We attemted to diagnose the depth invasion and lymph node metastasis of esophageal cancer by endoscopic ultrasonography (EUS). The results were as follows; 1) The ratio of accuracy in the diagnosis of infiltrating depth of esophageal cancer was 70%. 2) In a histological investigation of 150 pieces of lymph nodes resected by operation, the incidence of lymph node metastasis was 48.1% in the size of over 10mm in diameter with round shape, and 14.3% in the same size with ellipse shape. It was 10% in the size from 5 to 10mm in diameter with round shape and 5.3% in the same size with ellipse shape. There were no metastatic lymph nodes in the size of less than 5mm in diameter. 3) The ultrasonographic visualization rate of lymph nodes surrounding the esophagus was 58.7% in the size of over 10mm in diameter, 34.4% in the size from 5 to 10mm in diameter and 6.9% in the size of less than 5mm in diameter. 4) Lymph nodes surrounding the esophagus and the stomach were enhanced by oral administration of "10% oil in water type emulsion". The visualization rate of the lymph nodes will be raised by using this new method. Moreover, by investigating the size, the shape and the form of enhancement in lymph nodes visualized by EUS, it may be possible to diagnose exactly whether these lymph nodes have the metastasis of cancer or not.

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It sometimes has been reported that the reddish markings (RM) found in non-B chronic hepatitis (NBCH) were different from those in type B chronic hepatitis (BCH). We then studied the characteristic laparoscopic findings of N BCH and the relationship between those findings and the progression of hepatitis, comparing with BCH. RM seen in BCH were mainly diffuse periportal RM, while in N BCH we found localized multilobular RM mostly, which we designated as "atypical redness". The cases with RM tended to have severe activity of hepatitis and to progress rapidly in the both types of hepatitis. In BCH, the patterns of progression resembled each other, and they progressed to liver cirrhosis with the findings of patchy markings and the RM became irregular redness in the interstitium. In NBCH, however, patchy markings were rarely seen, and they presented various patterns of progression in which we found sulcus forma-tions, fine and irregular undurations, increasing white marking and so on. The variety of the liver surface seen in N BCH would be due to the various range and distribution of the liver cell damages. As the liver cell damages in NBCH occur in multiple sites but ununiformly, we considered them to be important findings for progression of NBCH.

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The importance of bloody stool as an indication of colonoscopy has long been estab-lished. Using 2, 151 new patients in the past three years (1982-1984), the importance of symptoms other than bloody stool as an indication of colonoscopy was studied. The complaints of the patients underwent colonoscopy and the colonoscopic diagnosis were paralleled. The following conclusions were obtained. (1) Patients under 40 : Only those complaining bloody stool are indicated for colono-scopy. The insertion is enough up to the splenic flexure. (2) Patients over 51: Any complaints should not be ignored as a chance for colono-scopy. Adenoma and/or early cancers are found around 20% of the examinees regardless of their complaints. (3) Those in forties accord with those over fifty. The importance of symptoms other than bloody stool was stressed for the detection of colonic adenomas and early cancers.

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Creeping villous neoplasms of the colon were removed together with the mucosa by means of endoscopic electroresection. In 15 patients tumors were located in the rectum and in 11 patients in the colon. In 19 patients tumors affected a half or more of the colonic circumference and had an extension of 3-5 to 8 cm. Endoscopic procedures in 16 patients resulted in complete recovery. Two patients were not examined due to a short period of follow up, and in 8 patients central recurrent tumor were detected and could be removed by repeated procedures. It is concluded that endoscopic electroresection of the colonic mucosae with tumors has proved to be a radical operative procedure in 15 patients with malignant villous neoplasm.

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Several endoscopic methods have been applied to the upper gastrointestinal bleeding. The present report describes a new method, using Aethoxysclerol, of treating upper gastrointestinal hemorrhage endoscopically. Aethoxysclerol commonly used as sclerosant of sclerotherapy, was applied to arrest hemorrhage from the upper gastrointestinal tract. At first fundamental effect of local injection of Aethoxysclerol solution was evaluated using the dog. It was recognized that effect of injection was due to compression of vessels by edema of stroma and microthrombosis and late effect was due to formation of thrombo-sis by endvasculitis. In clinical use, Aethoxyscleral was injected circumferentially to a total of 3-4 ml beneath the base of bleeding lesions. In 13 of 15 cases, this procedure had a definite benefit for the patient and no complication occured. It was concluded that local injection of Aethoxysclerol was safe and an effective method for the hemostasis of upper gastrointestinal bleeding.

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Endoscopic findings of the stoma in 193 cases following Billroth-I and -II gastroctomy were investigated. Stomal ulcers were confirmed in 34 cases endoscopically, 17 of 128 cases following Billroth-I, and 17 of 65 cases following Billroth-II, respectively. The incidence of stomal ulcer after Billroth-II (26.2%) was higher than that of Billroth-I (13.3%). In cases of Billroth-I gastrectomy, 15 ulcers were found on the suture line, and 6 of them (40%) were associated with non-absorbable suture material. On the other hand, in Billroth-II 13 ulcers were found on jejunum, however, any ulcer associated with non-absorbable suture material was not found. Therefore Stomal ulcer associated with non-absorbable suture material have a tendency to occur after Billroth I gastrectomy. In the 6 cases of stomal ulcer associated with non-absorbable suture material mentioned above, the ulcer healed within a month in 3 cases in which the suture material was removed by endoscopy. But in the other 3 cases, in which the suture material was not removed, the ulcer continued to be present. On diagnosis of stomal ulcer, it is important to ascentain the presence of suture material. If suture material is present, endoscopic removal of the suture material is an effective treatment.

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From October 1977 through March, 336 cases of esophageal varices have been treated with injection sclerotherapy which have been established in our institute (endoscopic embolization). Main complication encountered in these 336 cases amounted to 12 cases (3.6%), which included 3 cases of esophageal stenosis, 2 hemorrhage due to erosion at the E-C junction, 2 renal dysfunction, 1 hemohydrothorax, 1 hemorrhage due to esophageal erosion, 1 hypotension, 1 esophageal varices bleeding, and 1 esophageal perforation. All patients with these complications, including a case of esophageal perforation, were cured through conservative therapy and discharged. Most of these complications were consid-ered to be due to a kind of technical failure. From the above it can be thought that if operation are performed with appropriate procedures and complication were treated satisfactorily, possible fatal risks of this procedure would be almost none.

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A new videoendoscope system (Welch-Allyn VideoEndoscope system) has been recent-ly developed. The image detected by the CCD chip which attached to the distal tip of the endoscope is passed in the form of an electronic signal through the endoscope to the video processor for display by the television monitor. Since the image of the videoendoscope is produced electronically, computer enhancement of the image and/or computer analysis on the mucosal changes of the GI tract become gotten in our pocket. We tried endoscopic examinations of the upper GI tract with Videogastroscope in 37 patients, and by the computer enhancement and computer analysis of the image minute morphological changes on the surface of the gastric mucosa were clarified. There is still some problems with this system, however, this system is likely to be useful and effective for more detailed diagnosis of the gastric disorders.

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Emergency colonoscopy for lower gastrointestinal bleeding was performed in 78 patients consisting of 36 of general medical service and 42 of emergency service. The causes of bleeding were diagnosed correctly by emergency colonoscopic examination in 57 cases (73%). When colonoscopic examination was performed earliar, the accuracy of final diagnosis was elevated. When the bleeding sources can not be detected by the initial colonoscopic examination, the superior mesenteric arteriography was the most effective prosedure for the diagnosis of massive bleeding, and barium enema study on the same day was the second prosedure for a small amount of bleeding. When the insertion of colonoscope was made up to the splenic flexure of the large bowel, 85 percent of lower gastrointestinal bleeding cases was correctly diagnosed in the present study.

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We recently found three cases of squamous cell papilloma of the esophagus. The first case was a 65-year-old-male who had been detected to have a movable mass at the lower esophagus by the upper G-I series. On endoscopy after admission, a pedunculated mulberry-like tumor with a marked reddish surface was detected on the right dorsal side of the lower esophagus. Polypectomy was performed and the size was 16×13×5mm. Histologically, proliferation of squamous cells with marked papillary growth and partial keratinization was observed on the surface and the tumor was diagnosed as squamous cell papilloma. The second case was a 71-year-old-male who was hospitalized due to hypothyroidism. After admission he showed positive occult blood in the stool and endoscopy detected a 5 mm flat and whitish mass on the ventral side of the lower esophagus. Biopsy was performed and the histological finding was similar to that of the former case and the diagnosis was squamous cell papilloma. The third case was a 64-year-old-male who had been detected an abnormal defect shadow by the upper G-I series due to the chief complaint of epigastric pain. After admission, endoscopy revealed a mulberry-like tumor on the ventral side of the lower esophagus. Polypectomy was performed and the histological diagnosis was squamous cell papilloma. Squamous cell papilloma of the esophagus is a very rare disease and only 25 cases including the present ones have been reported in Japan.

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We have recently experienced two cases of minute esophageal carcinoma detected and totally excised by panendoscopy. The first case was a 74-year-old man who was found elsewhere to find an esophageal diverticulum on UGI series and a small flat lesion near the divesticulum by subsequent endoscopy performed by chance during hospitalization for pneumonia. Endoscopic dye method using a 3% Lugol solution revealed a tiny unstained area where carcinoma in situ (about 0.3 cm in size) was confirmed in one of two biopsied specimens. The second case was a 63-year-old man who was referred to us for further examination of the stomach. Panendoscopy revealed a small irregular red-spot in the middle esophagus where one of four biopsied specimens obtained made a diagnosis of moderately differentiat-ed squamous cell carcinoma. Since two more biopsied specimens repeatedly taken from the same area unstained with 3% Lugol solution again revealed squamous cell carcinoma, surgical operation was performed. An irregular erosion of 0.6×0.45 cm in size was demonstrated macroscopically on the resected specimen. However, no cancer cells were found with only regenerating epithelium in the resected specimens of two cases despite thorough pathological examination. UGI series could not demonstrate any abnormalities in both cases. The authors would emphasize that careful observation of the esophagus at the time of panendoscopy is indispensable in detecting such a minute carcinoma of the esophagus.

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Twenty years old male with Schoenlein-Henoch purpura was reported. He was hospitalized because of abdominal pain, nausea and vomiting. During the admission purpura, microscopic hematuria and proteinuria as well as gastrointestinal lesions devel-oped. Diagnosis of IgA glomerulonephritis was made by kidney biopsy. Various gastrointestinal lesions were demonstrated. Multiple reddish elevated lesions with central coating were observed in the second portion of the duodenum by endoscopy, which almost disappeared 2 weeks later. X-ray studies of the small intestine revealed skipped lesions in the jejunum and the ileum. The one in the jejunum was a narrow segment of about 9 cm in the length with an irregular margin. These lesions disappeared by the X-ray study done four weeks later. On the 7th week of the admission, purpura in the leg and duodenal lesions reappeared but disappeared soon. As symptoms subsided he was discharg-ed on the 55th day of the admission. But the 3rd day after the discharge he was readmitted because of upper abdominal pain and purpura. An endoscopy revealed multiple ulcers like AGML in the antrum. Ranitidine was given and these lesions disappeared in six weeks.

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This paper describes 2 cases of multilocular liver echinococcosis that occurred in brothers residing in Rebun Island. It developed with a chief complaint of epigastric distension at 35 years of age in the elder brother and with a chief complaint of epigastric pain at 52 years of age in the younger brother. On initial examination, a very hard, irregularly contoured swelling of the liver was palpable in the upper abdomen in both of them but the systemic condition was favorable. Hematological examination revealed almost no abnormality. However, im-munoserological test for echinococcosis was positive in both of them. Laparoscopy resulted in similar findings demonstrating a greyish-white, solid mass typical of multilocular liver echinococcosis expanding from the right quadrate lobe to the entire left lobe. Biopsy of the tissue confirmed the cyst enclosed with a peculiar chitin membrane. Liver scintigraphy, ultrasonography, CT and angiography also showed characteristic findings. Although the ages of the onset differed, the clinical manifestations and pathologi-cal characteristics resembled considerably. The elder brother retained almost the normal liver function until 8 years after the onset but eventually died of hepatic failure. The younger brother was relieved of epigastric pain and returned to the occupation of fishery. However, regular follow-up is still continued.

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Familial incidences of Crohn's disease (CD) reported in Europe and USA are about 10%, but there are only two case reports in Japan. In our hospital, in two families of 67 unrelated patients with CD, a first-degree relatives with CD was found. In this paper, we report a mother-son case. The mother is 48 years old. She had dairrheas in 1975, and slight fever in 1977. She had pains in the periumbilical and ileocaecal region and the anus in 1980. In September 1983, she had a ileocaecal pain again. Her condition became worse from December 1983. She was admitted to our hospital on April 1984. Barium enema, small bowel enema and colonoscopic examination revealed cobblestone appearances and longitudinal ulcers. Furthermore, granulomas were found in biopsy specimens. Her second son is 18 years old. Epigastric hunger pains began in march 1984. He had aphthoid stomatitis and complained of watery stools in September. X-ray and endoscopic examinations revealed duodenal ulcers, a longitudinal ulcer and cobblestone appearance in the terminal ileum and aphthoid ulcers in the sigmoid colon. We found granulomas in all biopsy specimens from the margin of the duodenal ulcer, the terminal ileum and the colon. We analized HLA antigens in this family. The mother had BW 61 and DR4, which have been reported more frequent in Japanese patients with CD, and her son had BW61.

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So-called early carcinoma of the bile ducts is rarely detected in Japan. Furthermore, there are no reports describing early carcinoma of the bile duct associated with ulcerative colitis. We report here a case 3f early carcinoma in the common bile duct associated with ulcerative colitis. A 47-year-old feamale visited our hospital for fever and diarrhea. Based on a barium enema examination and colonofiberscopy, a diagnosis of ulcerative colitis was made. Five months after hospitalization, the patient began to complain of pain in the right hypochon-drium accompanied with high serum level of γ-GTP. Endoscopic retrograde cholangiogra-phy (ERC) was performed. ERC demonstrated a small elevated lesion in the common bile duct and cytologic examination of bile revealed adenocarcinoma cells. The operation for the carcinoma of the common bile duct was performed. Because the tumor was localized within the wall of the common bile duct, a diagnosis of so-called early carcinoma in the common bile duct was made. In order to detect early carcinoma in the bile ducts, we should perform ERC examina-tion before the developement of jaundice, paying attention to the subjective symptom and high serum level of enzymes derived from the biliary system.

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A 20-year-old man had been complaining of abdominal pain and melena. He was referred to our hospital with the diagnosis of chronic, intermittent ileus of one month duration. A barium meal follow-through examination demonstrated an ileal intussusception, with a protruding lesion at the distal end, resembling an intestinal tumor. After an ileus tube was inserted, an ileoscopy was performed using an Olympus CF-IBW. The tumor-like lesion was covered with reddish, smooth and partially nodular epithelium. We made a diagnosis of an intussusception due to small intestinal submucosal tumor and partial resection of the ileum was performed. Macroscopic and histological examination of the operative specimen revealed that the elevated lesion was an inverted Meckel's diverticulum. There was no evidence of ectopic tissue in the diverticulum. In the medical literatures we have not located other cases with intussusception due to the inverted Meckel's diverticulum which was seen by endoscope preoperatively.

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Two cases of rectal carcinoid detected by endoscopic polypectomy are reported. Case 1 is a 29-year-old female who complained of lower abdominal pain. Colonofiber-scopy demonstrated sessile polypoid lesion coverd with normal rectal mucosa. Endoscopic polypectomy was performed. The excised tumor was 5×5×5 mm in size. Microscopic examination of the specimen confirmed carcinoid tumor. Neither argentaffin nor argyro-phil reaction were positive. Electron microscopic examination revealed numerous round electron dense granules. Case 2 is a 54-year-old female who complained of anal bleeding. Barium enema showed polypoid lesion at the rectum. A yellowish sessile polypoid prominence was revealed endoscopically at the rectum. The tumor was removed by endoscopic polypectomy. The excised specimen measuring 14×14×10 mm in size, revealed his-tological features of carcinoid tumor. Both argentaffin and argyrophil reaction were positive. Pleomorphic electron dense granules were observed by electron microscopy. In this case residual tumor cells at the resected margin were suspected ; additional surgical treatment was done. We reviewed previous case reports of rectal carcinoid and stressed endoscopic polypectomy is a useful diagnostic procedure for rectal carcinoid. But it must be used discreetly as a therapeutics, because a few cases of rectal carcinoid with metastasis were reported among ones with a size under 10 mm or without invasion to muscularis propria.

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We report a case of pseudomembranous colitis (PMC) localized in the transverse colon. This 53-year-old female patient visited a OB-GYN clinic in November 1983 because of vaginitis and endometritis. Slle was placed on oral Amoxicillin lg/day from November 11 to 17, followed by oral Bacampicillin lg/day from November 18 untill the morning of December 1. She experienced diarrhea, melena, vomiting, lower abdominal pain and tenesmus in the afternoon of December 1 and was admitted to our hospital on the same day. The colonofiberscopic examination (CF) on December 5 disclosed severe yellowish white, hemispheric pseudomembrane formation localized in the transverse colon, which was consistent with PMC. Anaerobic cultures of the feces on December 2, 7 and 8 were all negative. The hospital course was uneventful with much improvement on December 6 without specific treatment. The barium enema examination on December 8 showed poor dilatation of the transverse colon and small elevated areas near the hepatic flexure. CF on December 19 was normal. To our knowledge, there have been no reports of PMC localized in the transverse colon.

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Endoscopic cutting method was applied to 14 patients with stenotic stoma after upper gastrointestinal operations. In some patients, dilatation by a balloon catheter method was used after the endoscopic cutting.(1) This method was successfully performed in 12 patients out of 14 patients tried.(2) Sufficient results were obtained in 11 patients within 1-2 times of the endoscopic cutting.(3) This method was successful in all of 9 patients with gastric diseases or esophageal varices, but not successful in 2 patients out of 5 patients with esophageal cancer. There were 2 common factors in these 2 patients. The first factor was severe esophageal stricture longer than 1 cm to the longitudinal axis. The other was a longitudinal axis deviation between the esophageal line and the stomal line.(4) This method is a safe and useful technique for the stomal stricture after upper gastrointestinal operations.

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