For a basic study of endoscopic injection sclerotherapy (EIS) for esophageal varices, a comparative study was conducted in terms of histological changes whereby sclerosing agent for the treatment of esophageal varices was infused into the veins of rabbit ears. The sclerosing agents included are classified in order from the strongest effect on thrombophilia to the least as follows : thrombin (T) > 5% ethanolamine oleate (EO) > 2% sodium tetradecyle sulfate (TSS) ≥ absolute ethanol (AE) > 1 % Aethoxysklerol (AS) > 50% glucose (G). Next, EIS using EO was studied clinically. Among 155 patients who underwent complete infusion with the agent into the varices, 150 cases (96.8%) were recognized of which the bronze varices changed into bronze spot, and the varices subsequently disappeared. Four cases (2.6%) revealed complications of necrosis and shedding of tissue associated with bronze varices and one case of recurrence was recognized from bronze varices. It was considered important to monitor the condition of varices after EIS in order to evaluate the effectiveness of treatment and to determine the prognosis.

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Two hundred forty one cases of gastric ulcer detected in gastric mass survey for the past 16 years were continuously followed up with endoscopy for 5 years or over. The records of long-term follow-up were analyzed to investigate the natural courses of gastric ulcers as compared with 139 hospital cases. The results were as follows ; The ulcers were single in 3/4 cases, and most frequently located at the angular region (in contrast to the body in hospital cases). Eighty% of the cases were discovered on the endoscopic stage of healing and scar. By the courses of the ulcers, 46.5% cases were in the recurrence group, 9.5% in the continuously open group, 26.1% in the scar group, and 17.8% in the continuously scar group. Recurrence occurred in half of the cases, and scar remained in 1/5 cases. There were 4 factors liable to recurrence and intractability; 1) male, 2) presence of complaints, 3) angular region, 4) multiple ulcer. The recurrence rate tended to rise as the duration of follow-up got longer, and the rate was higher in the treated cases than in the untreated ones. Severe cases are fewer in mass survey cases than in hospital cases. There is no essential difference between mass survey cases and hospital cases. Treatment and care of the ulcers should be considered individually in daily life, regardless of mass survey cases or hospital cases. It seems important in the management of ulcers to be based on the characteristics of the individual observed in the follow-up as long as possible.

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The relationship between the methylene blue staining method and other staining method such as LAP staining, ALP staining and A. B. staining were studied. To confirm the relationship, firstly, the methylene blue staining was edoscopically performed and jumbo biopsy technique called strip biopsy was carried out. Then the strip biopsied specimens were stained by LAP, ALP and A. B, and comparison was made on stained and unstained areas by these staining methods by the use of the dissecting microscope. As a result, the intestinal metaplasia as goblet cell metaplasia was broadly recognized by A. B. staining method. Methylene blue stained area was more broadly recognized than LAP and ALP stained area. Methylene blue absorptive activity was recognized before PAS positive brush border was recognized, however LAP and ALP enzyme activity were recognized at the time when PAS positive brush border was recognized. Complete intestinal metaplasia on the enzyme-histochemical study was recognized in the intermediate zone, and the intestinal metaplasia composed of only complete absorptive cells on histochemical study was also recognized in the intermediate zone.

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For the last one year, two hundred and twenty-one ERC were successfully done in our institution. Among them, gallbladder was not demonstrated in twenty-eight cases (12.7%) because of the presence of gallbladder diseases. On the other hand, in 68 cases (30.8%) the gallbladder was demonstrated with double contrast method by the injection of a proper quantity of the contrast medium, however in the rest of the cases gallbladder failed to be demonstrated. We developed a new method "double balloon catheterization" in order to demonstrate the gallbladder successfully with double contrast method. Double balloon catheter is a newly made instrument which is provided three lumens, and two balloons around the distal end at interval of 3cm. Three types of double balloon catheter were used, 5.5, 8 or 9 French in diameter. How to use this catheter is as follows ; By the same manner as regular ERCP, the double balloon catheter is introduced deeply into the common bile duct. Then, both balloons are expanded at the upper and lower side of the cystic duct. The gallbladder is demonstrated selectively by injection of the contrast medium, CO2 gas and jimejicon through the side hole between two balloons. Using this method, 7 cases of negative gallbladder in regular ERCP and 3 cases of elevated lesion of gallbladder have successfully demonstrated. Negative gallbladder was demonstrated in all cases and elevated lesions of the gallbladder was demonstrated more clearly in 2 out of 3 cases by this new method. In conclusion, double balloon catheterization can demonstrate gallbladder selectively, and is useful for the precise detection of gallbladder disease.

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To assess the reliability of the azygos flow volume value, obtained from endoscopic real-time two-dimensional Doppler echogmaphy (EUS2DD), it was compared to the value obtained from the established continuous therodilution technique (CTD). Nineteen adult patients, most of whom suffered from the liver cirrhosis, underwent two sets of hemodynamic study with a interval of at most one month. In EUS2DD, a convex array transducer with a 5 or 7.5 MHz was used. Blood flow volume (BFV : ml/min) was calculated by multiplying the mean velocity (cm/sec) by the cross sectional area (cm2) of the vessel and 60 (seconds). The blood flow volume index (BFVI), defined as mean velocity in cm/sec x square of diameter in cm, was also calculated. In CTD, a thermodilution catheter (Webster Lab) was advanced into the azygos vein up to 5 cm from its junction with the superior vena cava. BFV was calculated with a digital electronic computer. The correlation coefficient was calculated by linear regression. The value of BFV (ml/min), obtained by CTD, ranged from 75 to 820 (mean : 392±249). The value of BFV (ml/min) and BFVI (cm² ·cm), obtained by EUS2DD, ranged from 170 to 2238 (mean : 944 ± 609) and from 7.2 to 47.5 (mean ± 20.0 ± 12.9), respectively. The former one correlated well to each of the latter two values (r = 0.79, P <0.01, both). EUS2DD, the less invasive method, seems useful and reliable in the assessment of flow volume of the azygos vein.

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We classified mucosal findings for marginal recognition of early gastric cancer by electronic endoscopy (EES-50 A ; Toshiba-Machida) into four groups, on the basis of an analysis of 37 cases. The four groups were as follows. (Figure 1-3, 4-a, 4-b)Group A : niveau differenceGroup B : disappearance of capillary transparenceGroup C : discolorationGroup D : spotty redness (coarse and fine) The accuracy of marginal recognition was evaluated by biopsy from the mucosa inside of the margin which was thought as a cancer ous lesion, and the mucosa outside of the margin which was thought as cancer free. The biopsy was performed at the margin as close as possible, without involving the boundary line. Cancer cells existed in 97.0% (32/33) in the biopsy specimens taken from the inside area of the margin (group A, B, C, D), and not existed in 75.6% (25/33) from the outside area. The accuracy was 89.5% (17/19) in differenciated adenocarcinoma and 50.0% (7/14) in undifferenciated one (Table 5). Undifferenciated adenocarcinoma, invaded more widely over the boundary line which was recognized by electronic endoscope The accuracy of marginal recognition on the four groups (A, B, C, D) was 33.3% (1/3), 100.0% (3/3), 61.5% (8/13), and 85.7% (12/14), respectively (Table 4). The probability of the carcinoma existence outside of the margin recognized by niveau difference and discoloration were 66.7% (2/3) and 30.8% (4/13), respectively.

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Effectiveness of endoscopic polypectomy in treatment of carcinoid tumors of the rectum was investigated by examining surgical specimens and clinical follow-up studies. Flat tumors of less than 15mm in longest diameter of normal or yellow color, consisted histologically of solid nodular nests or trabecular ribbon-like structures were "early" tumors. Eight patients with early carcinoid tumors were treated by endoscopic polypectomy. Histological examination of the specimens obtained from 2 patients showed no residual carcinoids at the site of polypectomy. Endoscopic follow-up on the remaining 6 patients also showed no local recurrence during the average observation period of 1.3 years. These findings indicate that "early" carcinoid tumors of the rectum, even though having submucosal tumor invasion, could be completely cured by local endoscopic excision.

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The effect of cigarette smoking on gastric mucosal blood flow was investigated in eleven healthy male non-smokers. The blood flow was measured after two levels of smoking, low level nicotine smoking (smoking 1), and nicotine containing smoking (smoking 2), by an electrolytic hydrogen gas clearance method In cigarette smoking 2, gastric blood flow increased from 93±25.5 (mean ±SD) ml/ min/100 g to 138±44.7 ml/min/100 g (P<0.005) in accordance with an increase in heart rate and serum nicotine concentration, but plasma catecolamines did not change. On the other hand, cigarette smoking 1 did not alter gastric mucosal blood flow These findings suggest that cigarette smoking is related to gastric ulcer formation with other mechanisms than gastric mucosal blood flow.

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Since November 1983, endoscopic injection sclerotherapy (EIS), which is sometimes followed by transiloncecal obliteration (TIO) has been performed in emergency to 42 cases of ruptured esophago-gastric varices, and clinical of f icacies were evaluated. After the initial EIS or TIO, the hemostatic success rate of the cases in which bleeding points were observed below esophago-gastric junction (EGJ) was about 43 %, while the hemostatic rate of the cases of ruptured esophageal varices was about 90 %. And we classified the esophago-gastric varices into three types according to the endoscopic findings as followed ; Type I : Esophageal varices without gastric varices on lesser curvature and/or f ornix of the stomach. Type II: Esophageal varices rises from gastric varices on lesser curvature of the stomach. Type III : Large nodular varices on the f ornix of the stomach with or without eso-phageal varices. The hemostatic rate after the initial treatment by EIS were 100 % to type I, however, 77 % and 57 % to type II and III respectively. On the contrary, the hemostatic rates after initial combined treatment of EIS and TIO were 100% on both type II and III cases. From these results, we conclude that hemostasis can be obtained by only EIS treatment in type I varices. However, combined treatment of EIS and TIO is strongly recomended to type II or III varices to obtaine deffinite hemostasis.

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The clinical features and the characterishis of 678 patients with gastric anisakiasis found in Kagoshima prefecture from 1982 to 1987 were analysed in this paper. Immediately after taking a history of the present illness especially when taking raw fish, emergency endoscopy was performed on the all patients, and parasites were removed with biopsy forceps. Most of the patients complained of severe epigastralgia with or without nausea and vomiting. The interval between taking raw fish and onset of the complaints were 6 to 8 hours, and 83.4% of onset were within 12 hours. Concerning to the attributable fishes, mackerel accounted for 74%, and then sardine and horse mackerel for 13% and 8% respectively. As for the locations in which the parasites had penetrated, the greater curvature of the gastric body and angle showed the highest frequency with a degree of 37.4%. Two peaks were seen in the monthly incidence of the anisakiasis, the first was in February to May, and the second in September to October. All of 158 parasites which could be examined parasitologically were identified as anisakis larva Type I.

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Golytely method has widely been used for precolonoscopic cleansing of the colon. However, it is generally administered in a massive dose and, therefore, fluid remains frequently in the colon. In this study, low-dose Golytely lavage (1, 000-1, 500ml) was carried out in 53 patient. The effects were compared with those of conventional methods. In 24 patients, the laboratory data were compared befor and fafter administration of Golytely. Results 1) Golytely method gave a better cleansing effect in the cecum (p<0.01) and ascend-ing colon (p<0.05) than conventional preparations. In other part of the colon, no signifi-cant differences were found. 2) After ingestion of Golytely, serum potassium, BUN and creatinine were significantly reduced, but this had no hazardous effect in all patients. 3) Patients preferred Golytely lavage to conventional methods. Conclusion Low-dose Golytely method was found usefull for colon cleansing before colonoscopy. Careful attention is needed to the serum potassium concentration which decreases after ingestion of Golytely.

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Recently the authors encountered seven cases of acute hemorrhagic colitis during one-year period. The clinical, endoscopic and pathologic findings of seven cases were characteristic. Constipation, troublesome defecation, abdominal pain and rectal bleeding were four major clinical features of this disease. Urgent sigmoidoscopies, which were perfomed in the first 48 hours, revealed superficial longitudinal ulcers of a sigmoid colon in 6 cases and a maplike ulcer of rectum in one case. The longitudinal ulcers changed to the map-like ones in the proximal portion. All ulcers were segmental. The specimen of the ulcer revealed four hist-pathologic characteristics. These were a superficial denuded mucosa, an irregular line of muscularis mucosae, an abutting glandular element in the submucosal area and a foreign body in the denuded mucosa which was probably a fecal material. All cases were almost in good conditions and not bed ridden. They ranged from 34 to 82 in age and had no severe associated diseases. They recovered in several weeks by only supportive cares. These 7 cases have the same clinical, endoscopic and pathologic findings. Therefore, these should be caused by the same disease prosess. The cause of this disease is thought to be impacted fecal materials, troublesome defecation and mechanical pressure effect to the mucosa. We propose to call these colitis the stercoral ulcer in the view of the pathologic findings. Although our cases of stercoral ulcer are different from those described by Grinvolsky in many aspects, these are better to be called under the same name. In our country papers of stercoral ulcer have not been published. And some cases of transient type of ischemic colitis seemed to belong to the same entity of our cases of stercoral ulcer. The entity of ischemic colitis is still controversial and it may include several types of colitis. The stercoral ulcer should be distinguished from the ischemic colitis. This is the first report, describing the clinical, endoscopic and pathologic features of stercoral ulcer in this country.

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A 63-year old man with liver cirrhosis was treated high grade esophageal varices with endoscopic injection sclerotherapy (EIS). About one year after EIS, a mucosal bridge of the esophagus was found in the follow up study. It was H-shaped from the middle to lower intrathoracic esophagus and both ends were adhered to the esophageal mucosa. It was resected endoscopically. Histrogical findings showed a rolled-shaped squamous epithelium with moderate chronic inflammatory cell infiltration. He had no symptom related to the mucosal bridge, but it was reported that patients with esophageal mucosal bridge some-times had a stenotic sensation. It was considered that endoscopical resection of esophageal mucosal bridge was useful to study the genesis.

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The most common etiology of esophageal varices is portal hypertension and obstruction of superior vena cava. Esophageal varices without identifiable etiology have been called idiopathic esophageal varices. We have recently experienced a case of idiopathic esophageal varices evaluated direct portal vein pressure. A 35-year-old man was referred to our hospital because of epigastralgia and upper GI endoscopy revealed esophageal varices. Laboratory studies including liver function tests were within normal limits. Laparoscopy showed large white liver and histopathological examination revealed mild fibrosis at the portal area. Portal venous phase of celiac and superior mesenteric arteriography showed normal finding. Percutaneous transhepatic portography revealed normal portal vein with a portal vein pressure of 8cm H₂O. Chest CT scan revealed no abnormal finding, either. This is the first case of idiopathic esophageal varices evaluated direct portal vein pressure and denied the presence of portal hypertension definitely.

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Two cases of the fibrovascular polyp of the esophagus were experienced during the past seven years. Case 1: A 66-year-old male was visited our hospital complaining of heartburn. A lobulated intraluminal mass was found in the lower esophagus by endoscopic examination (Figure 1). The lesion was resected by endoscopic polypectomy. Case 2 : A 25-year-old male presented with epigastralgia for two months. Endoscopic examination revealed a small protruding lesion in the lower esophagus (Figure 3). The surface of the polyp was smooth and not lobulated under the indigocarmine contrast method (Figure 4). This lesion was removed endoscopically (Figure 5). Histopathological study showed that these tumors were covered with normal squamous epithelium, and proliferation of the fibrous and vascular components in the submucosa were prominent (Figure 2 and 6). These findings were compatible with the criteria proposed by Stout et al, as fibrovascular polyp. The benign tumors arised in the esophagus are rare. As for the fibrovascular polyp of the esophagus, only 18 cases have been reported in Japan from 1978 to 1987 (Table 1). Less than 60 cases have been reported in the literatures from other countries except Japan.

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A case of gastric plasmacytoma was reported and 38 cases of plasmacytoma reported in Japan upto 1987 were reviewed. A 60-year-old woman was admitted to Okazaki Municipal Hospital complaining of nausea. She was suspected as having malignant lymphoma of the stomach by roentogenography. Total gastrectomy was perf ored, and the resected specimen showed multiple erosions from the upper body to the antrum. Histological examination revealed that plasma cells were dominant in the tumor tissue and the invasion was confined to the mucosa and submucosa. Immunohistochemical study showed positive staining of IgM and Kappa in the cytoplasma of the tumor cells. Of 38 cases of gastric plasmacytoma reported in Japan, Immunohistochemical study of immunoglobulin class was done in 16 cases, of which IgG staining was found in 6, IgM staining in 5 and IgA staining in 4. In plasmacytoma of the stomach, Remigio's classification has been commonly used, whereas 5 cases including the present case were not defined by Remigio's one. We proposed that superficial type of plasmacytoma should be added to Remigio's classification.

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A 51 year-old man was admitted to our hospital complaining of palpitations and tarry stool. Severe anemia and hypoprotenemia were detected in the initial laboratory investiga-tions. On barium meal examination, a large protruding lesion, which had a granular appearance at the apex on its mucosal surface, was observed on the posterior wall of the upper gastric body. On endoscopic examination, the surface of the granular portion of the tumor was red and smooth, and the surface of the lesion around the granules was covered with normal mucosa. The biopsied specimen obtained from the granular portion showed no malignancy. On EUS, the lesion was a hypoechoic tumor with an cystic region, and was situated in the submucosa and proper muscle layer. Preoperative diagnosis was leiomyosarcoma of the stomach and total gastrectomy was performed. The tumor was found to be 65×55×50 mm in size. Immunohistochemical studies showed a positive reaction for S-100 protein, so it was diagnosed as schwannoma of the stomach. The granules on the mucosal surface of the tumor on histological examination were shown to be composed of edema, haemorrhage and the infiltration of the inflammatory cells into the mucosa. Such findings are uncommon and of interest in a submucosal tumor.

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A 40-year-old man with a history of ulcerative colitis over 20 years was admitted to our hospital because of bloody diarrhea. Barium enema and endoscopic examination revealed two nodular tumors and many flat elevations surrounding tumors in the rectum. Total coloproctectomy was performed. H istological examination revealed that two protruded lesions consisted of four tumors, i. e., two moderately differentiated adenocar-cinomas, tubulovillous adenoma, and carcinoma in adenoma. Flat elevated lesions found by endoscopic examination were histologically dysplasia and many dysplastic lesions were seen in the flat mucosa of the rectum and sigmoid colon. Periodic surveillance is recomended to be performed in cases of long-standing ulcera-tive colitis, and the possible relationship between ulcerative colitis and colorectal cancer is clinicopathologically discussed.

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