To assess the characteristics of the gastric mucosa in patients with gastric foveolar hyperplastic polyp (HP), the determination of gastric acid secretion, serum gastrin levels, and serum pepsinogen I (PGI) levels were undertaken in 128 patients with HP and in 230 controls who had no gastric lesion. Moreover, the differences of the state of gastric mucosa were studied in patients with HP, according to the number and the location of the polyp. The following were the results of our investigations. 1) Hypochlorhydria or achrolhydria, hypergastrinemia, and hypopepsinogenemia I was more common in patients with HP than in controls. 2) Gastric acid secretion was significantly lower and serum gastrin levels were significantly higher in the case with solitary polyp than in that with multiple polyps. 3) As to the location of the polyp, serum gastrin levels were significantly higher and serum PGI was significantly lower in the case with the polyp located in the fundic mucosa than in that with the one located in the pyloric mucosa. From the results obtained, atrophic gastritis of the fundus was common in patients with HP. However, the development of antral gastritis was different according to the number or the location of the polyp.

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The authors already reported the basic resarch by applying the videoendoscope illuminating the stomach from outside of the body though the abdominal wall with infrared rays. That report revealed that prototype of videoendoscope brought the information of the deeper layers of the mucosa. On this report the authors have developed the videoendoscope illuminating directly inside of the stomach with infra-red rays, in order to apply it to clinical cases and study the clinical effect of the observation by infra-red rays esp. that of vessels' appearance. The objects are 134 cases, which include 3 of early gastric cancer, 8 of advanced gastric cancer, 46 of gastric ulcer (12 on active stage, 14 on healing stage and 20 on scar stage), 11 of gastric polyp, 3 of gastric submucosal tumor, 22 of atrophic on erosive gastritis, 29 of normal cases, and 12 of duodenal ulcer and others. It is possible for the infra-red videoendoscope which directly illuminates inside of the stomach with infra-red rays to observe the whole area of the stomach. This type of infra-red videoendoscope does not have any blind spots for observation compared with another type. Besides this fact, it is possible for this type to observe the objects by increasing the volume of infra-red rays even when they are apart. It is one of the endoscopic criteria for atrophic gastritis that fine vessels are observed under visible light, but they are not appeared under infra-red rays. It is possible for this prototype of infra-red videoendoscope to seize the appearance of vessels in the deeper layer by demonstrating the passway and their branches. In gastric ulcer on active stage, coat is shown light black by this prototype of videoendoscope. In acute phase of gastric ulcer, the vessels are not observed around the ulcer margin. In scar stage the vessels in deeper layers are observed to run toward the center of the scar although no vessels are seen in the center of scar at all. Judging from these results, it is expected that infra-red videoendoscope will be a help for not only judging the depth of scar but also predicting the recurrence of ulcer. In gastric polyp and submucosal tumor, neither surface structure nor vessels' appearance is observed. In gastric cancer, vessels are seen to be ceased around the cancer, but not seen on the crater. More over vessels are observed to be enlarged around the cancer crater. In IIc type of early gastric cancer the pooling of vessels is seen in the lesion. The authors are planning to accumulate clinical cases and study the appearance of submucosal vessels by infra-red rays in various diseases in order to clear the characteristics of that of infra-red rays.

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We reported the effect of EMT (Endoscopic Microwave Tissue Coagulation Therapy) for GI bleeding, especially in arterial bleeding cases. The subjects were 30 GI-bleeding cases, who were admitted to out hospital during a period January 1983 to Febrary 1988, (gastric ulcer: 17, Dieulafoy's ulcer : 7, gastric cancer : 2, duodenal ulcer : 2, rectal bleeding : 2). Emergenct endoscopy using Olympus GIF type Q was done in the patients with hematemesis and melena. After confirming the bleeding point, a needle or round type electrode was thrust into the bleeding point, and microwave was then discharged at the level of 40 watt for 5 to 15 sec. Hemostasis for more than 1 week was regarded as effective. Results : The hemostatic effect was obtained in 87.5% of gastric ulcers, 100% of Dieulafoy's ulcers and in total, 90%, 27 of all 30 cases. Hemostatic effect was also seen in patients with carcinomatous bleeding and rectal bleeding. As to type of hemorrhage, hemostatic rate was 100% (10/10) in arterial bleeding cases (such as jetting or pulsating bleeding), 85% (17/20) in oozy type bleeding. Although 13 of all 30 cases had severe underlying diseases, EMT was also considered to be clinically useful in these cases.

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There is a distinct benign clinical entity called heterotopic submucosal gastric cysts and association of these cysts with carcinoma of the stomach has been suggested. However, its difficulty in predicting the existence of such cysts preoperatively has resulted in a lot of surgical resection with mistaken diagnosis. Four surgically resected cases with preoperative endoscopic ultrasonography (EUS) were studied. In three of these superficial depressed type of early cancer was noted simultaneously. The clinical feature of these cysts on EUS was characterized by multiple small cystic areas, which were less than 2cm in diameter and located in the superficial hypoechoic portion of the 3rd layer of the stomach with preserved wall distensibility. Histopathologically, heterotopic glands with dilated grandular cysts were seen in the superficial layer of the submucosa. In one case which was associated with gastric cancer, these cysts could be accurately diagnosed by EUS even when an irregular mucosal surface mimicked the invasion of the neoplasm. EUS is useful for clinical diagnosis of the heterotopic submucosal cysts and differentiation of these cysts from other types of gastric cysts.

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It is well known that peptic ulcer frequently occurs in patients with rheumatoid arthritis (RA). To elucidate clinical features of peptic ulcer in patients with RA, a comparative study of gastric ulcer in 81 RA patients (RA group), 23 patients with nonsteroidal anti-inflammatory drugs (NSAID group) and 155 patients (ordinary group) was carried out. The mean age of the RA group and the NSAID group was older than that of the ordinary group. There was significantly higher proportion of women in the RA and NSAID group than in the ordinary group. Concerning the location of ulcer, gastric ulcer, especially antral ulcer, was found more frequently in RA group and NSAID group than in the ordinary group. The RA group tended to have large and hemorrhagic ulcer, on the other hand, the NSAID group tended to have small and non-hemorrhagic ulcer. All of irregular shaped ulcers in the RA group were found in antrum. Healing time of ulcers in the RA group was more longer than ulcers in the NSAID group and the ordinary group. However, healing of ulcer in the RA group was achieved by H2-receptor antagonists. Therefore, long-term treatment with antirheumatic drugs seems to induce gastric ulcer in patients with RA. And RA itself contributed to morphorogical characteristic and to the delay of healing of ulcer.

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Endoscopic, Macroscopic, and Histological findings of superficial esophageal carcinoma in 40 cases were compared each other retrospectively, and histological measure-ments were performed in 20 cases (Figure 1). In this study, findings obtained were reclassified as follows ; A : protrusion or depression was not recognized, B : almost flat, but slightly protruded or depressed, C : apparent protrusion or depression was recognized (Table 1). Following results were obtained : 1. The rate of correspondence of all endoscopic, macroscopic, and histological concavo-convex factor was 74% (Figure 2). 2. Histologically measured values of protrusion or depression were considerably different from endoscopic impression (Figure 3). The value in each group (A: 0.2 ± 0.1 mm, B : 0.7 ± 0.9 mm, C: 1.6 ± 0.9 mm) was fairly similar, but the index -100 represents the mean depth from normal surface to internal border of proper muscle layer in intact region (A:6.0±7.2, B :27.9±38.6, C: 127.5±55.1) was more differential (Figure 4, Table 2). 3. As to depth of invasion, index (ep :10.3 ± 7.8, mm : 5.3 ± 2.3, sm :110.1 ± 62.1) corresponded better with the actual impression than observed values (ep : 0.2±0.1 mm, mm : 0.5 ± 0.4 mm, 1.5±1.0 mm (Figure 4, Table 3). 4. Almost all cases which belongs to group A and C were classified as ep and sm on depth of invasion, respectively. Group B included ep, mm, sm cases. Lymphnode and vascular involvement were rare in groups A and B, compared to the group C (Table 4). We conclude that the classification based on concavo-convex factor shows the charac-teristics of superficial esophageal carcinoma well. However, histological mesurements may be greately influenced by variability of histological specimens. Therefore, comparative study between endoscopic and histological findings must be made carefully.

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In order to investigate causes and backgrounds of bleeding from upper gastrointestinal tract in the aged elders, we analyzed findings of upper gastrointestinal panendoscopies in 409 patients over 60 years of age with and without recent gastrointestinal bleeding. In patients with hematoemesis and/or tarry stool, endoscopic examinations were performed within 5 days after bleeding by using forward-viewing endoscopes (GIF P₃, GIF Q). Fifty-five of 409 cases had episodes of hematoemesis and/or tarry stool. For evaluating backgrounds of gastrointestinal bleeding, 43 cases whose bleeding was not attributable to malignant lesions or esophageal varices were selected and defined as a group of bleeders. Forty cases were chosen from 354 patients who had some lesion on endoscopy, but had no episode of bleeding as a control group of non-bleeders. Two groups were well matched about age, sex, duration of admission and underlying disease. The most frequent cause of upper gastrointestinal bleeding in the aged elders was hemorrhagic gastritis, and second one was gastric ulcer. The incidence of bed-ridden state, infection, disseminated intravascular coagulation and drug intake (antibiotics) were significantly higher in the group of bleeders than those in the control group. Oral intake was significantly smaller in bleeders than that in controls. Total protein, albumin, total cholesterol and choline esterase in serum were significantly less in bleeders than those in controls. From these findings, malnutrition and infection are considered as risk factors of upper gastrointestinal bleeding in the aged elders. Management of general condition seems important for the prevention of upper gastrointestinal bleeding in the aged elders.

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In Japan several reports, PEG method was rapid, effective and well-tolerable compared with the conventional method, but more than 3, 000 ml of PEG was necessary in preparation for colonoscopy. More than 3, 000 ml of PEG is a problem of unacceptance of patient. Therefore, we developed Combination method (sennoside and metoclopramide) in order to decrease the ingested volume of PEG and improve patient acceptance. To determine the usefullness of Combination method, 20 Patients were received Combination method and PEG method for colonoscopy at interval of one week. The both methods were equally adequate due to colon cleansing, but Combination method had significantly less water retension than PEG method. The ingested volume of Combination method (2, 000 ml) was significantly less than that of PEG method (2, 610 ml), and the time required for ingestion of Combination method (120 minutes) was significantly shorter than that of PEG method (167 minutes). Combination method was superior to PEG method due to patient acceptance. This study suggests that Combination method is effective and well tolerated by patients, and has become the standard method using PEG in preparation for colonoscopy.

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To clarify the pathogenesis of reddish marking on the liver surface with special reference to microvessels, the factor VIII related antigen was stained by an enzyme-linked antibody method. Reddish marking was observed in 27 of 128 (21%) patients with chronic hepatitis type B, and in 31 of 120 (26%) patients with chronic hepatitis of non-A non-B type. In autoimmune hepatitis, it was observed more (8 of 12 (67%)) frequently than in chronic hepatitis (P<0.05). In liver biopsy specimens which were taken from the reddish markings on the liver surface, there observed abundant liver cell necrosis, mononuclear cell infiltration and microvessels. In chronic viral hepatitis with reddish marking, the number of microvessels whose diameter was smaller than 50, am in the portal tracts was larger than those without reddish marking (P<0.05). In autoimmune hepatitis, the reddish marking was improved in 2 of 3 cases following administration of prednisolone (PSL). Comparison between reddish marking on the liver surface and microvessels in the portal tract before and after administration of PSL revealed that there may have a close relationship between the reddish marking and microvessels. These data suggest that the reddish marking on the liver surface and microvessels are mutually in close relation.

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With the advent in the technique of colonoscopic polypectomy, the value of colonoscopic polypectomy for diagnosis and treatment of early colorectal cancers was highly estimated. However, the efficacy of biopsy with forceps still remains to be recognized in the case that the lesion is too large to resect by colonoscopic polypectomy. In this article, 22 early colorectal cancers (12 lesions of mucosal cancer and 10 lesions of submucosal cancer) were studied concerning what information was obtained from biopsy with forceps. Results were as follows. 1. The overall diagnostic accuracy was 68% in early colorectal cancers. Concerning the difference of the depth of cancer, the diagnostic accuracy was 58% in mucosal cancers and 80% in submucosal cancers. 2. Concerning the difference of the macroscopic shape, the diagnostic accuracy rate was similar. On the other hand, the diagnostic accuracy was improved with growth of tumor in lesions smaller than 4cm in diameter. However, the diagnostic accuracy was 40% in tumors larger than 4cm in diameter. 3. Concerning histological findings, the diagnostic accuracy was 100% in polypoid cancer or adenoma in carcinoma, most part of which was composed of cancer tissue. On the other hand, the diagnosis was not made in all 4 tumors of focal cancer. 4. All biopsy specimens were composed of cancer tissue without adenoma in 7 of 8 submucosal cancers which were diagnosed as cancer by biopsy. In conclusion, these findings suggest that biopsy with forceps was useful as regards the diagnosis of submucosal cancer.

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A case which developed complete dysphagia and severe persistentret rosternal pain immediately after endoscopic injection sclerotherapy (EIS) was reported. EIS was done by paravariseal injection with 1.5 ml of 5% ethanolamine oleate (EO). Symptom of complete obstruction had continued for two days and was abruptly resolved by the rupture of the hematoma under conservative treatment. Endoscopic examination done on the 7th days after EIS revealed giant ulcer with extensive desquamation of the esophageal mucosa. It extended from the upper third to the lower third of esophagus. Dissecting intramural hematoma due to EIS may have been the cause of this ulcer considering from the clinical course.

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A 77 year-old man was admitted to our hospital with the chief complaint of heartburn. Endoscopic examination revealed Yamada' stype III polypoid lesion with smooth surface at the middle portion of the thoracic esophagus. The tumor was resected easily by endoscopic polypectomy. Resected tumor was 15 mm in diameter and soft. A diagnosis of cystadenoma was made by histological examination. This tumor consisted of multiloculated cysts and proliferated epitherial cells lining on the cystic wall. Benign tumors of the esophagus are relatively rare and there was no case report of cystadenoma of the esophagus as far as we reviewed the literature. Therefore, origin of cystadenoma of the esophagus has not been established.

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A 54-year-old man visited our hospital complaining of epigastralic pain. The initial X-ray and endoscopic examinations revealed a slightly protruded lesion with a shallow saucer-like ulceration on the posterior wall of the antrum (Figure 1 and 2). He was followed by X-ray and endoscopic examinations with routine histological evaluation of repeated biopsies. The gastric lesion showed marked shrinkage and a deformity on the serial rentogenographic and endoscopic findings (Figure 3, 4, 5, 6 and 9). The lesion was devided in three parts connecting each other, showing a clover-like appearance. The ulcer on the lesser curvature side appeared to be benign in the healing stage (Figure 5) and in the scarred stage (Figure 6) with smooth mucosal convergency. The ulcer on the greater curvature side suggested a malignant lesion showing a protuberant tumor with irregular ulcers (Figure 5 and 6). The gross appearance of the resected stomach showed an irregular shaped ulcer with a scar on the lesser curvature side of the lesion (Figure 7-a). Histological study on the operated specimen revealed non-Hodgkin lymphoma, diffuse lymphoma, large cell type involving the mucosal and submucosal layers of the posterior wall of the antrum (Figure 8). The malignant lymphoma occupied only a small part o the lesion at the time of operation (Figure 8). The lymphoma in this case showed marked regression in 3 months and changes in the shape is described in Figure 9. The presented case suggests the possibility of spontaneous regression or the existence of so-called "malignant cycle" in the early gastric malignant lymphoma.

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A 26-year-old unmarried woman complained of epigastralgia and nausea. X-ray examination showed narrowing of the antrum with granular appearance. On endoscopic examination large shallow ulcers and numerous irregular shaped polypoid masses were seen above the anglus to the antrum. Malignant lymphoma was suspected, however, the biopsy showed only mononuclear infiltration with no evidence of malignancy. There was no healing tendency of the lesion by using cimetidine, so it was suspected that the lesion may be gastric syphilis or tuberculosis. Based on a positive result of serologic test for syphilis, the anti-leuetic therapy was initiated. Her chief complaint was relieved and the gastroscopic findings were rapidly improved after the therapy. Therefore, this case was diagnosed as gastric syphilis. Gastric syphilis is relatively uncommon and it is difficult to distinguish from gastric malignant disease. It is important gastric syphilis should be considered in the differencial diagnosis of malignancy.

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We experienced a case of common variable immunodeficiency (CVID) associated with double early gastric cancers. A 45-year-old female was admitted to the Kanauawa University Hospital for further examination of the stomach. Her illness first became manifest at the age of 27 with the development of recurrent pulmonary infections and otitis media after the delivery of her first baby. She was diagnosed as CVID at the onset of illness based on the laboratory findings. Endoscopic examination of the stomach showed early gastric cancer (IIc) in the angle and subtotal gastrectomy was done. Resected specimen had IIc+IIa lesion (well-differentiated tubular adenocarcinoma) in the angle. Microscopic examination revealed the second early gastric cancer (IIb) in the antrum. The IIb lesion was also well-differentiated tubular adenocarcinoma. Many cases of cancer have been reported in patients with primary immunodeficiency disorders, especially with CVID. The frequent association of gastric cancer is noteworthy in the world literatures, however, in Japan, a few cases of CVID with gastric cancer have been reported.

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A 55-year-old housewife was admitted to our hospital because of tarry stool and syncope. Physical examination showed nothing in particular except for anemic conjunctiva and cardiac systolic ejection murmurs. Laboratry findings indicated anemia, hypoproteinemia and occult blood in the stool. A hypotonic duodenographic X-ray study revealed an elevated ulcerating lesion in the 2nd portion of the duodenum. A biopsy specimen of the lesion revealed well differentiated tubular adenocarcinoma. We performed pancreaticoduodenectomy. There was a 4.0 × 3.0 cm elevated ulcerating lesion just caudal to the papillae of Vater, extending from the lamina propria to the subserosa. An area of normal mucosa between the lesion and Vater's papillae could be seen microscopically. No metastatic lesions were found in adjunctive lymph nodes or elsewhere. The patient complained of melena, which is sometimes a sign that the tumor has reached an advanced stage. However, the tumor proved to be still remained in the subserosa, and we succeeded with a radical operation. These circumstance are considerably rare, so we reported the case and referred to some reviews of primary duodenal cancer.

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A 52-year-old male was admitted to our university hospital because of epigastric distress and abnormal liver function test. He was a drinker having taken 80g ethanol per day for 35 years. On admission, severe hepatomegaly was observed. The serum iron was 216 μg/dl and the serum ferritin 423 ng/ml. Peritoneoscopy revealed a segmentation, 10mm in diameter, on the surface of the liver and diffuse black-violet patches ranging from 0.2 to 2mm in diameter in the right lobe. The histological finding of the liver specimen was hepatic fibrosis. Mild hemosiderosis was seen diffusely in hepatocytes. The histological study of the black-violet patches revealed hemosiderin deposits in hepatocytes and Kupffer cells lmm long beneath the capsule. We reported the presence of patchy marking of iron-deposits for differentiation of patchy livers.

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A rare case of ileocecal valve lipomatosis removed by endoscopic polypectomy was reported. A 71-year-old female complaining of chronic constipation was examined endoscopically. On the first colonoscopy, a yellowish low elevation localized on the upper lip of the ileocecal valve was obserbed. One and half a year after the first endoscopy, the lesion had remarkably enlarged in diameter and hight, growing up to a subpedunculated polyp. In addition, a new lesion with similar shape and color to the polyp, but larger, was found on the lower lip of the ileocecal valve. With a diagnosis of lipomatosis on both lesions, endoscoppc polypectomy was successfully performed. The size of the polyp removed from the lower valve was 12 x llmm in its longest and shortest diameters and that from the upper valve 9 x 9mm. Histologically, they were diagnosed as lipomatosis, consisting of submucosal fatty tissue without capsulation. On X-ray and endoscopy, no recurrence has not been confirmed yet for past one and half a year since they were polypectomized. Lipomatosis of the ileocecal valve in very rare and no case resected endoscopically has been reported on the literature.

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A 76-year-old man was found to have the "ulcerative lesion of the colon" by a doctor without any complaint, and visited our hospital for the further examination. The first colonoscopy showed a small elevated lesion with redness in the sigmoid colon. The second colonoscopy after forty days revealed a reddish depressed lesion with marginal elevation and fold convergence at the same site. The irregular margin and bleeding of the depressed area suggested II c type early colon cancer. Histological finding showed adenocarcinoma, Group V. Resected specimen showed depressed lesion, measuring 11×5mm, with only a slight marginal elevation macroscopically, although microscopically cancer cells invaded subserosa without any metastasis. Histologjcal diagnosis was moderately differentiated adenocarcinoma, HoPoSlNo Stage II. This case was considered to be the so-called "IIc advanced colon cancer". Adenoma was not detected at the resected specimen, indicating the de novo cancer. This case is valuable for the investigation of the evolution and the growing process of a colon cancer.

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Acute colitis caused by Mycobacterium chelonae is a rare disease. A 27-year-old man was admitted to our hospital for fever, diarrhea and lower abdominal pain. Barium enema and colonoscopy showed an edematous stenosis and a slight erosion at the rectosigmoid colon (Figure 1, 2). The Ziel-Neelsen stained biopsy tissue from that mucosal lesion demonstrated numerous acis-fast bacilli (Figure 3-a, b), which were identified as Mycobacterium chelonae subsp. cholonae by tissue culture. The patient was initially treated with isonizid, rif ampicin and ethambuthol, but the organism was found to be resistant to these drugs, which were discontinued. Four months later, the rectosigmoid colon stenosis disappeared with no further treatment (Figure 6, 7). The contamination during the colonoscopy procedure was not conceivable and the source of infection was not identified. In conclusion, this patient was diagnosed as acute colitis caused by the infection with Mycobacterim chelonae subsp. chelonae.

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We experienced two early rectal carcinomas of depressed type. Colonoscopy in Case 1 showed an irregular ulceration covered with white coat, spontanous hemorrhage and sourrounding protrosion. The diagnosis of IIc+IIa type carcinoma (approximate 10 mm in diameter) was made endoscopically. Microscopically, the lesion was mostly well differenciated adenocarcinoma but a part of the surrounding protrosion was tubular adenoma. The lesion of Case 2 was recognized as a tiny abnormal reddness endoscopically. This reddness showed an erosive depressed area in the close-up view. From these endoscopical findings, IIc type carcinoma (6 mm in diameter) was most likely diagnosed. Microscopically, the lesion was well differenciated adenocarcinoma not accompanied with adenoma. The IIc+IIa type carcinoma of Case 1 was succesfully treated by piecemeal polypectomy. In IIc type carcinoma of Case 2, transanal local excision was performed. But no carcinoma existed in the excised specimen microscopically. It is considered that the whole of carcinoma had already dropped out because of ulceration after the biopsy procedure. Therefore, there may be the posibility to eradicate even depressed type cancer by means of endoscopic surgery.

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A case of eosinophilic enteritis was experienced. The case which was 63 y. o. woman with chief complaints of abdominal pain and watery diarrea was admitted on 28th Sep. in 1988. Laboratory data on admission showed leukocytosis with remarkable eosinophilia. By gastrointestinal endoscopy edematous change of the mucosa was observed diffusely in the duodenal bulb and 2nd portion. Biopsy specimen from the duodenum revealed diffuse infiltration of eosinophils in the mucosal and submucosal layer. The case was diagnosed as eosinophilic enteritis and her clinical symptoms and eosinophilia were improved significantly with corticosteroid therapy. The patient had gastrointestinal endoscopy again on the 18th day after the beginning of corticosteroid therapy. No edematous change was found in the mucosa of the duodenum, and biopsy specimen showed no infiltration of eosinophils. We have shown the rapid effectiveness of corticosteroid therapy to eosinophilic enteritis not only in clinical symptoms and eosinophilia but also in histological findings. By reviewing the Japanese literatures on eosinophilic gastroenteritis, we have concluded that it would be better to add the "Transmural disease" to Klein's classification, as we reported.

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The case is a 58-year-old woman. The chief complaint is epigastric pain. She had the history of extirpation of myoma of uterus, duodenal ulcer and gall stone. As for present illness, no abnormality is seen physically. N o abnormal findings are noted except that the blood sedimentation rate was slightly increased on the laboratory examination. Radiological examination revealed many irregular deposits of barium over an rectal area of about 5×5 cm in size. Endoscopic examination of the large intestine showed a number of round or oval depressions in that region. A mucosal bridges were formed between the depressions through which a biopsy forceps could be inserted. At biopsy taken of the reagion where the bridges were formed with the histology of aimost normal mucosa. In Japan, cases of mucosal bridges had been reported in 37 cases. Ulcerative colitis in 6 cases and intestinal tuberculosis in 5 cases are mentioned. Among the cases of unknown etiology, twelve had histories of infections diseases.

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