Motor disorders of the sphincter of Oddi may be one of the etiology of chronic pancreatitis. To elucidate this hypothesis, endoscopic measurement of the sphincter of Oddi pressures and cholescintigraphic evaluation of papillary function were performed in patients with chronic pancreatitis and controls. Infused open manometric system (infusion rate 0.17 ml/min) was applied to obtain a recording of the sphincter of Oddi motor activity in patients with chronic pancreatitis (n= 23) and controls (n=13). From this record the author measured systolic pressures, diastolic pressures, cycles, and in addition, the area surrounded by phasic waves and the base line for one minute (index A), and the area surrounded by phasic waves and the line connecting each bottom of the waves for one minute (index B). As a result, systolic pressures (48.9 + 16.1 mmHg), diastolic pressures (33.9 ± 14.3 mmHg), index A (10.4 ± 3.2 cm²/min) and index B (3.1 ± 0.9 cm²/min) in patients with chronic pancreatitis were significantly (p <0.01) higher than those in controls (28.3 + 8.3 mmHg, 19.5 ± 7.6 mmHg, 6.1 ± 1.7 cm²/min, 1.7 + 0.9 cm²/min, respectively). And systolic pressure differences (9.4 ± 4.1 mmHg), diastolic pressure differences (6.7 ± 3.3 mmHg), cycle differences (3.1±2.1 sec) on two consecutive waves in patients with chronic pan-creatitis were significantly (p <0.01) higher than those in controls (4.3 ± 3.8 mmHg, 2.8 ± 2.2 mmHg, 1.3±0.7 sec, respectively). Therefore irregular waves were more frequent in patients with chronic pancreatitis. Next, the cholescintigraphic examination using Tc-99m-IDA revealed that the CD time, which is the time from the appearance of image on common hepatic duct to that of duodenum, was significantly (p <0.01) longer in patients with chronic pancreatitis (44.1 ± 22.4 min, n=27) than controls (18.5±17.3 min, n=24). In summary, increased papillary resistance in patients with chronic pancreatitis resulted in retension of pancreatic juice. Papillary dysfunction is proved to play a role in the pathogenesis of chronic pancreatitis.

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We studied endoscopic appearance of the proximal margin (OW) of intramucosal cancerous extention in 117 cases of flat or depressed type gastric cancer, more than 20mm in diameter and locating in the gastric body. Macroscopically, we devided them into three groups such as groups A, B and C. In group A, OW was clearly depressed. In group B, OW was clear as the discrimination of color or changes in the area gastricae. In group C, OW was unclear. Endoscopically, OW was clearly reddish or discolored in group A. On the other hand, OW was unclear in group B or C. On these cases, the irregularity or disappearance of capillary transparency was very imporatant to determine the resection line. Dye-spraying contrast tegnique using indigocarmine was useful in group A because it facilitated to recognize the depression. However, it was not so effective in group B or C, because indigocarmine made the recognition of capillary transparency rather difficult.

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The utility of magnifying observation has been recognized since the era of fiberscope. During the last 6 years since the development of electronic endoscope, objective diagnosis has been gradually realized by the introduction of image processing and analysis. A newly developed magnifying electronic colonoscope, CF-V200HM, is equipped with a high resolu-tion image of one hundred thousand pixels like CF-V200, and with a zooming mechanism of upto 50 magnifications, at the same time. We used this scope for the observation of 28 colorectal elevated lesions, and the images were analysed by computer. The manipulation of the scope and the endoscopic observation were similar to those of the ordinary electronic colonoscope. By observation with 50 magnifications, individual pits could be clearly recognized, and the classification of the pit pattern has become more reliable. Further-more, by the introduction of enhancement in color space into the magnifying images, the contrast of the demarcation of pits has become clearer. These achievements are consid-ered to contribute to the realization of objective diagnosis.

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We examined whether maginifying electronic endoscopy (Olympus, GIF-V10Z, XGIF -200Z) can detect "the microstructure of the gastric mucosa" (gastric pit or sulcus, Leistenspitz) in cases with gastric elevated lesions such as the hyperplastic polyp, gastric adenoma, I type or IIa type early gastric cancer and ordinary fundic or pyroric gland mucosa. Magnifying electronic endoscopy can distinguish the line of the X-ray test chart which width is 50, um. On the other hand, the size of the microstructures measured by the computer system and the film of two dimensional microscopy is over 100μm. Therefore, we concluded that the magnifying electronic endoscopy can detect the microstructure of the gastric mucosa. We also developed an image processing of "band enhancement" which can visualize clearly the fine gastric mucosal pattern from the original endoscopic image. By using magnifying electronic endoscopy and "band enhancement", the characteristic mucosal patterns of the various kinds of gastric lesions can be understood and the diagnosis of gastric lesions is thought to be more accurate.

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We studieid on clinical evaluation and characteristic endoscopic pictures of 79 foll-owed up gastric ulcers. Most of ulcers located at gastric angulus were identified as UL-IV ulcers, but UL-IV ulcers at gastric body were only a half of cases. Based on the healing time, UL-III ulcers and UL-IV ulcers at gastric body without distinction of location were intracatable. On the other hands, UL-II ulcers were tractable and UL-IV ulcers showed intractable ulcer pattern, but UL-II ulcers showed tractable ulcer pattern by conventional endoscopic pictures. UL-III ulcers showed the mixed characteristics of both UL-IV and UL-II ulcers. A half of cases with UL-IV ulcers relapsed for 12 months, but UL-II ulcers relapsed no case and UL-III relapsed a few cases. We followed up scar lesion endoscopical-ly. The shallower depth of ulcer, improved disappeared earlier the ulcertive changes. In order to estimate characteristics of ulcer relapse of UL-IV, we compared endoscopic pictures. The relapse of ulcers showed low frequency, when the scar lesion changed to white scar. Based on these findings, we described the ulcer treatment in reference to depth of ulcer.

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In 7 patients surviving f ulminant hepatitis, laparoscopy and liver biopsy were perform-ed within 1 to 4 weeks from the onset and followed up for 6 to 106 months. In the first laparoscopy, 4 patients had small depressions on the liver surface and 3 patients had large depressions. The patients with small depressions were diagnosed to have acute hepatitis by histological findings. Three of them had acute type, taking less than 10 days from the onset to coma and the remaining patients had subacute type. On the follow-up laparoscopy and biopsy, small depressions were not observed. The histological examination showed chronic active hepatits in 2 cases and prolonged hepatitis in 1 case and the remaining case had minimal change. Hepatitis C virus antibody was positive in 2 cases of chronic active hepatitis. Three patients with large depressions had submassive hepatic necrosis on histological examination. 2 had acute type, and 1 had subacute type. By the follow-up examination, depressions remained in 2 cases. Histological findings showed chronic active hepatitis in 2 cases and fatty change in 1 case.

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Visualizing capability of the cystic duct (CD) by endoscopic ultrasonography (EUS) was assessed in 162 preoperative patients with biliary tract disorders. Scanning was performed via the descending part of the duodenum (DD-scanning), the duodenal bulb (DB-scanning) or the stomach (S-scanning). 1) The CD was visualized as a tortuous tubular structure joining the gallbladder (GB) and the common bile duct (CBD). In some cases, the wall of the CD was imaged as a three -strata structure. 2) The overall visualization rate of CD was 56% (91/162) with a respective rate of 58% (84/144) by DD- / DB-scanning and 39% (7/18) by S-scanning. 3) A high visualization rate of 60-100% was obtained when EUS was intended to observe the ductal system per se in cases of colecyctocholedocholithiasis, CBD cancer, ampullary cancer or anomalous union of the ductal system. 4) Among the three routes of scanning, DD-scanning was the most effective to demonstrate the entire course of the CD with a maximal visualization rate of 41% (14/34), whereas DB- and S-scanning most effectively visualize the proximal (GB-side) part of the CD with a maximal rate of 46% (23/50) and 57% (4/7), respectively. 5) The diagnostic accuracy yielded by EUS for CD lesions was 75% (6/8) for anoma-lous union or tortuous anatomical structure and 100% (17/17) for calculi, malignancies and other conditions, respectively. 6) The overall visualization rate found during the most recent 16 months has increasd up to 88% that was satisfactory. In conclusion, EUS is a useful means to diagnose CD lesions.

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The aim of this study was to elucidate the progressive mode of C type hepatitis from the view point of liver surface. Laparoscopic findings of 16 patients with C type hepatitis were compared with those of 8 patients with B type hepatitis to whom laparoscopy was repeatedly performed during their clinical course. Although there was no difference in the progressive rate between both types, the progression of C type hepatitis seemed to be slower than B type hepatitis. Moreover, even in patients with cirrhosis, the nodularity of the liver surface of C type patients was much less completed than B type patients. In the B type hepatitis patients who showed the progression, on the initial laparoscopy, both reddish marking and patchy marking were predominant compared with the patients who showed no progression. On the other hand, in the patients with C type hepatitis, many depressions adding to those findings were predominant in the progressive group. The progression of B type hepatitis seemed to occur around the age of 40, while that of the C type hepatitis did between the age of 50 and 60. From the evaluation of 65 patients with hepatocellular carcinoma (12 of B type and 53 of C type, including the patients who developed the lesion after the laparoscopy), the nodular formation of C type patients was much less outstanding than B type patients.

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A 91-year-old female with a complaint of epigastric discomfort underwent panendo-scopy. Panendoscopy disclosed a short fold suggesting a mucosal bridge on the lesser curvature of the upper gastric body. We could easily pass under the fold using biopsy forceps. A diagnosis of gastric mucosal bridge was made. The bridge was considered to be a congenital abnormality based on her past history, the mucosal structure of the bridge and the results of biopsy. This case may provide valuable data because of its rarity.

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A 70-year-old man took an endoscopic examination in our hospital because of epigas-tric discomfort. A small elevated lesion divided by grooving erosions was found in the lesser curvature of the gastric antrum. In the biopsy specimen taken from this erosion, diffuse infiltration of B-lymphocytes with slight atypia (L26 + and MT1-) was observed. Under the diagnosis of malignant lymphoma, distal partial gastrectomy was performed on May 21, 1990. Lymphoma cells invaded to mucosal and upper submucosal layers within the extent of 0.7 × 0.5 cm in size without regional lymphonode metastasis. Pathological diagnosis of the lesion was as follows. It showed diffuse lymphoma, medium sized cell, type, B-cells (L26+, TM1- and UCHL1-). Based on reported cases, characteristic findings of early gastric lymphoma revealed by endoscopy were discussed. The findings of gastric mucosa caused by lymphoma cell infiltration seemed to be "coarse granules surrounded by grooving erosions" (cobble stone appearance), which was also the case with our minute superficial lymphoma. Dye spreading method will usefull to get these findings and contribute to the endoscopic diagnosis of malignant lymphoma of the stomach in the early stage.

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A case of stomal polypoid hypertrophic gastritis (gastritis cystica polyposa) removed by endoscopic polypectomy was reported. A 72-year-female was referred to our hospital because of a protruded lesion in the remnant stomach detected by routine barium swallow study. She had a history of subtotal gastrectomy (Billroth I) for gastric ulcer 9 years ago. Endoscopic examination showed a sessile polypoid lesion at the lesser curvature of the stomal site with focal redness. Biopsy specimens taken from the lesion revealed foveolar hyperplasia. We could remove the lesion by endoscopic polypectomy and diagnosed it as SPHG (GCP). Although 31 cases of SPHG (GCP) have been reported in Japan, including our case, only 3 cases were removed by endoscopic polypectomy. Flow cytometric analysis also indicated DNA diploid pattern. In addition, 31 cases of SPHG (GCP) were briefly reviewed.

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A case of heterotopic gastric fundic mucosa presenting as tightly grouped small elevated lesions occupying the whole space of duodenal bulb, was presented. Acid secretion by these heterotopic gastric fundic mucosa was demonstrated by congo red dye spraying method. A 35-year-old man visited to our hospital because of the epigastralgia. Radiographic examination revealed small elevated lesions which occupied the whole space of duodenal bulb. Endoscopic study showed that small elevated lesions distributed in the whole space of duodenal bulb. The color of these elevated lesions were identical to that of the duodenal mucosa and small red spots were scattered at the top of the lesions. Congo red dye endoscopy revealed the black staining spot at the protruded lesions adjacent to pylorus and the acid secretion from these lesions. Biopsy specimens taken from these lesions revealed the gastric type surface epithelium with well developed fundic glands containing parietal cells and ECL cells. This is a rare case of acid secreting heterotopic fundic mucosa occupying the whole space of duodenal bulb.

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A 64 year-old man complaining of epigastric pain was admitted to our hospital. Endoscopic findings revealed a granular and lobular tumor in the bulb from which the biopsy specimen showed group IV, a flat elevated lesion on the anterior wall of the middle body of the stomach from which the biopsy specimen showed group V, and a small polyp on the anterior wall of antrum. Histopathological examination revealed that the tumor in the bulb was papillary adenocarcinoma, 50 × 50mm in diameter, and its depth of invasion was confined to the submucosal layer, 1y₀, v₀. The elevated lesion on the anterior wall of middle body of the stomach was a ha type papillary adenocarcinoma, 25×16mm in diameter, and it invaded to the submucosal layer, ly₀, v₀. The polyp on the anterior wall of antrum was type I, histologicaly, it. was well differentiated tubular adenocarcinoma, 8 × 7mm in diameter, localized within the mucosal layer, ly₀, v₀. Lymphnode metastasis was not found. This is the 25th case of the double cancer, and the 8th case of double early cancer of the duodenum and the stomach reported in Japan.

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A 21-year-old female was hospitalized because of abdminal pain and bloody stool in 1984. Colonoscopic findings showed multiple small erosions and lead pipe finding was shown by barium enema. These findings were compatible with ulcerative colitis (UC). The patient's younger identical twins brothers, 19-year-old males, were also hospitalized because of diarrhea and bloody stool in 1989. The similar multiple small erosions were shown by colonscopy as in the sister. These findings suggested a familial occurrence of ulcerative colitis. HLA-BW52, DR2, DQW1 were found in the sister and her twin brothers by HLA analysis. We presented the above mentioned three cases, because there have been no reports like this familial occurrence of UC, especially three persons occuring in the same family.

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Types of early colorectal cancer have been almost protruded one, and typical early colorectal cancers of depressed type have rarely reported. We report here a case of superficially depressed type early colonic cancer. The patient is a 54-year-old man with a chief complaint of diarrhea. A typical IIc type lesion was observed in the descending colon on endoscopic examination. There were no other lesions in the colon and rectum. Endoscopic resection was performed. Using a dissecting microscope, we noticed that the resected specimen showed a diminutive and shallow depressed lesion, measuring 2.5×1.8mm in size. Histological findings showed well differenciated adenocarcinoma limited within the mucosa. No adenomatous component was contained. Therefore, the lesion was proven to be a IIc type "de novo" cancer of the colon. The incidence, histogenesis and developmental process of this type of early colorectal cancer is still unknown. To elucidate these questions, we need more accumulations of depressed type early colorectal cancers. Colonoscopist should be aware that colorectal cancer can exist as a superficially depressed (IIc) lesion.

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A rare case of carcinoid tumor of the gallbladder was reported. The patient was a 40-year-old man with a chief complaint of nausea and epigastralgia on the 2nd of March in 1991. US, DIC, CT and ERCP revealed a 15mm-sized polypoid lesion at the neck of the gallbladder. Cholecystectomy was performed. The resected specimen contained no stones. A yellowish-white 15×10mm-sized sessile polyp was noted at the neck of the gallbladder. Microscopically, the polyp showed a nodular proliferation of uniform cuboidal tumor cells which revealed positivity for Grimelius staining, and was covered by ordinary gallbladder epithelium. Immunohistochemically, these cells revealed positivity for Neuron -Specific-Enolase.

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A 43-year-old woman was admitted with a complaint of general malaise. CT scan and USTG showed a solid tumor of the pancreatic head. ERP through the papilla Vater showed only a short and smoothly tapering pancreatic duct. Therefore, non-fusion of pancreatic ducts was suspected. Pancreatography through the accessory papilla was performed and irregularly stenotic dorsal pancreatogram was observed. Dorsal and ventral pancreatic ducts had no fusion. Tumor excision was performed by pancreatoduodenectomy under the diagnosis of pancreatic head cancer associated with pancreas divisum. Histological diagnosis was well differentiated adenocarcinoma. All reported cases of pancreas divisum associated with pancreatic cancer in Japan were reviewed and discussed. There were 21 cases and 20 of them were associated with cancer of dorsal pancreas. Pancreatic head involvement of the cancer was observed in 11 cases but 9 of them were anicteric. The relation of the non-fused pancreatic ducts, chronic dorsal pancreatitis and dorsal pancreatic cancer has been still unclear.

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