Gastric ulcer was studied by the dissecting microscope in 23 resected stomachs. The healing process of gastric ulcer was divided into the following 3 stages : acute, healing and scarring (Table 2). In the acute stage, pallor of the marginal mucosa and irregularity in the size and shape of the "papillae", which, by our definition, indicate the architectural units of the gastric area, were observed (Figures 2 to 6). There were two phases in the healing stage. In the early healing stage, a membranous structure with parallel capillaries was seen to grow from the marginal papillae towards the ulcer base. We called it "palisade structure" (Figures 7 and 8). This is supposed to be the beginning of healing. In the late healing stage, regenerative papillae appeared following the growth of the palisade structure. The regenerative papillae were red, spindle-shaped and arranged in radiating directions (Figures 9 to 11). Also in the scarring stage, two phases were recognisable. In the early scarring stage, the colour of the papillae were still red, while the shape became cubic (Figure 12). As the scarring proceeded, they became pale but some degree of papillary irregularity still remained (Figures 13 and 14).

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Fiberoptic duodenoscopy has opened new vistas in diagnostics of obstructive jaundice and pancreatic diseases by its versatile functions such as direct visualization of the papilla of Vater and retrograde contrast visualization of the pancreaticobiliary complex. During the year of 1971 the author performed duodenoscopy with Olympus Duodenofiberscope JF-B in 120 cases among which pancreatocholangiography was successfully done in 52 and direct-vision biopsy in 23. Laparotomy (63 cases), autopsy (4) and other diagnostic means confirmed duodenoscopic diagnoses, which included cardiac carcinoma (4 cases), gastric sarcoma (3), pyloric ulcer (7), prepyloric polyp, (3), duodenal ulcer (16), duodenal polyp (13), duodenal diverticulum (12), cholelithiasis (25), biliary-tract carcinoma (10), pancreatic carcinoma (6), carcinoma of the papilla of Vater (1), chronic pancreatitis (10), hepatoma (1), hepatitis (2), amyloidosis (1), biliary cirrhosis (1) and retroperitoneal sarcoma (2). Correct differential diagnoses were reached in 24 cases with obstructive jaundice. Examples of most convincing cases were cancer of the papilla of Vater preoperatively diagnosed by ducdenocsopic biopsy leading to successful pancreatoduodenectomy and a pancreatic pseudocyst visualized by cluodenoscopic pencreatography and treated by distal pancreatectomy. Duodenoscopic cholangiography was especially useful in demonstrating presence (location and number) or absence of gallstones which was not confirmed either way by IV. cholangiography. By simultaneous pancreatography informations were obtained regarding accompanying papillitis or pancreatitis. Pancreatocholangicgrams were not obtained in 9 cases (such as cancer of the gallbladder infiltrating the duodenum, cancer of the head of the pancreas, chronic cholecystitis with thick adhesion with the pylorus and gallstone wedged in the ampulla of Vater) in which percutareous transhepatic cholangiography proved more effective. Currently duodenoscopic pancreatography is the only practical way of non-operative visualization of the pancreatic duct. Its significant role cannot be overemphasized in the diagnosis and effective treatment of pancreatic disorders which has continued to be a challenging problem. For correct interpretation of pancreatograms findings of operative pencreatography and pathologists' observations of bile anal pancreatic ducts were reviewed in detail. Preoperative duodenoscopy with retrograde pancreatocholangiography can correctly influence surgeon's selection of operative procedures in papillitis, chronic pancreatitis, pancreatic cancer and obstructive jaundice. No serious ill-effects of the examinations were encountered. Postpancreatographic rise in serum amylase was detected, usually in the first few hours, in one-third of cases, but was not considered as a reflection of acute pancreatitis. Its possible mechanism was discussed. Duodenoscopy is a safe and effective technic which permits over-all observation of the upper gastrointestinal tract and a new approach to the binary tract-pancreatic disease.

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A minute mucosal excrescence can be documented by the progressed fiberscopy, even though barium enema radiography fails to reveal the shadow of the polyp. Of 250 cases examined using colonofiberscope model CF-SB or CF-LB (Olympus Optical Company, Tokyo) 30 cases were diagnosed as having polyps of the rectum or colon including 2 cases of Peutz-Jeghers syndrome. Twenty eight cases with 45 polyps including 3 mucosal excrescences were classified into 4 groups according to the shape and into 3 groups according to the size endoscopically, and into 6 groups according to the degree of histopathological atypia ranging from normal to cancerous mucosa. In 18 cases with the single polyp, glandular hyperplasia or slightly atypical changes of the glandular epithelial cell and its structure are seen. In 5 cases with 19 multiple polyps, mean histopathological changes were also similar. In the group accompanied by cancer of the rectum or colon, one revealed an adenocarcinoma tubulare which is presumed to be canceration of a benign polyp, but the remaining 4 showed only glandular hyperplasia or atypical changes. Prevalence increased with the age of the subjects examined especially in females. However, age distribution is equal in males over 30 years but the great majority are encountered in 5 th decade group. More than 50 per cent of polyps are found in the rectum endoscopically and almost all we found are present below the junction between the descending colon and sigmoid. As we routinely used the colonofiberscope model CF-SB with 85cm. in working length for examining the rectum and sigmoid, it was impossible to evaluate the exact distribution through the data obtained using this scope. Polyps in the proximal segment of the large bowel are found usually by accident in using colon-fiberscope model CF-LB with 200cm. in working length. In the near future, one will be able to visualize the locational incidence through the cases observed up to the cecum. In comparison with the endoscopical shape and size of the polyp, the pedunclated polyp is larger and sessile one is smaller as indicated previously. In the sessile group, mucosal excrescences are 0.5cm. or under, hemispherical polyp is 0.5 to 1 cm., and spherical one is mainly 1cm. (0.5 to 2cm.) in diameter. These suggest noticiable correlation between shape and size of the polyp. Relationship between histopathological change and size of the polyp with or without stalk are scrutinized simultaneously. Glandular hyperplasia or slight atypical changes are seen mainly in polyps of 0.5cm. or under in diameter, while highly atypical changes are seen in polyps of 1 cm. or greater in diameter. Although it has been bescribed previously that the relationship to cancer correlates to the size and multiplicity of the polyp, overall agreement can be scarcely obtained in our series. Unsatisfactorily, shape, size, multiplicity, and endoscopical nature of the surface of the polyp are not effective way for early diagnosis of inclination to the malignancy, especially in small sized one. Endoscopical follow-up study along with zeal and motive of the examiner is necessary in order to control the polyp for long time and not one but a few biopsies under direct vision will be helpful to find the cellular irregularity in the early stages.

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Usually the esophagoscopic findings of esophageal cancer have been classified into six types, such as the superficial type, the tumorous type, the ulcerated type, the tumorous type with infiltration, the ulcerated type with infiltration and the seriously narrow type. 714 cases of esophageal cancer have been examined in our clinic for past six years. 85% of them were the ulcerformed type. Some typical cases were shown in pictures. The endoscopic findings of the superficial type, which was suspected to be the cancer limited to the submucosal layer in its infiltration, were moreover classified into five groups. There were the elevated type (tumorlike protruded and flat-elevated), the flat type and the excavated type (slightly depressed and excavated). In Japan total number of the superficial type of the cancer was about 40 cases and in our clinic 11 cases. The elevated type was occupied in more than 50% of all cases.

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Accurate diagnosis of the diseases of the pancreas still offers many difficulties. Although great advances was made in the endoscopic transduodenal pancreaticography, a search for even more accurate diagnostic method still continues. We have made a new approach to this problem by direct endoscopic study of the pancreatic ductal system. We tried to gat access to the pancreatic duct through common bile duct during operative choledochoscopy in 70 cases, but failed in all cases. Thereafter we have changed to direct operative transduodenal pancreaticoscopy through the opening of papilla of Vater. We have done this on experimental animals (dogs) and on 9 clinical cases, with satisfactory results. These experiences including the size of the endoscopes used, the endoscopic findings, the technical details, some suggestions for designing the clinical pancreaticoscope, and the clinical aspect of these cases will be presented.

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Evaluation of our three cases of the volvulus (2 cases of mesentero-axial type and 1 case of combined) were discussed. The fiberscopic examination was valuable on the chronic cases, and even the acute ones. So it might be found the etiological factors and/or the coexisting lesions. Findings of the volvulus by the fiberscopy are as follows ; 1)sign of gastric torsion, 2) "septal formation" like gastric angulus, 3)displacement of the anterior and posterior walls or the curvatures, 4)easy conversion of the scope. FDS and FGDS with lightguide system (Machida) may be suitable instruments for the gastric volvulus.

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