The first prototype of fiberscope was developed by Hirschowitz et al and reported at the Congress of American Gastroscope Society in May 1957. In 1960, the ACMI Company made the commercial applicable models of the fiberscope based on these prototypes as Gastroduodenal Fiberscope.
It was in June 1962 that a fiberscope was introduced in Japan for the first time. The first domestic prototype of fiberscope was developed in March 1963 by Kameya et al, which was developed mainly for observation of the esophagus and not suitable for observation of the stomach except near the cardia.
Machida Company made a side-view fiberscope for stomach observation in October 1963. In March of the next year, Olympus launched GTF which was Gastrocamera equipped with fiberscope. GTF was widely used due to its high quality of observation and the intragastric photography. A new type of GTF with a thinner diameter (GTF-P), was announced later on and in the same year also had a angulation mechanism model GTF-A.
Only side view observation system was applicable to Gastrocamera and the early models of Fiberscope in order to spare enough room for the lens, the lamp and the film storage in the tip part. But after invention of illumination method using glass fiber, it became possible to take photos with a camera equipped on the eyepiece of the scope, which eventually enabled to apply forward view observation system of the fiberscope (GIF). However, stomach observation through forward view observation system had many difficulties to be cleared at that time. To complement this, forward oblique view type fiberscope GIF-K was created.
After that, so-called “a small diameter pan-endoscope,” a very thin gastrofiberscope with a short bending part, was launched. It made it possible to observe all the upper GI tracts in a single insertion. Due to its short bending part, wide bending angle and high quality observation, a forward straight view scope became the standard device.
Although the time of fiberscope lasted for only 50 years due to invention of videoscope, almost all the important problems of gastroenterological endoscopy were solved during the time of fiberscope. It can be said that fiberscope played a significant role in the history of endoscope.

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Recntly, cytomegalovirus (CMV) infection has been increasing due to the increase in the number of immunocompromised patients. Althogh the gastrointestinal tract is a common site of CMV infection, it is difficult to diagnose by endoscopy because its endoscopic features are diverse. The aim of this study was to clarify endoscopic findings and clinical features of CMV infection. Thirty-two patients (esophagus : 12, stomach : 20, duodenum : 6) with CMV infection comfirmed by histological examination of the endoscopic biopsy specimens were enrolled in this study. Of the 32, 21 were HIV infected patients, and 11 were non-HIV patients. All non-HIV patients had a history of the usage of immunosuppressants, anticancer agents or steroids. There were no deaths in HIV patients, whereas three non-HIV patients within the observation period. Esophageal lesions were frequently detected in HIV patients. Frequent endoscopic findings were as follows ; punched-out ulcer type was observed in 83% (10/12) in the esophagus, erythema or erosion type in 55% (11/20) in the stomach, and erythema or edemic type in 50% (5/10) in the duodenum. In immunocompromised hosts, when gastrointestinal CMV infection is suspected, close attention should be paid not only to the typical esophageal “punched-out lesion” but also to the “atypical lesions” in the stomach and duodenum.

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A 62-year-old woman was referred to us for hematemesis after the surgery for an intracranial aneurysm. Upper gastrointestinal endoscopy revealed longitudinal black mucosa in the upper part and a deep ulcerlation in the lower part of the esophagus. Chest CT showed air and fluid collection in the mediastinal space. Based on these findings, the patient was diagnosed with acute necrotizing esophagitis accompanied by ulcerlation. We performed an emergent esophagectomy and saved her life.

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A 61-year-old female was diagnosed as an unresectable advanced esophageal cancer with hepatic and lymph node metastases. Firstly, CDDP (70mg/m²/day, day 1)/5-FU (700mg/m²/day, days 1-4) combination therapy was given every four weeks for a total of five courses. After chemotherapy, both the hepatic and lymph nodes metastases could not be detected on computed tomography. Next, 60Gy-radiation therapy was given for residual esophageal cancer in the mid esophagus. Diagnostic testing confirmed the disappearance of the residual cancer. After six months, a IIb recurrent esophageal cancer was detected in the mid esophagus on diagnostic imaging. The tumor was resected en bloc using endoscopic submucosal dissection (ESD). No complication was noted. On histpathology, the resected tumor was an intraepithelial esophageal cancer. Both the lateral and vertical margins were negative. There was no recurrence for six months after ESD. In this paper, we report this case together with a review of the literature.

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The patient was a 78 year-old male, who was being followed after radiation therapy for cervical esophageal cancer diagnosed when he was 75 years old. During follow-up endoscopy confirmed a 7 mm reddish elevated lesion in the anterior wall of the lower thoracic esophagus was found. On magnifing esophagoscopy with NBI, a localized brown colored region traversed by a web of large diameter blood vessels of varying sizes was observed. No avascular areas were detected. On pathology of the biopsied specimen an undifferentiated carcinoma was diagnosed, but no definitive diagnosis. Therefore a total excision was done endoscopically. On pathology, atypical cells which had scant cell cytoplasm and rich chromatin were noted growing in a rosette pattern in the lamina propria mucosa located directly below the thinned epithelium, a pseudo-cavity was noted in one area. The lesion was positive for Chromogranin A, synaptophysin, and CD56, and was diagnosed as an endocrine cell carcinoma. Vein growth in the tumor was observed through CD34 staining. Though a high grade squamous intraepithelial neoplasia was found, no connection was established with the endocrine cell carcinoma noted in the lamina propria mucosa. Microscopic examination of blood vessels under magnification is useful for determing the depth of cancer invasion, as well as its specific histological type.

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Gastric endocrine cell carcinoma is a relatively rare disease. The prognosis of this disease is very poor because of rapid growth, metastasis and invasion at the early stage. This paper presents a case of gastric endocrine cell carcinoma with duodenal cancer. A 58-year-old man visited our hospital because of palpitation and shortness of breath. Endoscopy showed a IIa+IIc type tumor at the antrum of the stomach. A biopsy from the lesion revealed moderately and poorly tubular differentiated adenocarcinoma. Furthermore, a semipedunculated tumor was revealed at the first portion of the duodenum. Biopsies of the tumor demonstrated tubular adenocarcinoma. Abdominal computed tomography showed no metastatic lesions. Pancreatoduodenectomy was carried out. Microscopically, gastric lesion was composed of two components. The majority of the tumor consisted of a population of small cells. The other component of the tumor was composed of tubular adenocarcinoma. On the immunohistochemical studies, the small cells were positive for CD56 and synaptophisin staining. The final histological diagnosis was endocrine cell carcinoma of the stomach invading submucosal layer, and well differentiated tubular adenocarcinoma of the duodenum with adenoma component.

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64-year-old female had extrahepatic bile duct resection with choledochoduodenostomy for cystoma of the common bile duct. Fifteen years later, a bilateral hepaticojejunostomy was required due to the presence of bilioenteric anastomotic stricture. Nevertheless, cholangitis repeatedly recurred. Percutaneous balloon dilatation for stricture of the bilioenteric anastomosis was ineffective. Therefore, the stricture of the bilioenteric anastomosis was cauterized using Nd-YAG laser with percutaneous transhepatic cholangioendoscopy. Balloon dilatation was then performed. A favorable degree of dilatation was achieved, and long-term catheter insertion was avoided.

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A 67-year-old man had been under treatment with placement of a biliary tube stent for a bile duct stricture associated with chronic pancreatitis. He suffered from high fever at 17 months after the stenting. He was admitted to our hospital for evaluation and treatment. He was diagnosed with cholangitis and stent tube migration caused by exfoliation of the flaps. Although insertion of the guidewire into the stent was difficult, we successfully managed to recover the stent by endoscopic procedure. Exfoliation of the flaps was thought to result from brittle fracture by quality deterioration. Care must be taken that a biliary stent tube may migrate by exfoliation of the flaps, particularly during its long-term placement.

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[Aims]
We contrived laparoscopy-assisted percutaneous endoscopic gastrostomy (L-PEG). L-PEG prevents injury of other organs, such as the transverse colon, liver and graft vessels. We describe the method and advantage of L-PEG.
[Methods]
Fifteen patients were selected as the candidates of L-PEG under local anesthesia, in whom with the colon gas in front of the stomach on X-P or CT image, operative scar in the upper abdomen and previous of coronary arterial bypass operation using right gastroepiploic artery graft.
[Results]
L-PEG was safely performed in all cases.
[Conclusion]
L-PEG may be a safe and useful method of gastrostomy in patients with the risk of injuring other intraperitoneal organs by usual PEG procedure.

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We have developed a new technique of performing gastropexy with the use of a simple device consisting of a spinal needle and a nylon thread. To evaluate the efficacy and safety of our technique, the procedural time (time needed to complete the suture) and its variance is compared between ours (31 sutures in 10 patients) and that used in the conventional Funada's technique (13 sutures in 7 patients). The average procedure time is slightly longer in ours than in Funada's. No significant difference in the variance of the operative time is noted, however, between the two techniques. There are no complications in our technique. These results suggest that our technique is safe, efficacious and cost-effective, and may be a good alternative for gastropexy.

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Endoscopic submusosal dissection (ESD) was developed, and the reliable en-bloc resection of the lesions which were conventionally hard to be removed has come to be enabled. However, colorectal ESD is rather difficult skill and the risk of complication is high. Therefore, the deliberate attitude is expected in its introduction. The indications are the lesions which have difficulty to be treated by EMR but need the en-bloc resection, and the cases that functional disorder becomes the problem by the surgical operation. Clinicopathologically, the most appropriate indications are regarded as the laterally spreading tumors non-granular type that are larger than 20mm. But these are the representative difficult cases because of the severe fibrosis in the submucosal layer. At the point of safety, difficulty, and functional preservation, the rectal lesions show most remarkably the merits of colorectal ESD.

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Background : The aim of this study was to evaluate and compare 4-h post-ERCP hyperamylasemia and hyperlipasemia as predictors of post-ERCP pancreatitis.
Methods : We reviwed 1631 consecutive cases consisting of 910 cases of diagnostic ERCP and 721 cases of therapeutic ERCP. Pancreatitis was diagnosed when abdominal pain persisted for 24 hr after ERCP and the pain was associated with high serum amylase level and /or lipase level.
Results : Pancreatitis developed in 69 (4.2%) of the 1631 cases. The receiver-operator characteristics (ROCs) of both the 4-h amylase level and 4-h lipase level after diagnostic ERCP showed good test performance, with an area under the curve of 0.88 (95%CI : 0.85-0.91) and 0.94(95%CI : 0.92-0.96), respectively. The ROCs of both the 4-h amylase level and 4-h lipase level after therapeutic ERCP also showed good test performance, with an area under the curve of 0.92 (95%CI : 0.90-0.93)and 0.96 (95%CI : 0.94-0.97), respectively. The optimal cutoff value for amylase after both diagnostic ERCP and therapeutic ERCP was 5 times the upper limit of the normal range. The optimal cutoff value for lipase after both diagnostic and therapeutic ERCP was 10 times the upper limit of the normal range. The serum lipase value after both diagnostic ERCP (p=0.025) and therapeutic ERCP (p=0.035) was a more effective predictor of post-ERCP pancreatitis based on the areas under the ROC curve than the serum amylase value was.
Conclusions : The 4-h post-ERCP lipase value is more useful for predicting pancreatitis after both diagnostic and therapeutic ERCP.

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