Serotonin (5-HT) has been suggested to be involved in the control of the colonic motility. To determine if the serotonergic activity would differ in different portions of the colon in humans, we measured concentrations of 5-HT and its major metabolite, 5-in-doleacetic acid (5-HIAA), in endoscopically biopsied colonic tissue specimens obtained from 11 patients with asymptomatic colonic polyps. Tissue specimens were obtained from endoscopically normal colonic mucosa at the ascending, transverse, descending and sig-moidal portions of the colon as well as at the rectum. Tissue 5-HT and 5-HIAA were determined by high-performance liquid chromatography with electrochemical detection. Results showed that the mean 5-HT concentration obtained from the rectal specimens was about twice (p <0.01) greater than those obtained from other four portions of the colon. In contrast, although the mean 5-HIAA concentration obtained from the rectal specimens was significantly (p<0.05) greater than those obtained from the ascending and transverse portions of the colon, the observed difference between these tissue specimens were less than 40%. Thus, the 5-HT turnover, difined as 5-HIAA/5-HT concentration ratio, obtained from the descending and sigmoidal portions of the colon were significantly (p<0.05, 0.01) greater than that obtained from the rectum. These data indicate that the regional distribution of the storage (i. e., tissue concentration) and turnover (i. e., 5-HIAA/5-HT ratio) of 5-HT would differ in human colonic tissues. In conclusion, the serotonergic activity in human colonic tissues might be assessed more accurately by the tissue 5-HT turnover index (i. e., 5-HIAA/5-HT) rather than the tissue 5-HT concentration perse.

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The role of Helicobacter pylori (HP) was studied in 53 cases with gastritis after distal partial gastrectomy. The percentage of HP positive patient of these 53 cases was lower than in other disease (atrophic gastritis, hemorrhagic gastritis and gastric ulcer) . There was no significant difference in endoscopic findings between positive and nagative cases for HP culture. Histologically, gastritis was more severe in positive cases for HP culture than in negative cases. The percentage of bile reflux was higher in negative cases for HP culture. Influences upon HP culture of bile juice, ursodeoxycholic acid and chenodeoxycholic acid were examined, and the results showed that these 3 materials seemed to inhibit HP growth in medium. These results suggest that HP has little influence upon gastritis after gastrectomy.

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We investigated the prognosis of endoscopic injection sclerotherapy (EIS) by endo-scopic color Doppler ultrasonography (ECDUS). We tried to detect intramural and extramural blood flow of the esophagus and left gastric vein (LGV), short gastric vein (SGV) by ECDUS after EIS. Prognosis was good in patients whose esophageal intramural and LGV/SGV blood flow markedly decreased, or whose LGV/SGV and esophageal extramural blood flow still maintained.

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The mucosa of free jejunal autoraft (FJG) was observed and the biopsies were obtained endoscopically in 24 patients operated on the pharyngeal and/or cervical eso-phageal carcinoma. The observation periods were within one year was 14 cases, from 1 to 3 years in 6 cases and over 3 years in 4 cases. The age ranged from 42 to 85. The results obtained were summarized as follows; The mucosal tissue blood flow of FJG was maintained constantly. The finger-shaped and leaf-shaped villi were most frequently observed in FJG and the mixed shape villi were observed in 25% of the patients. Villous height was significantly lower within one year and reached the constant level over one year and the width of villi was wider than the preoperative level within one year. Histologically, the stained zone of the mucin components did not change. It is concluded that, villous height and width show changes within one year and maintained the constant level there after.

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We processed the VTR images of the main pancreatic duct which were obtained by using the ultra-thin pancreatoscope applying the sequential video converter for the purpose of clarifying improvement of quality of the images and diagnostic ability. We applied sharpening, smoothing, gray scale transformation, contrast transformation and other ways by means of computed analysis to the VTR images. The results obtained in this study were as follows; 1) sharpening used by the image enhancement of G-component was very useful for improvement of quality of the images, 2) contrast transformation by reduction of R-component and magnification of both G- and B-component was effective for the diagnosis of the redness. These findings suggest that computed analysis is an effective means for improvement of the diagnostic ability in the ultrathin pancreatoscope. In addition, real time image processing is considered to be necessary for more accurate diagnosis, though the above-mentioned results have been studied on the paused images.

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A new balloon-expandable metal stent (Strecker stent) was implanted in 11 patients with malignant biliary stricture, in whom 7 patients had pancreatic cancer, 3 patients bile duct cancer and 1 patient hepatic hilar invasion of colon cancer. Implantation was successfully performed in 10 patients by mean of endoscopy and in a patient through percutaneous transhepatic route. In 5 patients external irradiation therapy was perf omed. Three patients died of malignancy progressed without stent obstruction, while 4 patients are still alive without stent obstruction. In 3 patients, stent obstruction caused by tumor ingrowth through the mesh of the stent occurred. The longest survived patient (without stent obstruction) is a 75-year-old female with pancreatic cancer, whose implanted stent has not been obstructed over 400 days without any procedures for cleaning inside of the stent.

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We studied the effect of sedation by IV butorphanol on blood pressure, pulse rate, and arterial oxygen saturation during upper gastrointestinal endoscopic examination. Butor-phanol decreased the retching of patients with resulting increase of the tolerance. In the non-sedated control group, gastroduodenoscopic examination induced the elevation of blood pressure and pulse rate. In young patients, butorphanol attenuated the endoscopy-induced rise in blood pressure and pulse rate without decreasing arterial oxygen saturation. In elderly patients, older than 61 years old, butorphanol administration caused the remark-able decrease of arterial oxygen saturation. Therefore, when butorphanoll is used as a sedation for gastrointestinal endoscopic examination in elderly patients, attention should be payed to the decrease of arterial oxygen saturation during the procedure.

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Peritoneoscopical findings and clinical features of three liver sarcoidosis patients, as diagnosed by means of peritoneoscopy and liver biopsy, were comparatively studied before and after treatment. The subjects were all females, ranging from 30 to 42 in age. Their chest x-rays revealed signs of BHL, pulmonary lesions, and fluid accumulation. Jaundice, splenohepatomegaly, and hemorrhagic ascites were detected as related physical manifesta-tions of their hepatic lesions. Liver function tests in some cases demonstrated elevated levels of GOT, GPT and total bilirubin or a rise in biliary enzyme levels and hyper-y-globulinemia, but in the other, virtually normal functions. ACE levels had increased in all patients. Peritoneoscopy revealed a typical whitish lesion on the liver surface, but its size and density varied considerably among the individuals. Steroids were effective in treating splenohepatomegaly and improved the hematobiochemical profile. Under the peritoneo-scope, however, the whitish lesion on the liver persisted even after the treatment.

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An esophageal mucosal bridge presenting as a double esophageal lumen is reported. A 68-year-old woman who had been treated for ref lux esophagitis had hematemesis under-went emergency endoscopy which revealed severe reflux esophagitis with active bleeding and ulcer formation in the lower esophagus. Nine weeks after medical treatment, follow-up endoscopy disclosed a double eso-phageal lumen presenting as bifurcation of the trachea in the lower esophagus. Neither the biopsy forceps nor tef lon tube could pass through this pseudolumen. An esophagogram taken under endoscopy clearly demonstrated a definite double-barreled esophagus in the lower region. A diagnosis of esophageal mucosal bridge was made. While reports of esophageal mucosal bridge are increasing due to the advances in panendoscopy, most are visualized as a thin band, cord or spindle in shape. Esophageal mucosal bridge as documented in this paper is still extremely rare. This case, therefore, is considered noteworthy in its features.

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We experienced a rare case of the polyarteritis nodosa (PN) with submucosal tumor -like PN angitis which was evaluated by gastrofiberscopic examination. The patient was a 73-year-old man who was admitted to our hospital with a complaint of sore throat, muscle weakness, and disesthesia. He was died of renal failure 5 months after development of the disease. PN angitis existed in the submucosal layer and subser-osal layer and formed semispherical submucosal tumor-like lesions. The stage of angitis was histologically II or III on the Arkin's classification. There was no ischemic mucosal change such as active erosion or ulceration. This findings was suggested that the gastric blood supply was different from that of the intestines. This is the first case that PN angitis showed submucosal tumor-like lesions that were detected by gastrof iberscopy.

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A 77-year-old male was admitted with complaints of a poor appetite. Gastroendoscopic examination showed an abnormal thick fold extending from the gastric upper body to the duodenum. A dark red polyp intussuscepted into the duodenum . Suddenly the intussusception was released, and the polyp was getting over the angulus to the upper part of the stomach during observation. Finally, the long stalk disappeared and the shape of the polyp changed into semipedunculated. When an upper G. I series and operation were performed, only a polypoid lesion without stalk existed in the posterior wall of the gastric upper body . Based on the endoscopic and pathological findings and same cases reported in Japan, it was concluded that this case was so-called complete type intussusception which involved the entire layer of the stomach wall.

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A 45-year-old female was admitted to our hospital because of abdominal pain and bloody stool. Barium enema study showed that sigmoid colon was imcompletely obstructed by Borrmann 2' type cancer and ragged sawtooth irregularity in the descending colon and thumb printing sign in the transverse colon. On the next day of the hospitalization endoscopic finding showed that multiple edematous nodular surface mucosa with diffuse ulcerations and erosions from the descending colon to the transverse colon through the normal mucosa proximal to Borrmann 2' type cancer of the sigmoid colon. It was diagnosed as obstructive colitis associated with the sigmoid colon cancer. One week later operation was performed. During the operation large geographic or longitudinal ulcers from the descending colon to the transverse colon was found by endoscopic examinations.

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Massive lower gastrointestinal hemorrhage is an infrequent complication of Crohn's disease. A 24-year-old man was admitted to our hospital because of loss of appetite and watery diarrhea. On the second hospital day, he developed gross rectal bleeding (approximately 2, 000 ml) without abdominal pain, followed by a syncopal episode. The upper gastrointestinal series revealed no abnormalities. Colonoscopy showed multiple punched-out ulcers and exfoliation of the colonic mucosa sparing the rectum. However, longitudinal ulceration and cobblestoning of the mucosa were not noted. Although it is not always easy to distinguish between Crohn's colitis and severe ulcerative colitis, a double contrast study of the small intestine performed at the time of a third episode disclosed longitudinal ulceration at separated regions of the terminal ileum, and the diagnosis of Crohn's ileocolitis was made. This case is highly unusual in that it involved recurrent episodes of sudden and massive hemorrhage that required blood transfusions. The bleeding was successfully controlled by conservative measures, including steroid therapy.

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A 38-year-old Japanese male was admitted because of high fever and loss of weight, 12kg in two months. Abdominal ultrasonography revealed defined hypoechoic lesions with internal focal high echoes in an enlarged spleen, which was recognized as low density areas on computed tomography. Abdominal paraaortic lymph nodes swelling was also observed by US and CT. _99mGa scintigram showed high uptake in the spleen and the paraaortic area. Laparoscopy disclosed a splenic protruded reddish tumor with a central white spot. Splenic tumor biopsy was performed using a 14-gauge Tru-Cut needle without any complications. Histology was compatible with Hodgkin's disease. Chemotherapy (Nitrogen-N-Oxide, Vincristine, Procarbazine, Prednisolone) was started. The patient soon became free from symptoms and splenic tumors and paraaortic lymphnodes almost disappeared. It was concluded that the needle biopsy of a splenic tumor under laparoscopy is safely performed and is a reliable technique for the diagnosis of hematological diseases.

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Complication of common ductal stones were observed in two children of anomalous arrangement of pancreatico-biliary tract : one was 4years old female and the other was 20 months old female. Abdominal pain was common initial symptom in both patients, and laboratory data indicated possible acute pancreatitis with obstructive jaundice. Both cases were diagnosed of anomalous arrangement of pancreatico-biliary ductal system compli-cated with stone by ERCP. In older case, stone was crushed up by pushing her abdomen with hands subsequently after ERCP and delivered. In another case, stones delivered during ERCP probably due to muscular relaxation with sevoflurane. After delivery, each patient returned to her ordinary life without any complaints. It seems to be worthy to report those cases from the view points of therapy of complicated stone and of etiology of dilatation of common bile duct in this disease.

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The advantages and problems of a catheter made of a shaped memorizing alloy (SMA catheter) were investigated in the pancreatico-biliary system. The tip of this SMA catheter has the ability to move either in one direction (one way angle type) or in both forward and backward directions (two way angle type). The latter two way angle type can be inserted into a micro fiberscope and used under the influence of an electric current determining flexibility by heat changes. Ten cases of pancreatico-biliary disease (4 cases of choledocholithiasis, 1 case of common bile duct stenosis and 5 cases of mucin producing pancreatic tumor) were examined using this catheter. The choledocholithiasis and stenosis cases had previously undergone endoscopic shincteropapillotomy. In the present study we inserted the fiber-scope and catheter into the main pancreatic duct or the bile duct endoscopically, in nine cases via the duodenal papilla and in one case via a gastropancreatic fistula resulting from tumor invasion. Using the two way angle type catheter the main pancreatic duct or the bile duct could be easily entered allowing clear observation after insertion via the duodenum. In the case of common bile duct stenosis an ERBD tube could be in place with the assistance of the moving tip We, therefore, conclude that the SMA catheter is a useful instrument for application with a micro fiberscope in pancreatico-biliary diagnosis or treatment.

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It is well kown that perforated peptic ulcer is an absolute indications of sergery. But recently, incidence of conservative treatment for it increases. We performed urgent laparoscopy and abdominal drainage for 2 cases with perforated duodenal ulcer. These 2 cases developed perforation in hungry and general condition was good. Signs of peritoneal irritation was localized and symptoms and peritoneal signs improved. The laparoscopic findings in 2 cases demonstrated that : anterior wall of the duodenal bulb was covered by the liver and peritonitis was localized and these was no food in abdominal cavity. These findings indicated a good indication of conservative therapy for perforated duodenal ulcers.

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We tried endoscopic variceal ligation (EVL) by means of three-forked forceps and end-loop ligature. EVL technique is shown. First, we inserted three-forked forceps and end-loop ligature through 2 channel fiberscope. The varices was pulled to end-loop ligature by three forked forceps, and was ligated. After the end-loop was closed and varices was ligated, the ligature was cut off with scissors forceps. As a result, esophageal varices was improved with healing of ulcer after EVL. We could conclude that this new method used easily without using of special instrument.

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A questionnaire survey was performed by the Laser Endoscopy Comittee on endo-scopic laser therapy for advanced gastrointestinal cancer in January 1991. Questionnaire forms were distributed to 187 major centers of gastroenterology or abdominal surgery in Japan. Out of the 187 hospitals, 140 (74.9%) answered the questionnaire. According to them, 1, 112 patients with advanced GI cancer are treated at 93 hospitals. An Nd : YAG laser is used at all the 93 hospitals treating advanced GI cancer. Therapy for malignant stenosis has been tried in 622 patients at 76 hospitals. Improve-ment has been achieved in 69.5% of patients based on X-ray or endoscopic findings referred to as "luminal success", while improvement of food ingestion (or ileus) or hospital discharge referred to as "functional success" has been achieved in 47.9%. As to the individual sites of stenosis, the "luminal success" and "functional success" rates are 69% and 53% for the esophagus, 69% and 53% for the cardia, 66% and 31% for the pylorus, 67% and 50% for the gastric anastomosis, and 78% and 25% for the cob-rectum, respectively. Endoscopic laser therapy has been employed in treating 198 patients with pm cancer or early-like advanced cancer at 59 institutions. The effect of the therapy is evaluated in terms of reduction in size of local lesions at all the hospitals. According to the data of those hospitals, though the criteria vary among the hospitals, the local improvement rate is 60.2% and the survival prolongation rate is 60.8%. On the other hand, an attempt has been made to reduce the size of advanced cancers on 292 patients at 45 hospitals. The local improvement rate is 39.3% and the survivasl prolongation rate is 28.9%, according to the criterion of these hospitals, namely, three-fourths of which consider that success is achieved when the tumor is reduced in size by 50% or more.

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