in the recurrence of varices. We concluded CDEUS is useful for evaluating the efficacy of EIS.

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Percutaneous endoscopic gastrostomy (PEG) was performed on 71 cases. Forty-five cases were applied by "Push" method and 26 cases were by "Introducer" method. We compared retrospectively Push method with Introducer one from the stand point of technique, indication, local care, catheter maintenance, complications and catheter troubles. Push method technique requires endoscope insertion twice. On the other hand, Introducer method needs once insertion. On changing the catheter insection under endoscopic : C observation was needed for Push method, but not for Introducer one. Necrosis around the feeding catheter was characteristic complication for Push method.

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We studied on bleeding foci, the relationship between bleedings and degree of renal failure of the upper gastrointestinal tract in patient with rapid gromeluronephritis (RPGN) with polyarteritis nodosa (PN). There were 6 cases (male : 2, female : 4). The average age of male was 64 years old, and that of female was 64.5. Endoscopic examination demon-strated 1 case with esophageal ulcer, 1 with duodenal ulcer, and 4 with Dieulafoy's ulcer. All of Dieulaf oy's ulcers located at the body of stomach. There was no relationship between gastrointestinal bleeding and degree of renal failure. Moreover, hemodialysis or not and period of hemodialys was not correlated. In this examination, incidence of gastro-duodenal bleeding, Dieulafoy's ulcer was higher in cases with RPGN with PN. Baced on this result, this study was very interesting, because it suggests the characteristic of PN as a systemic vasculitis.

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Endoscopic ultrasonography (EUS) was performed in 4 cases of the schwannoma of the stomach and their ultrasonograms were investigated. The subjects were consisted of 4 cases of the schwannoma of the stomach (3 benign cases and 1 malignant case) which received preoperative EUS, surgical resection and pathologic diagnosis in this center. Ages ranged from 29 to 78 years and averaged 48 years. The ratio of males to females was 2 : 2. The chief complaint was epigastric pain in 2 cases, anorexia in 1 Base. According to the Agreed Method of Handling Stomach Cancer, the occupied area was area C in 1 case and area M in 3 cases. The maximum diameters of tumors ranged from 15 mm to 40 mm. According to the EUS findings of schwannoma, the tumor was oval in 3 benign cases and nodular and lobular in shape in 1 malignant case. The tumor continued to the 4th layer of the gastric wall in all the cases. The echo level was hypoechoic in all the cases, which was the same level as in the 2nd or the 4th layer of the digestive tract. The internal echo was relatively uniform in benign tumors but relatively uneven in malignant tumors. A problem in differential diagnosis from other diseases is myogenic tumors and their differentiation is considered to be difficult at present.

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We studied on the "gutter-or-trench shaped depression" (G. T. S. D.), which appears characteristically during the developing process of type-C hepatitis, investigating its influence on the type of cirrhosis, its location on the liver surface, its incidence of occurrence, and its time of appearance, etc. G. T. S. D., like reddish markings (RM), were also observed in the following 4 peripheral regions of the hepatic lobes, namely, along the Cantlie line, inside of the left lobe, outside of the left lobe, and outside of the right lobe. The incidence of its appearance was highest in the region along the Cantlie line, then inside of the left lobe, and then lower at outside of the left lobe and right lobe. The time of its appearance varied. Namely, in cases of chronic hepatitis with peritoneoscopic code number 200, the rate of appearance of RM (13.7%) was higher than that of G. T. S. D. (7.6%), whereas in cases with code number 300 (pre-cirrhotic stage), the rate of appearance of both RM (40.7%) and G. T. S. D. (55.6%) were higher, and as code numbers progressed, the rate of appearance of G. T. S. D. became higher (in code number 400, RM 45.7% and G. T. S.D. 52.2%, and in 500, RM 22.2% and G. T. S.D. 66.7%). In conclusion, most of HCV-Ab positive cirrhotic livers hecame more and more distorted in shape by the progressive increase of G. T. S. D., however, the active derangement to cirrhosis was mild in most of the liver tissues except the peripheral regions of the lobes.

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Endoscopic examination was performed in 23 patients with HIV infection. Esophageal ulcer was found in 7 (30%) of the 23 patients. Most of the lesions distributed in the middle to lower third of the esophagus. Huge ulcers were found in 6 of the 7 cases. Dimensions of ulcers were from 2 to 7 cm. Only one case had a small ulcer, 2 mm in size. Large ulcers showed distinct depressions with well defined margin, suggesting "punched out appearance". The CMV inclusion bodies were detected in 5 of 6 cases with large ulcers. These facts suggested probability of CMV infection as a cause of ulcer formation in patients with HIV infection. The incidence of esophageal ulcer in our patients was higher than those reported in western countries.

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We reported a rare case of triple cancer of the stomach, lung and esophagus after endoscopic injection sclerotherapy for esophageal varices. A patient was a 66-year-old male. In Februaly 1983, he developed massive bleeding from the esophageal varices, and at the same time, early gastric cancer (Type I+IIa) was found. We injected 3oml of 5 ethanolamine oleate intravariceally. After 18 months later from sclerotherapy, esophageal varices disappeared. In October 1984, subtotal gastrectomy was performed for the early gastric cancer. In June 1989, the patient was readmitted with complaints of disturbance of swallowing. Endoscopic examination revealed esophageal cancer at middle third of esophagus, and thoracic CT showed lung cancer in S₁₀ of a right lung. Also, reported cases of esophageal cancer after endoscopic injection sclerotherapy for esophageal varices in j apan were reviewed.

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We experienced a rare case of juvenile submucosal heterotopia of gastric glands which was removed by endoscopic polypectomy with high frequency electric currents. The patient was 15-year-old female. X-ray and endoscopic examination revealed an elevated lesion which appeared a submucosal tumor on the posterior wall of the upper body of the stomach. Endoscopic ultrasonography findings suggested an epithelial tumor. Endoscopic polypectomy was performed. Microscopically, multiple heterotopic gastric glands were observed in the submucosal layer. The mucosal layer appeared partially injured, and the muscularis mucosa was obviously cleft. The heterotopic glands continu-ously shifted to the superficial normal glands through the cleft of muscularis mucosa. Ectopic glands were mostly composed of f oveolar epithelial cells, and a small amount of the fundic glands were also observed. From these findings, we concluded that this case is an acquired juvenile submucosal heterotopia of gastric glands arising from inflammation.

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A 60-year-old man was admitted to our hospital, in a state of unconsciousness and shock. He took Methyl-Ethyl Ketone Peroxide (MEK-P) in an attempt for suicide. Upper gastrointestinal endoscopy revealed multiple esophageal ulcers, which correspond Rosenow's classification type 1 (Figure 1), and gastric ulcers (Figure 2). We were able to treat this patient under intensive care including H2-blocker. An esophagogram on the 30th day after admission revealed a non-stenotic esophagus (Figure 4), so he did not require the surgical operation. MEK-P causes injury to the gastrointestinal tract through free radicals, and its chemical burn has the alkali character. It is important to examine the gastrointestinal fiberscopy at an early stage because extended tissue damage may led to esophageal perforation. This is the first curable case of corrosive esophagitis caused by MEK-P in Japan.

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A 43-year-old female, diagnosed as having Hashimoto's Thyroiditis previously, was admitted to our hospital for further examination of the stomach following the gastric cancer mass survey. Endoscopic study showed an irregular-shaped erosion with purpurae on the anterior wall of the lower gastric body. Histological studies of the biopsy specimen revealed malignant lymphoma. Chest X-ray, abdominal ultrasonography, and whole body computer tomography revealed no lymphadenopathy. We, therefore, diagnosed as primary gastric malignant lymphoma and carried out total gastrectomy. Histological and immunohistochemical studies of the resected specimen showed that the lymphoma was of diffuse, medium-cell type with helper/inducer T cell phenotype. Primary solitary gastric T-cell malignant lymphoma is rare, and only ten cases have been reported in Japan. It is also interesting to consider the association between malignant lymphoma and Hashimoto's thyroiditis, because both diseases are associated with immunological abnormalities.

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Recently we experienced two cases of liver cirrhosis associated with duodenal varices. First case a 52 year-old woman who was admitted to our hospital with melena. He had a history of having abdominal operations four times The purpose of her admission was the endoscopic injection sclerotherapy for bleeding esophageal varices. By endscopic examination a varix was found in the second portion of the duodenum. Two years ago the cholecystectomy for a polyp in the gall bladder had been performed. Second case was a 54-year-old man with liver cirrhosis, who had been followed up as a outpatient of our hospital. The endoscopic and angiographic examinations revealed a varix in the third portion of the duodenum. He had a history of having the endoscopic injection sclerotherapy twice, 3 month and three years prior to admission, respectively. Two our cases suggest that the postoperative intraabdominal adhesions and previous sclerotherapy of the esophageal varices were related to the pathophysiology of the possible development of the duodenal varices.

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We observed gastroduodenal Crohn's disease with duodenal stenosis and effective response to conservative therapy in a 22-year-old male patient. He was admitted to our hospital complaining of upper abdominal pain, vomiting and weight loss. Upper gastro-intestinal X-ray series and endoscopic examination showed shallow ulcer and erosion in the pyloric region, and multiple elevated lesions in the duodenal bulbu. Longitudinal ulceration with stenosis and "cobblestone appearance" were observed in the second portion of the duodenum. Endoscopic biopsy revealed granuloma in all specimens taken from all these lesions. A barium follow-through examination of the jejunum and ileum did not reveal any abnormal findings. The examination of the large intestine showed inflammatory small polyps and ulcer scar in the caecum. These findings established the final diagnosis as gastroduodenal and colonic Crohn's disease. This patient responded well to therapy with intravenous hyperalimentation, elementary diet and salazosulf apyridine, and the symptoms were resolved and the duodenal stenosis was improved. Most of cases in gastroduodenal Crohn's disease reported in Japan was observed during the course of Crohn's disease in ileum and large intestine (14 out of 16 cases), and there were rare cases that gastroduodenal symptoms and lesions were the initiating disease. Four cases of gastroduodenal Crohn's disease including our case were treated successfully only by conservative therapy.

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We have previously reported on our original technique of esophageal mucosal resection using a specially devised over-tube (EMRT) for early esophageal cancer, through which obtained specimens lent themselves well to accurate histopathological diagnosis. Based on the clinical experiences that we learned from the EMRT procedure, we now introduce a much more simplified technique of mucosectomy using a cap-fitted panendoscope (EMRC). Four consecutive cases underwent this jumbo biopsy. Mucosal specimens about 2 cm in size were dissected safely, while keeping the surface of the proper muscle layer intact. It is concluded that this EMRC procedure is less invasive, valuable treatment modality for use in both making an accurate diagnosis of mucosal lesion and resecting early cancer of the esophagus.

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The removal of choledocholithiasis using percutaneous transhepatic cholangioscopy (PTCS) was performed in 10 cases with large choledocholithiasis. Endoscopic sphincter-otomy (EST) was failed to remove the stones in 8 cases, and 2 cases wer impossible to perform EST. The stones were destructed with electrohydrauric lithotriptor (EHL) and pushed outto duodenum or removed with basket catheter under jejunoscope. The success rate to remove the stones was 100 %. The average frequency of treatment with EHL was 3.2 ± 2.7 times, that of the basket catheter treatment with jejunoscope was 1.3 ± 2.0 times, and average period of admission was 74±30 occured in 3 cases, cholangitis, congestive heart failure and bleeding while making the tract for PTCS. Inflammatory stenosis of the bile duct occured in one dead case as a late complication. Our results indicate that EHL under PTCS is useful to remove these stones.

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We evaluated an analysis of 21 patients who were performed percutaneous endoscopic gastrostomy (PEG) from the view point of respiratory tract infection and complications and investigated also changes of gastric emptying during 2 years in 9 PEG patients. The mean duration of PEG was 24.9 months. The incidence of pulmonary infection was 18 patients and improved in 16 patients (88.9%) soon after PEG, but 3 patients accompanied with gastroesophageal ref lux (GER) were worse long after PEG. Major and minor complications occurred in 14.3% and 28.6% of patients, respectively. In 5 patients, the fistula was damaged and PEG was necessary to replace at another portion. A radioisotopic method was employed to study the rate of gastric emptying in 9 patients before, l month and 2 years later after PEG and when PEG was placed at another portion. In all cases, severe delay was observed after 2 years later after PEG, especially after PEG replacement. Our study suggents that PEG placement and especially replacement causes a delayed gastric emptying and perhaps deterioration of respiratory tract infection as a result of GER.

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According to the recent progress of endoscopic treatment, some types of an early gastric cancer have been able to be treated radically with endoscopy. Methods of endoscopic treatment can be classified to endoscopic resection (ER) and non-endoscopic resection (non-ER). In ER, there are endoscopic polypectomy, strip biopsy and ERHSE and in non-ER, there are laser endoscopy, microwave coagulation treatment, heater probe coagulation and endoscopic injection of pure ethanol etc.. ER has the advantage in histological study on the removed lesion to non-ER, but has usually a limit in the size of lesion. On the hand, non-ER cannot remove the lesion and cannot study its histology, but can treat larger lesion than ER. For the indication of radical endoscopic treatment of an early gastric cancer, following factors are requested, as no lymph node metastasis and no massive invasion beyond the mucosal muscle. Macroscopic type, size and ulceration of the lesion are also important factors for the indication. Although exact diagnosis of lymph node metastasis in individual case is impossible, pathological study on large number of the lesion performed surgery has proved following types of the lesion without lymph node metastasis. These are 1) a type I in m invasion, regardless its size, 2) a type ha in m and sm, less than 2cm, 3) a type Ul (-) IIb ·IIc in m, regardless its size, a type Ul (-) IIc in sm, less than 3cm, 4) a type UI (+) IIc in m, less than 2cm. Here, these types are called an early gastric cancer with absolute indication, which have to betreated by endoscopy. The other types of the lesion should be treated principally with surgery. However, patients with the lesion and with high surgical risk or refusing surgery have to be treated by ER or non-ER. In these patients, the lesion over the indication of ER is a relative indication and have to be treated by non-ER. Recently, it is going to increase as endoscopic treatment for the lesion that the combination therapy of ER at first and then non-ER is performed or after ER in the meaning of diagnosis, non-ER or surgery is selected, if necessary.

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In 1983, Welch-Allyn developed a new CCD-based endoscope. A videoendoscope or an electronic endoscope primarily uses electric signal through wires, notoptic signal through glass fiber bundle, for transferring images. Taking this advantage over a fiberscope, a number of endoscopists have developed computerized image analyzing system for elecrtonic endoscopy. This tutorial focused on the recent advances in image processing in electronic endoscopy. The image processing in electronic endoscopy includes reproduction or improvement of the image, analysis of morphological character of the lesion and analysis of GI functions. The reproduction (or improvement) of the endoscopic image reduces noises, compresses endoscopic image for picture archiving communication and storage, enhances color of the image, or makes a map of the lesions from a series of endoscopic pictures of narrow GI tract. The morphological analysis measures the size of the lesions or estimates malignant lesion from its texture. Oshiba et al. have reported a morphometric analysis of mucosal reepithelization around the gastric ulcer. Other groups of endoscopists also have contributed to morphometric analysis of various gastric disorders using electronic endoscopy. Since 1986, endoscopic mucosal hemoglobin analyses have been developed by the aid of an electronic endoscope, an image processor and a personal computer. (1-4). Mucosal hemoglobin distribution around gastric ulcer have been demonstrated. Gastric submucosal blood vessels have been analyzed with infrared electronic endoscopy and computer. Such an analysis of GI functions will open a new era in electronic endoscopy.

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Many gastrointestinal disease show specific changes morphologically, and these morphological changes may affect the function resulting in manifestation of clinical feature. Therefore, it is important to evaluate the functional disturbance using gastroenterological endoscopy in the understanding of the pathophysiological mechanisms underlying the gastrointestinal diseases. Vascular pattern in the gastrointestinal mucosa reflects the blood flow in the submucosa. The peptic ulcer tends to relapse frequently when surrounding microvessels are few, irregular or interrupted. Thus, assessment of not only endoscopic findings but microvascular appearance is necessary to judge whether the structure of ulcer scar is mature or immature. The microvascular pattern in the duodenal mucosa changes after administration of gastrointestinal hor-mone such as CCK. This result suggests the possibility that endoscopic observation can indicate the process of digestion or absorption. It is necessary to establish the clinical entity of duodenitis and the concept of bulbitis, which is differ-ent from panduodenitis in pathological feature. The true purpose of therapy for peptic ulcers is to get the complete ulcer healing without relapse. We introduced a new concept of "Quality of ulcer hear-ing ; QOUH"to evaluate the therapy for peptic ulcers. Electronic endoscopy, fluorescence endoscopy and ultrasonic endoscopy are very useful for the assessment of QOUH. The presence of Helicobacter pylori (HP) may affect healing of gastric ulcer and gastritis. However, infection of HP is local or patchy in the stomach. We succeeded in showing the distribution of HP in gastric mucosa during endoscopy using pigments of red cabbage, which changes its color by NH3 produced by HP. I would like to emphasize that correction of basic and primary pathophysiological findings supplies useful many information in order to recognized the pathology of gastrointestinal tract and its therapy. And, at the same time, these findings contribute the elucidation of cause of disease.

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