This paper is to discuss the accuracy rate of direct vision biopsy, results of endscopic diagnosis and follow-up studies of atypical epithelium. The material consisted of 807 lesions in 621 cases encountered in our clinic from March, 1968 to May, 1971. Following conclusions were obtained: (1) In regard to the results in relation to the macroscopic types of cancer, depressed type of early carcinoma was somewhat difficult, with the accuracy rate being 95.2% in the type IIc, 88.8 % in the type IIc+III. All cases of the other types were correctly diagnosed. In advanced cancer of Borrmann type II, III, IV, the acouracy rates were 87.5%, 95.0%, 91.7% and those were lower than the mean accuracy rate. (2) There was no relationship between the size of specimens and diagnostic accuracy by gastric biopsy, but there was sonewhat relationship between the depth of specimens and diagnostic accuracy. (3) The histopathological pattern of cancer tissue obtained by biopsy was compared with that of surgi-cally resected specimen. Coincidence rate was 94.0% in differentiated carcinoma and 69.2 % in undif f ere-nciated carcinoma respectively. (4) In 401 cases which underwent biopsy with a tentative diagnosis of benign lesion, 12 cancer positive cases (2.9%) were experienced. (5) Biopsy is most effective in the differential diagnosis between IIa type early cancer and ATP. (6) With the use of measurement of gastric me-mbrane temperature at the same time, the accuracy rate of malignant lesion or border line lesion of stomach is improved.

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1. The patients with gastric ulcer that came under the attention of the Kanto Rosai Hospital during the past two and a half years were 160, 115 being males and 45 females, thus a sex ratio of 2.6 : 1. The peak incidence of the disease was noted in the 4th to 5th decade of life. 2. Examination at serial time intervals of 67 cases of active-phase ulcer found 48 cases (71.6%) shifting to endoscopic cicatricial phase within three months. 3. plotting the time as the ordinate and the dura-tion of clinical course as the abscissa and connecting the active phase A₁ with 3 manths, a right triangle is formed. The cases outside the triangle may possibly be defined as indicated for surgery. 4. Defining an endoscopic exacerbation at the same site as recrudescence and an endoscopic discovery of a fresh developmeet of ulcer more or less deviating from the center as relapse, recrudescence was found in 19 (31.7%) of 60 cases. including recrudescence within 6 months in 17 cases (89.5%) . Relapse, within 2 months, was observed in 19 (31.7%) of 60 cases. Putting recrudescence and relapse together, exacerbation of var-ying degreess was observed in 38 (63.3%) of 60 cases in two years. 5. While recrudescence was observed in 35 (29.7%) of 35 cases, the time phase of recrudescence was C in 13 ulcers (37.1%) and B₃ in 8 (22.9%), totalling 60%; and B₁ in 3 ulcers (8.1%) and B₂ in 5 (17.1%), totalling 8 ulcers. Incidence of recrudescence at B₁ and B₂ in the course towards healing was low, and incidence of recrudescence at practically healed B₃ and cicatricial C was higher. 6. Positional relationship of the relapsed to the initial ulcer in 39 cases was: proximal, including adja-cent, relapse in 28 (72%) of 39 cases; in the remaining 11 cases (28%), relapse took place on the distal cardiac side. 7. Summarized location of active-phase ulcers was as follows. The ulcelation tended to be observed from the pyloric vestibulum to gastric angle in the first and second decade of life, from the gastric angle to the lower body of the stomach in the third and fourth becade, from the lower to middle body of the stomach in the fifth and sixth decade, and in the upper body of the stomach in the seventh decade. Thus, the incie-ence of ulcer on the rostral side increased with age. Examination of the cases not in line with the above tendency (i. e. active-phase ulcer on the pyloric side in cases of advanced age) found all to be ulcerative rela-pse at the adjacent side. 8. The temperature of the cicatrix of gastric ulcer was measured to the accuracy of 1/100°C, and was divided into three types. Recruscence was found not in Type, I, frequent (40%) in Type, III, and intermed-iate (27%) in Type. II, Pathological biopsy findings obtained at the same time indicated the incidence of congestion including interstitial cell infiltration, edema, and capillary hyperplasia to be high in Type, III, low in Type, I, and intermediate in Type. II. By the studies above narrated, the following conc-lusion seems to be justified : the incidence of gastric ulcer is observed at the increasingly upper position of thet stomach with age of the patient ; ulcers not in line wih this tendency are relapsed ones, with a nearby cicatrix. The cicatrix itself may be considered occasion-ally to have a great influence on the development of a relapsed ulcer.

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Histological studies are conducted in more and more details recently and the gap between endoscopic and histological observation cannot be readily filled, even becoming wider as the electron microscope was intro-duced. On the other hand, it becomes necessary to make observation more detailed than ordinary observa-tion in today's endoscopy. For these purposes, we had developed a magnifying f iberscope and recently intro-duced a new mechanism to improve it, which is FGS-ML type 2. This scope also employs a straight viewing system, and has an addticnal magnifying lens attached at the tip of the conventional object lens. The rate of magni-fication is 15 times of ordinary f ibergastroscopes, and it has almost satisfactory qualification as a magnifying fiberscope. With this scope, we observed some kinds of gastritis such as superficial gastritis, atrophic gastritis, and intes-tinal metaplasia, and gastric ulcers. Almost normal gastric mucosa has wave-like patterns or spotted patte-rns with white spots abreast relatively regularys. The significance of these patterns is not made clear distinc-tly and the analysis of the magnified pictures obtained remaids as a future problem, because our experience of magnifying observation is not yet so much. However this fiberscope has some points to be improved, the role of this scope will be important and it must be great to be got by magnifying observation in the future endoscopy.

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