In our clinic, the primary attempt on duodenal endoscopy has started on 1962, at that time an intraluminal camera was built. Soon after the device, several improvements in this field was done by buil tin duodenofiberscope of front-and-side view type, cuff type, bro-nchofiberscopic type, and finally esophagofiber-scopic type in 1968. Experiences obtained from the above devices made the present side view type duodenofiber-scope clinically practicable since 1969. This scope is equipped with a side view lens and a four directions tilting mechanism on its tip. The light source utilizes light guide system originated from a Xenon lamp. The forceps channel allows trans-scopic biopsy, cannulation through the ampulla of Vater, and retrograde pancreatocholangiogram. By using present duodenofiberscope, our examination results are summerized and analyzed. They are classified and indicated as follows: The spe—ific endoscopic figures of the pyloric ring during the existence of duodenal ulcer can be described as passing fold (i. e. a specific gastric fold which may pass through the ring to the bulb), prepyloric vision (i. e. an indirect sign of the existence of bulbar ulcer which can be defined through prepyloric endoscopic observation), spirality (i. e. a spiral shaped of ring which may appear in stead of the ordinary round shaped during the disease), and irregularity (i.e. an irregular shape of ring with loss of expansibility). The abovd described specific endoscopic findings occupy 90% of our duodenal ulcer patients, thus the relationship between these findings and bulbar deformity seems greater than that of the location of ulceration in the bulb. Whatsoever, the endoscopic figures of the duodenal ulcer can be classified as giant ulcer (i.e. a big sized ulceration surrounding by a rand wall without evidence of mucosal incision and radiating folds), round ulcer (i.e, a round shaped ulceration with mucosal incision), irregular ulcer (i.e. an irregular shaped shallow ulceration), linear ulcer (i.e. a linear shaped ulceration which always taken place the margine of mucosal incision), and paper-in-salt ulcer (i.e. an area of reddness with some whitish spots coating on it). Analyzing the location of lesion occupied on the duodenal bulb, there are nearly half cases appear on the anterior wall of the bulb followed by the posterior wall, lesser curvature, and finally the greater curvature site of the bulb. In addition, there are rarely existence of the case of mucosal atypism, mucosal fibrotic change, polyp, submucosal tumor, diverticulum, infiltrative cancer and extra-luminal compression in our clinic. An attempt on the retrograde pancreato-cholangiography can-nulated through the ampulla of Vater has been placticed in our clinic. Cases of the pancreatic cancer, pancreatic stone, common bile duct stone, cholangio-carcinoma, and gall bladder stone are experienced. No severe complication due to the performance of this procedure is experienced. It is concluded that, the present duodenofiberscope is proved as a useful and safety instrument for the diagnosis of duodenal diseases, periduodenal disorders as well as of pancreatic and biliary diseases.

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Because of recent improvement in diagnostic method, esophageal hiatus hernia is found more often now. For the X-ray and endoscopic diagnosis of esophageal hiatal hernia, various authors have made different. classifications, but no clear-cut endoscopic diagnostic criteria have been made so far. We have investigated the relationship between gastric wall distensibility of the upper part of stomach and intragastric pressure controlled by air insufflation. We have reported the normal opening process of the esophago-gastric junction. The esophago-gastric junction can be identified endoscopically. by the difference in tint When the junction is observed by the reverse turn technigue of a FGS, it starts to open when the intragastric pressure reaches 11 mmHg, and when completely open, the opening will be 22mm in diameter, and the junction can then be clearly identified. In this respect, we have studied the endoscopic picture of cases diagnosed as esophageal hiatals hernia by X-ray and esophagoscope in this institute, by obser-ing the dynamics of the hernia opening under pressure control with intra-gastric pressure stabilizer. technique. By using the stabilizer, the esohageal hiatal hernia can be classified into 3 grades by the state of the hiatal margin in relation to intragastric pressure. Grade : The opening of the hital margin becomes visible at pressure of 15cm H₂O. Grade 2 : The opening is complete but the distention of the hernia pouch is still incomplete at 15 cm H₂O. Grade 3: The opening and hernia pouch are recognizable at 5 cm H₂O. Endoscopic view of the herniation under maximal dilatation can be classified into 3 types, that is, simple type, concentric type and complex type. In this respect comparison between endoscopic and radiologic findings was made. Most the simple types were in general, the small sliding type. Concentric types showed moderate size of hiatal margin, radiologically seen as the Bell hernia. Complex type corresponded with the eccentric short esphageal type and redundant esophageal type as described radiologically by Zaino. Gastroscopy permits visualization of a hernia pouch but the concomitant use of controlled intra-gastric pressure appears to aid in the demonstration of small hernias. Furthermore, this endoscopic examination makes it possible infer the radiologic findings of these. hernia types.

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Melanosis coli is a disease without specific symptom and cannot be diagnosed by barium enema that is why melanosis coli is not frequently diagnosed prior to fibercolonoscopy. As melanosis coli is not a surgical disease we did not know the distribution and the grade of pigmention accurately. However, with the fibercolonoscope. we are able to study the condition in more detail. In our Institute, we have experienced 7 cases of melanosis coli among 828 cases (0.84%) of endoscopic examination of the colon from Dec. 1968 to Sept. 1971. There are 4 males and 3 females, and the ages ranges from 42 to 85 years old. Endoscopically the most characteristic finding in our series is the localization of pigmentation at the recto-sigmoid area. Histochmical studies of biopsied specimen in our cases, the pigmentation shows it to be melanin1ike substance. All except one cases have history of prolonged use of laxatives of anthracene group from 3 months to 30 years. Of our 7 cases, colon cancer was found in 2 cases and colon polyp or polyps was found in 5 cases.

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