A new endoscopic method, the peroral direct cholangioscopy (PDCS) is described. A prograde fiberscope of 8.8 mm diameter can be directly inserted, without using a second scope as a guide, into the biliary system after EPT (endoscopic papillotomy). The lumen of the common bile duct is observed entirely and exactly. The image is excellent. Also acessories may be inserted into the duct via the biopsy channel under direct control.

The complete type of gastric metaplasia occurred frequently without H. pylori infection, whereas the incomplete type was frequently associated with H. pylori infection.

Most low-grade gastric MALT lymphoma histologically regressed after H. pylori eradication. The appearance of whitish mucosa after histologic regression reflected the degree of gastric gland loss. Whitish mucosa is an endoscopic characteristic and may be an endoscopic marker for regression of low-grade gastric MALT lymphoma.

The value of ERCP in children is demonstrated on 3 cases. By using a usual duodenofiberscope (JF-B2), in 2 cases under general anesthesia and in one case after premedication with 1 ml Buscopan i.m., a similar technique is used as in adults. In congenital choledochal cyst only ERCP allowed the exact judgement of the distal part of the common bile duct and its relation to the pancreatic duct. Therefore, an exact preoperative diagnosis can be established. When duodenofiberscope will be more improved ERCP will also be possible in the newborn infant. Than the differential diagnosis of congenital biliary atresia, other congenital failures in infants causing jaundice and hepatitis in infant will be established endoscopically.

Peroral cholangiopancreatoscopy (PCPS) using a mother and babyscope was attempted in 30 cases and the duct systems were successfully inspected in 25 cases. This procedure should be useful in cases with biliary and pancreatic diseases if the bending system and biopsy channel of the babyscope can be improved. Peroral direct cholangioscopy (PDCS) using four kinds of forward-viewing small-caliber fiberscopes was successfully employed in 14 of 22 cases. These instruments have a biopsy channel as well as an air-supplying and an aspiration channel, so that a stone can be removed with a basket catheter under visual control. PDCS should become valuable therapeutically in bile duct diseases if the fiberscope can be improved.