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Endoscopists have been examining the esophagus for 40 years, but that portion of the gastrointestinal tract beyond the pylorus has eluded them. Hirschowitz1 in describing the application of his fiberoptic gastroscope claimed that this instrument could enter the duodenal bulb. Few others were able to emulate him. When certain technical refinements, including a controllable tip for the gastroscope, were introduced in 1968, many examiners could maneuver the instrument into the duodenal bulb in about 20% of their examinations. It was not until early 1971 that the American Cystoscope Makers, Inc. introduced an instrument (Model 7089-J) with which an experienced operator could examine not only the esophagus and stomach, but also the duodenal bulb in most of the cases studied. In rare instances, it was possible to advance the instrument beyond the bulb and into the descending duodenum. Meanwhile, Japanese instrument makers had developed instruments designed exclusively for examination of the duodenum and had adopted a side-viewing instrument, because they wished to catheterize the ampulla of Vater for the purpose of obtaining pancreatograms and retrograde cholangiograms. Reports of experiences with these new instruments were published in the Japanese literature beginning in 1968.2–5

We have had an opportunity to use both instruments. The ACMI instrument is forward-viewing, 105 cm long, has a directable tip, a biopsy channel, and facilities for suction and inflating. Photographs are made by an external camera. The Olympus JF-B Duodenoscope, 120 cm long, has a diameter of 10 mm at its distal end, and four-way deflection is . . .



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