Einhorn published his idea of intragastric photography in 1889, but technology had not developed enough to realize his idea. Esophageal photography was experimented by Oebermann in 1890 and by Kelling in 1897. Shaaf conducted an experiment using his device for intragastric photography in 1898, but the device was a forward straight view type and could provide only one photograph at a time, which was far from practical application. Lange and Meltzing published their device for intragastric photography in 1898, too, which was developed basing on the same principle, structure and handling as the Japanese Gastrocamera to be developed 50 years later. It was a side view type, and it was possible to shoot about 50 photographs on a film. However, quality of the photographs was insufficient due to immature technology of sensitive materials, with rough resolution and without sensitivity to red color range. As X ray was yet to be discovered at that time, they had no idea of the position and form of the stomach in the living human body. Guessing that stomach was positioned much higher than actual, they did not insert the camera deep enough to acquire photographs helpful for diagnosis. Furthermore, no one took over their research after them. Porges and Heilpern developed the pinhole type 3 dimensional device for intragastric photography in 1929, which did not have enough practical applicability. Henning's device in 1931 was used only for experiments, too. Uji et al developed an intragastric photography device, gastrocamera, in 1950. It was a sideview type camera and able to take multiple pictures, but it was soon abandoned because of easily breakdown and insufficient quality of the photographs. However, the reseachers in 8 th lavoratory of the University of Tokyo led by Sakita added improvements to Uji's device. They established the techniques of intragastric photography and the methods of picture appreciation for diagnosing to spread this device for practical application. In 1964, basing on the principle that "Gastrocamera for diagnosis, fiberscope as a finder, " a Gastrocamera equipped with a fiberscope was developed. With some improvements, a new device that had functions of Gastrocamera, fiberscope and biopsy was developed and disseminated widely. Judging from the facts above, it would be fair to say that the first inventor of an intragastric photography device was Lange et al, and Uji et al developed an improved device. It can also be said that the reseachers of 8 th laboratory of the University of Tokyo led by Sakita made a great contribution to development of intragastric photography, as they focused on the Ujis insufficient invention, added proper improvements, established diagnostic techniques and made the device a truly practical apparatus. It may well be said that their achievement was even greater than the original invention.

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Percutaneous Endoscopic Gastrostomy (PEG) is the established first choice procedure for long-term enteral nutrition and/or decompression. However, PEG is not always suitable for the patients who have not indicated because of various reasons. Percutaneous Trans-Esophageal Gastro-tubing (PTEG) is developed for such difficult case of PEG. Using a rupture-free balloon the procedure become improve with safe. The tube in PTEG by first report is inserted from the neck under ultrasonographic control with fluoroscopy, without endoscopy. It has very few complications. However safer procedure is expected. Endoscopic support PTEG is certainly confirmed the every part of procedure directly. The important things in management of PTEG are the measures against the accidental removal and obstruction of the feeding tube which is longer than that of PEG. Major complication is few and skin trouble is less than PEG. It is the state that insurance adaptation stopped at one time, but It is not thought that the number of indicated cases are decreased, and the early adaptation reopening is expected now.

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We analyzed 4 judeicial decisions of criminal liability against medical staffs in accident cases related to digestive endoscopy practice. One case was associated with overlooking of colonic perforation due to colonoscopy, one with misintubation of gastric tube, one with mishandling of X-ray apparatus, and the remaining one with misstenting for duodenal stenosis. All the medical staffs (three doctors and one radiological technician) in charge were judged as climinally liable. We pointed out the matters that require attention in the digestive endoscopy practice from analysis of these judicial decisions. At the present, there are arguments on what criminal sanction and administrative measure should be in medical malpractice. We have to keep an eye on the trend of the arguments.

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Esophageal diverticulum is a rare problem on clinical medicine because it does not cause any symptoms. But we have had five cases of esophageal carcinoma arising from diverticulum. We studied clinical features, endoscopic diagnosis and treatment for these cases seen at our hospital. The subjects consisted of three men and two women with average age of 68.8. The locations of diverticula were as follows ; one case at cervical esophagus, two cases at middle thoracic esophagus, one case at between middle and lower thoracic esophagus and another one at lower esophagus. All cancers were superficial types in endoscopic gross classification. Esophagectomy was performed for three cases, diverticulectomy with irradiation was performed for one and only irradiation was performed for another one. Pathologically, all resected specimens showed squamous cell carcinoma. Three cases performed esophagectomy are alive free from recurrence. In other two cases, esophageal cancer had recurred. One received diverticulectomy with irradiation died after five years and four months of operation. Another one received only irradiation is alive with local recurrence. We studied clinicopathological findings, diagnostic features and treatment about esophageal carcinoma arising from deverticulum reported in Japan.

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A 63-year-old male complained of coughing and a choking sensation in the throat and was examined in our hospital. On esophagogastroscopy, a slightly depressed tumor in the middle of the esophagus was found. The tumor, as well as a widespread area of the mucosa in its periphery, was not stained by iodine. On histology, the diagnosis of poorly differentiated, superficially widespread squamous cell carcinoma was made. An esophagectomy was done with a two-field lymphadenectomy. The final histological diagnosis after detection of peripheral unstained mucosa was of a squamous cell carcinoma limited to the muscular layer of the mucosa ; the depressed tumor was diagnosed as an undifferentiated carcinoma with massive invasion of the submucosal layer. Thus, this patient presented with a rare combination of an undifferentiated carcinoma accompanied by a widespread superficial squamous cell carcinoma. Of note, it is difficult to correctly diagnose an undifferentiated carcinoma based solely on a biopsy specimen if a superficial squamous cell carcinoma is present.

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A 45-year-old man was admitted to our hospital with consciousness disorder. He was diagnosed as disturbances of circulation caused by diabetic acidosis. Because he vomited blood 4 days before hospitalization, upper gastrointestinal endoscopy was performed after hospitalization. It revealed a black esophagus and biopsy specimens disclosed necrotizing tissue and granulation tissue, and the patient was diagnosed as having acute necrotizing esophagitis. Upper X-ray examination showed esophageal hernia, decreased LES pressure and hypomotility of esophageal contraction were indicated by esophageal manometry. It was suspected that ref lux of gastric juice from stomach to esophagus was a cause of this case.

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A 72-years-old man visited our hospital for treatment of chronic renal failure and angina pectoris. He was reffered to our department for the examination of anemia. EGD showed 0 IIa+IIc lesion in the antrum and polyposis in the duodenum. Colonoscopy showed many flatelevated lesions throughout the colorectum. Double-balloon enteroscopy revealed multiple lymphomatous polyposis (MLP). Histological diagnosis of MLP was mantle cell lymphoma. We diagnosed mantle cell lymphoma with early gastric cancer. We performed distal gastrectomy. Now, he is undergoing combination chemotherapy with CHOP plus anti-CD20 antibody (Rituximab).

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The patient was a 71-year-old man with gastric cancer. A superficial elevated and depressed (0-IIa+IIc type) early gastric cancer located on the greater curvature of the pre-pylorus. We suspected the lesion was limited in the mucosal layer by the findings of endoscopy and endoscopic ultra sonography. We judged the lesion was expanded indication in endoscopic therapy. The lesion was resected by endoscopic submucosal dissection (ESD) procedure using an IT knife. An ulcer with four-fifths circumference on the pre-pylorus was observed after ESD. But, pylorus ring was intact. Pathological findings of the resected specimen showed a well differentiated adenocarcinoma (73×25mm) with a clear lateral margin. There were no complications such as postoperative bleeding and perforation. He discharged 1 week after ESD. On postoperative day 30, he complained of abdominal fullness. Abdominal X-ray examination showed dilatated stomach, endoscopy was done and he was diagnosed as having pylorus stenosis. Endoscopic balloon dilation was performed twice. He enabled to take meal after these procedure. We experienced a case of pyloric stenosis after endoscopic submucosal dissection for early gastric cancer and successfully treated by endoscopic balloon dilation. We have to perform preventive dilation, if we resect a large area of a pre-pylorus by ESD.

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An 84-year-old woman was introduced to our hospital for anorexia and inflammatory reaction on laboratory data. Abdominal CT and ultrasonography revealed abscess, 4 cm in size, close to the inferior surface of a hepatic left lobe, and the slim calcification density penetrating the duodenal wall. Endoscopic examination showed a pinf all in the anterior wall of the duodenum, and opalescent pus from there was draining into the duodenal lumen. The penetra-tion of a fish bone to the abdominal cavity was thought.

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A 78-year-old man was treated with cisplatin and 5-f luorouracil (5-FU), and radiation for advanced esophageal cancer. Six days after the start of chemoradiotherapy, he had mild abdominal pain, and frequent diarrhea. The total dose of 5-FU given was 2.5g. Colonoscopy revealed multiple erosions and ulcers on ileal mucosa. Histological examination of the biopsy specimen showed stromal edema, inflammatory cell infiltration, and atrophy of the duct. Based on clinical course and colonoscopic findings, we diagnosed this patient as diarrhea due to 5-FU -induced enteritis. Colonoscopy performed 3 weeks after cessation of chemoradiotherapy confirmed complete recovery of the ileal mucosa. The present case indicates the importance of colonoscopic examination for the small intestine as well as the colon.

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A 55-year-old man was hospitalized because of intestinal obstruction. On admission, endoscopic examination showed multiple ulcers in the sigmoid and descending colon and a colonic stricture in the transverse colon. It was diagnosed as intestinal tuberculosis. The colonic stricture was successfully treated with endoscopic balloon dilation. It is rare that stricture of intestinal tuberculosis is treated with endoscopic balloon dilation.

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The mucosal pattern using enhanced-magnification endoscopy with 1.5% acetic acid in the distal esophagus and esophagogastric junction was classified into 3 types : I, normal pits; II, slit-reticular pattern; and III, gyrus-villous pattern. The presence of type I, type II, type III surface patterns was characteristic of, respectively, fundic epithelium, cardiac epithelium, and intestinal metaplasia. Additionally, type IV (irregular pattern) and type V (destructive or nonstructural pattern) are associated with Barrett's carcinoma and gastric carcinoma. Because some cases showed acetowhite reaction in surrounding mucosa of early gastric cancinoma conventional endoscopy after instillation of 1.5% acetic acid may be useful to detecting the margin of early gastric cancinoma.

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