To know the limit of the reliability of endoscopical diagnosis of the gastric lesions, the author picked up the minor changes such as the erosions in the stomach as a subject of this study. The endoscopical features of gastric erosions were analysed and compared with that of the proved tiny early gastric cancers, and furthermore the minor changes in color as well as the diagnostic limits of the gastric ulcerations produced in the dogs by means of thermocautery procedures were studied on the series of gastro-camera films which were taken on every 2-4 days. The results were as follows. 1. On the 22 resected stomachs, 93 erosions were found macroscopically, among which 82 were noted as erosion or erosion-like on the gastro-camera films. 2. The gastric erosions more than 1 mm in diameter were classified into 4 types according to the features of their bulging borders (R₁ or R₀) and marginal demarcations (U₁ or U₀). 3. In 93 erosions, 39 were classified into R₁ type and 54 into R₀ type. The erosions were ranged from 1 mm to 80 mm in diameter, but almost of them were distributed within 2-8 mm. Seventy three per cent of the erosions distributed within the region of the gastric incisura and antrum, and there were no differences as to the R classification. 4. Thirty four erosions out of 93 found in resected specimen were identified with those erosions on the gastro-camera films taken within 24 hours prior to operations and their endoscopical features were compared with histological ones. As characteristics of R₁ type, localized swelling, reddening of mucosal folds and white or yellowish coating at the top of swelling were found endoscopically. In R₀ type, slightly demarcated reddening and hemorrhage were observed. 5. Eighty two lesions of erosion in gastro-camera films were analysed by RU classification to determine how many lesions could be diagnosed before operation. Applying such endoscopical criteria, endoscopical diagnostic accuracies of R₁, R₀ and U₁, U₀ types were 24/32, 10/50 and 25/50, 9/32 respectively. U₁ means distinct margin and U₀ indistinct one. In total, 34 lesionsr of erosions were diagnosed correctly by endoscopy before operation. 6. Nine cases with tiny early gastric cancers of depressed type were detected by us sof ar. As the endoscopical characteristics, interruption, bulging and irregular swelling of the terminal of converging mucosal folds, abnormal reddening, lack of uniformity in color, unevenness of the surface, roughness of the margin, irregular shape of the central depression and islands-like abnormal reddening were observed. Among those findings, irregular margin, irregular shape in central depression and lack of uniformity in color were most important for diagnosis. 7. By the methods of thermocautery procedures, numerous mucosal defects ranging from erosion to ulcers in various type were produced in dogs and were followed endoscopically at 2-4 days intervals successively. Hemorrhages with localized mucosal swelling were found in a few days after thermocauterization. After the hemorrhages disappeared, persisting localized mucosal swelling and white coating at the top of ulcer were observed. Most of the mucosal swelling disappeared on 14th-16th day after thermocauterization, although there still remained patchy mucosal reddening. On the 20th day after thermocauterization, color of central parts changed into grayish-white and thereafter whitish discoloration, which persisted about 2 months. Then, they recovered to similar tone in color to the sorrounding mucosa. 8. From the results above mentioned, it is possible to diagnose the minor lesions of few mm in diameter such as erosions in the stomach by endoscopical examination. Also, the degree of mucosal epithelizations could be determined endoscopically by observing the minor changes in color

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The fibergastroscope, thanks to its great flexibility, has proved to be invaluable in the diagnosis of Gastric Suffering. This report concerns a new approach in diagnosis, whereby the visibility and features of the mucosal surface are enhanced by surface staining of the gastric lesions under observation with a solution of 0.4% Coomassie Blue and 0.6%Evans Blue. With this new staining process, changes involving mucosal unevenness or fine pathological irregularities are contrasted against the gastric surface, so that the resulting photographs are far clearer than those obtained in the process ordinarily used at present. Fibergastroscopes of the K and C types made by the Machida Co. in Tokyo, Japan, have been used in this new procedure. These fibergastroscopes contain two tubes : air is injected through one, and water through the other. In this new procedure, however, a dye solution has been used instead of water, and the staining process can be observed and photographs taken at the same time. Since February 1966, 750 cases of gastric cancers, ulcers, ulcer scars, polyps, etc., have been examined with the fibergastroscope. They have been submitted first to routine observation and photographing, then to surface staining, observed again and recorded. As a result of these experiments, gastritis also can be diagnosed easily with this new procedure. For the whole gastric area concerned can be observed clearly, even down to munute changes of the gastric mucosal surface. In the case of protruding lesions (cancers, po lyps, etc.), for example, the shape and features of their surface, as well as the usually undetectable portions around the base, are perfectly clear. Again, the circumf arence of an ulcer, as well as modifications in the surrounding areas, slight depressions within mucosal lesions, various forms of gastric folds and their delicate variations at the area of convergence, all can be seen clearly. Thus, this new staining procedure should be of great service in differential diagnosis for benignancy and malignancy, as well as in determining the degree of malignancy. Finally, this procedure is absolutely safe and can be employed quickly and easily.

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A 40-year old house wife was admitted to the hospital of Gunma University with a chief complaint of indigestion. Physical examination was normal. X-ray examination of stomach revealed two ulcer scar focuses with converging folds on the posterior wall just above the angulus. Endoscopical examination showed a slightly depres-sed area with a few folds converging to it. But the changes of the depressed floor was not remarkable and the so-called interruption of the folds were obscure. Two biopsy studies were negative for malignancy. The lesions were concluded to be cicatrices of ulcers. And the patient was discharged. After 3 months, the following endoscopecal examination revealed an early cancer of type II c with a reddish slightly depressed area on the angulus. Surprisingly, however, on the resected stomach a wide IIc area almost equivalent to a IIb lesion spreading on the anterior wall, and in other part, a true IIb lesion were found. Interestingly, the IIc lesion was consisted of two parts. The inner IIc area was more depressed comparing to the outer one, and it had been correctly diagnosed by the gastrocamera examinations but the outer part hadnot showed any endoscopical abnormalities the latter could be recognized only with a very careful inspection of the gross-specimen. On the other hand, the last true IIb lesion showed neither endoscopical nor macroscopic abnormalities ever after careful retrospective xaminations, and it was discovered only after a microscopic examination of the specimen. The cancerous invasion was restricted in the mucous membrane itself without a very limited area with submucosal invasion. A case of an early stomach cancer of type IIc+ IIb was reported. This case is very interesting because of suggesting the process of the cancer development.

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This is a case that a 33-year-old woman has had cardialgia as chief complaint. For 9 months before operation, we followed her up by endoscopic and xray examinations. Then, we performed gastrectomy on suspicion of early gastric cancer. We found 12 various shaped, slightly elevated, protuberances over the antrum in resected gastric specimen. Some of them have small raised area of mucous, or valiof ormic type cavity like verruca of an octopus. And others have erosive cavities around the center of snak-like long protuberances or flat ones. Theses changes consisted chiefly of a remarkable hypertrophy of the pyloric gland, and are the same in the structure as adenomatous polyp or regenerative polyp. We could not find any sign of malignancy. Clinical findings of the similar cases have been very rarely reported. It is necessary to differentiate these erosive changes from early gastric cancer, especially elevated type (IIa).

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