The myeloperoxidase (MPO) activity and mucosal hemodynamics in the reddish area of gastric mucosa proven endoscopically were investigated in 10 patients. The MPO activity which had a good correlation with the number of infiltrated neutrophils in the mucosa was significantly higher in the reddish mucosa than normal mucosa. The organ reflectance spectrophotometry revealed that the index of mucosal blood volume was significantly increased, and the index of mucosal hemoglobin oxygen saturation was significantly decreased than those of normal mucosa. The results indicated the gastric mucosal congestion in the reddish mucosa. In conclusion, the reddish area of gastric mucosa proven endoscopically was one of the signs of acute inflammation in gastric mucosa, although the causes remain to be determined.

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With the progress of endoscopy, the ratio of minute lesions (especially minute cancers) of the colon and rectum detected by colonoscopy has been increasing. But these lesions are so small and flat that it is very difficult to detect these lesions clinically. To detect these lesions, we need a simple supplemental method enhanceing the slight change in color and the slight uneven surface. We developed the "ORAL DYE ADMINISTRATION METHOD FOR COLONO-SCOPY" which is better than screening but not as difficult as an intensive examination, and we have reported its convenience and utility. Now, we are able to get more information than before by obtaining an increased staining effect from choosing both proper timing and dosage of the dye administration.

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Nineteen cases of reflux esophagitis (RE) showing, endoscopically, longitudinal ulcerations coated by whitish exudates, were compared with 1349 of non-RE controls. Endoscopic and clinical evaluations were made upon the relation to peptic ulcers. The results obtained were as follows; 1) The average age of 19 patients with RE was 54.6 years old. RE peaked at 60 to 70 years of age. 2) The main symptoms of nausea and vomiting, upper abdominal pain, and abdominal fullness occurred in 79%, 42%, and 26% of the patients, respectively. 3) The incidence and grade of concomitant esophageal hiatal hernia increased in patients with RE older than 60 years. However, the grade of hiatal hernia was not significantly associated with the severity of RE. 4) Six out of 19 cases were related characteristically to simultaneous duodenal ulcers with an active stage, all showing deformed and stenotic bulbi. The association of RE with duodenal ulcers was statistically significant (p <0.001). 5) The grade of RE in patients with bile ref lux was less severe than that in patients without it. 6) Not a specific but a number of components in pathogenesis derived from the accompanying diseases such as duodenal ulcer, diabetes mellitus in addition to alcoholic intake, and/or medications may contribute to the development and severity of RE.

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The cause of post-endoscopic acute gastric mucosal lesion (PE-AGML) has been unknown for 15 years. Recently we suspected that it could be an infection caused by the endoscope. We report here clinical features of 145 patients with PE-AGML over a 15 year period and prevention method. Results : (1) The incidence of PE-AGML was higher in patients (68%) who had under-gone an endoscopy for the first time than in patients (32%) who had experienced before. (2)2 These patients complained of severe epigastralgia (96%) and vomiting (58%) on the 4-7th day (85%) after the endoscopy. (3) Acute antral hemorrhagic gastritis or multiple ulcers, which were not detected in the initial endoscopy, were observed in 93% of the patients. (4) The incidence of PE-AGML was 1 versus 800 cases after endoscopic examination. (5) PE -AGML also occurred in younger people (20's-40's) more than in older people (beyond their 50's). (6) PE-AGML never occured aftre changing the disinfection method of an endoscope, which was cleaned automatically with "Olympus EW20" for 15 minutes and disinfected in a solution of 2% glutaraldehyde for 3 minutes during that period. Conclusion : The clinical features of 145 patients with PE-AGML and prevention method were reported.

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Emergency colonoscopy for lower gastrointestinal bleeding was performed in 145 patients. Total cases were deviled into 70 males and 75 females and mean age was 50.1 years old. One hundred thirty five of 145 patients (93.1%) were correctly diagnosed by emergency colonoscopy examination. 78.6 percents of cases were also diagnosed, even if endoscopy was inserted to the sigmoid colon.Ten patients were necessary to manage the bleeding. Eight patients had endoscopic hemostasis, including 6 patients treated with an electrocoagulation method using "Heater Probe" and 2 patients injected with aethoxsclerol. Surgery was performed in 2 patients. Colonoscopy was possible not only the detection of the bleeding point, but also evaluation of the characteristic of the lesions and bleeding condition and, in many cases, it was also possible effective endoscopic hemostasis. Especially, endoscopic hemostasis showed extremely effective role in the treatment for focal colonic hemorrhagic lesions such as arteriovenous malformation and acute hemorr-hagic rectal ulcer. We concluded that colonoscopy was consider to be an important first-choice examina-tion for diagnosis and therapy of the lower gastrointestinal bleeding.

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We conducted a comparison study concerning the effect of hemostasis of acute bleeding gastric ulcers between the injection therapy with only ethanol and ethanol with Aethoxysklerol (AS-E) using endoscopic thechnique. Before injection with ethanol, Aethoxysklerol was injected to 3 to 4 sites around an exposed vessel in one treatment group with 28 cases. Successful endoscopic hemostasis were achieved in all patients treated with AS-E. In another group treated with only ethanol injection, we had several f ailured cases in hemostasis of gastric bleeding. At the view point of healing process of the ulcers, there were no significant difference between two treatment groups. The volume of ethanol administered was almost same in two groups. These results suggested that endoscopic AS-E injection therapy is safe and clinically effective in the treatment of hemostasis of acute bleeding gastric ulcers.

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Some gastic elevated lesions diagnosed as group III by forceps biopsy are finally diagnosed as carcinoma by means of endoscopic gastric mucosal resection (EGMR). The purpose of this study is to clarify the difference between malignancy and benignancy of the endoscopic findings, especially the surface feature and color. EGMR was performed on 55 lesions of an elevated group III which had been diagnosed by forceps biopsy. According to the endoscopic findings, the surface feature of these lesions were classified into the following five types ; Type A, smooth (2 lesions) ; Type B, micronodular (18) ; Type C, nodular (16) ; Type D, division (8) ; Type E, depressed (11). The color was classified into three types : Type a, whitish (21 lesions) ; Type b, the same (32) ; Type c, reddish (2). As to the surface feature, 3 of 10 cancers were Type C, 3 were Type D and 4 were type E and none of Type A and B. As for the surface color, 7 of 10 cancers were Type b, 2 were Type c and 1 was Type a. Twenty of 45 atypical epithelial lesions were Type a and 25 were Type b. The both findings of the surface feature and color of these lesions were considered to be helpful for making the final diagnosis. As the conclusion, EGMR is a greatly useful method for the correct diagnosis of group III lesions which had been diagnosed by forceps biopsy.

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The patient was a 57-year-old man who was admitted to our hospital with a complaint of severe epigastric pain. Ultrasonographic examination revealed that the gallbladder was filled with a sludge like substance mixed with low and high echogenecity. On computed tomography the gallbladder wall was enhanced by contrast material. At the time of performing ERCP we found the blood outflow from Vater's papilla. The contrast material's inflow to the gallbladder was poor and unequal on the cholangiographic exami-nation. Though the gallbladder wall showed a flat shadow defect partially, the angiogra-phy detected no definite abnormal finding. According to these findings, we suspected the hemobilia associated with cholecystitis. But as malignant tumor could not be ruled out, we performed cholecystectomy. Histologically, the gallbladder wall revealed so-called "Adenomyomatosis" ac-companied by gallstones and chronic cholecystitis. There was an ulcer formation on the body, which was considered to be the origin of the hemobilia.

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A 57-year-old man complained of epigastralgia and weight loss. Gastrofiberscopic examination showed multiple, irregular gastric ulcers. Biopsied specimens of gastric mucosa showed deposit of eosinophilic, amorphos substance, which was positive for Congo -Red staining in mucosal layer. The diagnosis of gastric ulcer due to amyloidosis was made, and further examination demonstrated that the large intestine and the lungs were also involved. Bone marrow was free from the disease. Deposit of amyloid in the gut, the lungs and the other organs was considered to be primary lesion on the basis of results in hematologic examinations and ulinalysis. Gastric ulcer was treated by H₂ blocker and cephalantine, but no remarkable improvement was obtained. The patient died of acute renal failure 1 year after presentation of the diseases. Primary, generalised amyloidosis has been often diagnosed by histopathologic exami-nation of biopsied specimens of gastric mucosa in recent years. Suspision of amyloidosis and histopathologic examination of biopsied spacimens of gastric mucosa is mandatry in cases of multiple, irregular gastric ulcers which do not respond to medical treatments.

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A 18-year-old woman was admitted to our hospital with complaints of lower abdomi-nal pain and bloody diarrhea. Colonoscopy and barium enema examination revealed many nodules spreading over the lower part of the rectum, which was similar to "salmon roe" appearence. Histological findings of the biopsy specimens showed lymph follicles with marked mononuclear cell infiltration. Chlamydia trachomatis was detected from rectal swab, and a diagnosis of Chlamydia trachomatis proctitis was made. After the treatment with a daily dose of 200mg minocycline for two weeks, colonoscopy revealed remarkable improvement of the rectal mucosa. We should pay attention to Chlamydia tracomatis proctitis when we examine patients with infectious coloproctitis.

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A 54-year-old female was admitted to our hospital complaining right lower abdominal pain. Abdominal ultrasonography, computed tomography and magnetic resonance image showed multiple concentric ring sign of the ascending colon, so that she was diagnosed as intussusception of intestine. Subsequent colonoscopic examination showed a stenotic change of the ascending colon and invasion of many whipworms into the edematous mucosa of the cecum. Mebendazole was give at a total dose of 1200mg as treatment. This is very rare case of Trichuriasis infestation, which caused acute abdomen like symptome. Only 11 cases were reported in literatures in Japan including our case.

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A 42-year-old man visited our hospital with complaints of diarrhoea and ileocecal pain. Since barium enema study showed a markedly swollen ileocecal valve, colonoscopic examination was subsequently performed. A reddish swelling with central ulceration of the ileocecal valve and multiple erosions with edema from the terminal ileum to the ascending colon were observed. Bacteriological and histological examinations showed no specific findings. We made a diagnosis of Yersinia enterocolitis, because of significant elevation of antibody titer to Yersinia (>0 : 80). Endoscopical examination two months later showed significant improvement of the swelling of the ileocecal valve and erosions. Cases with consecutive endoscopical observations of this disease have been rarely reported. In this case, the swelling of the ileocecal valve drew our attention, but we found it difficult to make an endoscopical differential diagnosis between Yersinia enterocolitica colitis and campylobacter enterocolitis by endoscopical findings alone.

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A 76-year-old female case with undifferentiated pancreatic carcinoma was reported, which showed cystic like lesion by imaging diagnosis, and the review of the report cases for 10-years in Japan was added up. She was admitted to our hospital because of further examination of epigastric discomfort. US showed a well defined tumor with hyperechoic capsule, in which was hypoechoic area. CT scan revealed an encapsulated mass with heterogenous density. Localized marked dilatation of the main duct was seen by endoscopic pancreatography. Angiography showed many tumor vessels in margin of the tumor. These findings were compatible with cystic neoplasma of the pancreas such as cystadenocarcinoma and mucin producing pancreatic tumor. Distal pancreatectomy was performed. Macroscopically, the tumor was mainly encapsulated with fibrous tissue containing necrotic tissue in pancreas. Histologically, fibrous capsule was composed of undifferentiated carcinoma cells. Immunohistochemical staining for EMA showed positive but negative staining by LCA, NSE, and Vimentin. Thirty seven patients with undifferentiated carcinoma in Japan were reported with reference to the characteristics of clinical features. Elevation in serum CEA level was not observed in eleven of twelve patients. The average of the survival period after detection of the pancreas tumor was about 5.5 months with poor prognosis. The morphological features were discussed in these cases.

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A case of diverticular bleeding in duodenum was experienced. A woman 59 years old was admitted to our hospital complaining of dizziness and tarry stool. Endoscopical examination showed a bleeding from erosive lesion in the second portion of duodenum. ^99mTc Pertechnate study did not show gastric tissue in the lesion, and endoscopic retro-grade choledocho pancreatography (ERCP) showed no abnormality. Diverticulitis caused by meal rest and ischemic change of diverticulum induced by smooth muscle contraction were seemed to be causative in this case.

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We tried endoscopic-injection-sclerotherapy (EIS) in a case who was 68year-old male with liver cirrhosis and severe esophageal varices with endoscopic-color doppler-ultra-sonography (ECDUS), and observed a change of intramural blood flow befor and after EIS. ECDUS was carried out with PENTAX-FG32UA (7.5 MHz, convex), which was equipped with a function of endoscopy as well as of color-doppler-ultrasonography. Immediately before EIS, we observed esophageal varices with PENTAX-FG32UA. Intramural blood flow was recognized in color on the display, and then, EIS was performed. The varices were punctured with a needle through the endoscopy channel, and 8ml of 5%-ethanolamine-oleate were injected into the varices. Two minutes after of EIS, intra-mural blood flow was not detected, and by fast-Fourier-transform either. We concluded that a definite congestion of intramural blood flow was successfully done with EIS. As ECDUS enables us to perform EIS under the observation of blood flow, it is very useful to analyze the hemodynamics of esophageal varices.

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On colonoscopy, colonic cleansing is very important to discover a minute lesion. Recently, with prevelence of PEG method, a lot of bubble formed from PEG has disturbed observation instead of feces. For rapid and easy cleansing on colonoscopy, we used an automatic lavage pump (FUJINON Water Jet Pump) with an endoscope for colon (FUJINON EVC-HM). Colonic cleansing and endoscopical operation can be done at the same time with this apparatus, since the colonoscope equipped the other channel for cleansing. The pump can also be used for dye solution which contrasts an outline of a minute lesion. There was no complication on lavage such as mucosal lesions.

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The molecular events of carcinogenesis are under-stood to be the activation of oncogenes and/or inactivation or deletion of tumor suppresoor genes. In fact there are many genotoxic agents in our environment, which have a potential to induce such genetic changes and many of them are shown to induce cancers when given in large doses to experi-mental animals. However, most of these environmen-tal genotoxic carcinogens are too small in quantity to explain the development of common human cancers. On the other hand, human cancer is markedly influenced by the life style such as dietary habit or smoking. A large amount of alcoholic beverages for esophageal cancer, high salt or very hot food for gastric cancer, and high fat diet for colon cancer are known as enhaning factors. High calorie intake is also supposed to enhance carcinogenesis. Milk and green yellow vegetables are thought to inhibit gastric carcinogenesis. Such modifying factors of car-cinogenesis act on the step when genotoxic agents work on cells or genetically altered cells proliferate. Toyama Prefecture is characteristic in its high mortality rate of gastric cancer and this is supposed to relate to relatively high intake of foods favorable for and low intake of stuffs inhibitory to gastric carcinogenesis. For primary cancer prevention improvement of intake of cancermodifying factors is much more practical than to control the amounts of environmental carcinogens which are present in very tiny amounts.

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Since the middle 1970s, high-power Nd : YAG laser with newly developed flexible optical fiber applied as a hemostatic procedure in gastrointestinal endoscopy. The conventional noncontact modality with Nd : YAG laser could not always irradiate accurately and safely because of difficulties in keeping a appropriate distance between the tip of the quartz fiber and the lesion, allowing reliable tissue changes to occur related to the applied energy. And then, the quartz tip will not infrequently be damaged when it comes into contact with blood or tissue. In 1980 more safe and accurate irradiation method with highpower Nd : YAG laser was studied using a bare quartz fiber by the technique of directly stick into lesions, modifying the tip shape of the quartz fiber which could irradiate with various beam pat-tern. On the other hand, high-power noncontact Nd :YAG laser irradiation started to apply for the treat-ment of gastrointestinal tumors in stead of hemos-tasis. In 1984 contact Nd : YAG laser irradiation using ceramic probes codeveloped by the author's colleague and Surgical Laser Technologies Japan Co.. Applica-tions of lowpower contact Nd : YAG laser irradia-tion made photocoagulation, vaporization, mucosal incision or cutting and interstitial local hyperthermia (Laserthermia) possible. Although low-power con-tact Nd : YAG laser has improved clinical effects and the cost less than about 30% of the conventional high -power Nd : YAG laser, endoscopic laser treatment to gastrointestinal early cancers has still some limita-tions. Further studies with lowpower contact irradi-ation method will be carried on as a minimum inva-sive therapy compared with local hyperthermia with another laser or microwave, and photodynamic therapy (PDT) with new exicimer dye laser, and widely used in the other clinical fields as the cardio-respira-tory systems, otolaryngology, neurosurgery, gynecology, urology and orthopedics.

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A gastric adenoma had been called in many terms. In 1977, WHO settled "Histological Typing of Gastric and Oesophageal Tumours". Almost all borderline lesions were included into the WHO's gastric adenoma. We have called clinically a lesion, from which Group III result was obtained by biopsy as "Group III lesion". According to our pathological study, when an adenomatous tissue composed from a papillary tissue, co-existing ratio of carcinoma was so high, as 60.0%. An Group III lesion has arrived at 722 lesions in our hospital, until 1990. The malignant ratio after resection in these Group III lesions was the highest, 17% in polypoid type and increased with the size of the lesion, as 33% in more than 2cm, and had closed relationship to the color of the surface of the lesion. After resection of these Group III lesions, focal carcinoma in adenoma was detected 9%. False negative ratio of initial biopsy for these Group III lesions was 9% in focal carcinoma in adenoma, and extremely high 22% in the group with papillary tis-sue. Group III lesions resected after more than twice biopsy were 56 lesions with surgical resection and 19 lesions with endoscopic resection. Detection rate of cancer was increased with follow up period. In 26 Group III lesions followed more than one year and confirmed their histology after resection, $ lesions of carcinoma. Out of them, six enlarged lesions during follow up study were all carcinoma. A carcinoma was detected in all three lesions, in which their sur-faces changed from granular to nodular. Even if high risk findings are not recognized, there may be co-existence of carcinoma. Therefore, endoscopic resec tion of polypectomy or strip biopsy for an Group III lesion is recommended, in the meaning of histological examination of whole the lesion.

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There are some different opinions on the natural history of gastric adenoma followed 3 years or more ; one is no remarkable change, and the other is that the tumor increases in size at 31% and shows malignant transformation at 15%. In these reports, histological criteria seem to be different. Therefore, I myself examined the initial biopsy-sections of 51 lesions (48 patients) originally diagnosed as gastric adenoma which was or has been followed up 3 years and more. Results ; The initial biopsy-section consisted of 9 differentiated-type adenocarcinomas with low-grade atypia, and 42 tubular adenomas. Thirty-five tumors including 2 carcinomas did not change in size and shape, but 16 tumors including 7 carcinomas in-creased in size during the follow-up period. Four of the 7 carcinomas changed into a high-grade carcinoma at the surgically resected time and showed a high growth-rate (2-6 times the initial size) during 3-6 years, and the remaining 3 carcinomas was still low-grade in atypia but increased 1.5 times the initial size during 3-5 years. Five of the 9 adenomas in the size-increased group changed into a low-grade (predominat) carcinoma with (2 tumors) or without adenoma. They grew up 1.5-2.0 times the initial size during 3-9 years. Four size-increased adenomas grew up to 1.3-1.7 times the initial size during 4-9 years. The low-grade (predominat) carcinomas and adenomas revealed a lower growth-rate than the high-grade (predominat) carcinomas. Conclusion ; It is concluded that the gastric tumor with well-developed tubules should histologically be classified into adenoma, low-grade carcinoma and high-grade carcinoma and that each tumor shows a different growth-rate and biological behavior, i. e., gastric adenoma is generally very slow in growth, but its growth greatly depends on the development of carcinoma as well as on histological grade of its malignancy.

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