To elucidate the effect of alcohol intake in anti-HCV positive patient with histologically confirmed chronic hepatitis, 134 patients were studied clinically, laparoscopically and histologically. According to the intake of alcohol, patients were classified to four groups : I. non or social drinker, II. habitual drinker (mild), III. habitual drinker (moderate), and IV. heavy drinker. Effect of alcohol on liver blood chemistry included tendency to higher value in serum γ-GTP in groupII, III and IV and in patients who had drunk just before hospitalization compared with patients who had stopped drinking more than 6 months before hospitalization. Laparoscopical findings of the liver in chronic hepatitis C patients did not differ between patients with alcohol intake and patients without. But whitish marking and reddish marking tended to be found less in group IV. Histologically, the findings suggestive of alcoholic liver fibrosis (ALF) were more frequently found in patients with alcohol intake, especially in group IV. However, there was no laparoscopical finding compatible with ALF on histology in alcohol drinkers. We conclude that effect of alcohol in chronic hepatitis C patient was found in histological study, but laparoscopical differentiation between alcohol drinkers and no drinkers was difficult.

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Clinical courses of 26 cases who were recognized to have residue (11 cases) or recurrence (15 cases) of cancer after endoscopic mucosal resection for early gastric cancer were retrospectively studied. Four of 26 cases (15.4%) underwent surgical gastrectomy, and other 22 cases (84.6%) were retreated by endoscopic procedures; 14 cases were treated by endoscopic mucosal resection, 7 by cauterization with high-frequent current, 1 by endoscopic local injection of OK-432. Finally 16 of 22 cases (72.7%) were cured, while the other 6 cases (27.3%) were not cured. Three (13.6%) of these non cured 6 cases are now receiving treatment, and 1 case (4.5%) died of pneumonia during repeat endoscopic treatment, and in the remaining 2 cases (9.1%) the lesions developed into advanced cancer because of inadequate follow-up and rapid growth of tumor. Generally surgical gastor-ectomy should be recommended for residual or recurrent lesions after endoscopic mucosal resection because of the possibility of lymph node metastasis. When residual or recurrent lesions are retreated by endoscopic procedures, we should decide it after evaluating physical status of patients and histological atipia of cancer.

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The usefulness of omeprazole (OPZ) was comparatively studied between two groups : 1) 95 cases of gastric ulcer and 54 cases of duodenal ulcer treated with OPZ, and 2)109 cases of gastric ulcer and 61 cases of duodenal ulcer treated with H₂-receptor antagonist (H₂-RA). The cumulative healing rates of the gastric and duodenal ulcers at the initial treatment were higher in OPZ group than in H₂-RA one. The recurrent rates during maintenance treatment were almost equal or higher in OPZ group. Serum gastrin level rose significantly after OPZ was administrated ; but it came down to the pre-administra-tion level 4 weeks after the administration was interrupted. Seven of 9 cases of H₂-RA resistant ulcer were healed with OPZ administered for 72 weeks or less. The abnormally high level of the serum gastrin was observed in 3 of 7 cases which were administered double doses of OPZ for a longer period, but it came down to the pre-administration level after the administration was interrupted. It was considered that OPZ is useful for the initial therapy to ordinary ulcer and also H₂-RA resistant ulcer, and hypergastrinemia does not occur if OPZ is administered within 6 to 8 weeks. The safety in long-term administration of OPZ needs further consideration, and more effective initial and maintenance treatment should be investigated to prevent ulcer recurrence.

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A slight and transient increase in the amylase level is believed to be frequently observed in the relatively early stage of chronic pancreatitis. To elucidate the morbidity of early-stage chronic pancreatitis, we selected 11 patients with mild hyperamylasemia and eight control patients with normal amylase levels, who had undergone pancreatic biopsy for various reasons, from a series of patients who had been undergone pancreatic biopsy under laparoscopic observation. The amylase level, diagnostic image findings in terms of ultrasonography, CT, endoscopic retrograde pancreatography and laparoscopic findings in these patients were compared with histological findings. No histological differences were noted between the mild hyperamylasemia and control groups, suggesting that it is difficult under the present conditions to screen for chronic pancreatitis in the early stage from the aspect of mild hyperamylasemia alone. A very close correlation was noticed between the definite diagnostic imaging and the histological findings. However, patients with a suspi-cious diagnosis or who were evaluated as showing referential findings on diagnostic imaging presented approximately normal tissues histologically. Thus, no finding of an initial image of chronic pancreatitis was obtained. Furthermore, no clear correlation was shown between the macroscopic findings of the pancreas obtained by laparoscopy and the histological findings. While accepting the fact that the morbidity of chronic pancreatitis should be elucidated on the basis of histological findings, it is also clear that multimodal diagnosis involving pancreatic biopsy under laparoscopic observation should be further developed.

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Intraoperative ultrasound utilizing a miniture mechanical radial-scanning probe (UM -1W, 3.5 mm o. d., 7.5 MHz) was performed in 18 patients during laparoscopic biliary surgery. 1) The gallbladder (GB), cystic duct (CD), and extrahepatic bile ducts (BD's) were visualized in all patients. The narrow distal segment, main pancreatic duct and papilla were demonstrated in some cases, while the distal part of the bile duct was unsuccessful to study in 3 patients. 2) The portal vein and hepatic artery were also identified in most of the patients. 3) The principal lesion, either GB stone, GB polyp or common bile duct stone, for which the surgery was primarily undertaken, was diagnosed in all cases. 4) Ten coexisting diseases including CD stone or impacted stone in the GB neck were diagnosed by this method, 5 of which had not been found by preoperative examinations. Other 8 concomitant lesions, cholesterosis or periampullary diverticulum ets. were overlooked, but they did not interfere with a complete surgery. In conclusion, intraoperative ultrasonography with a radial scanner exerted an excel-lent visibility to show an otherwise undetectable coexisting disease, thereby facilitating a safer and more definite laparoscopic biliary surgery.

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We developed a jelly infusion method enabling the evaluation of the duodenal ulcer. From February 1992 to April 1993, ultrasonic probe (USP) were performed in 100 lesions of duodenal ulcer (32 single anterior ulcers, 2 single posterior ulcers, 66 multiple ulcers) using this method. The following conclusions were obtained ; Detection rates of duodenal ulcers were 80% in anterior ulcers, 31% in posterior ulcers, 85% in single ulcers and 52% in multiple ulcers, respectivelly. Extraluminal ulcer echos of U1-IV duodenal ulcers were detected in 3/10 lesions (30%) at healing stage and in 32/36 lesions (11%) at scar stage using USP. Regarding the depth of duodenal ulcers diagnosed by USP the ulcers consist of 2% of U1-II, 30% of U1-III and 68% of U1-IV, respectivelly. Number of folds, central depression, surrounding protrusion and deformity in endoscopic findings at S1 stage reflected the depth of ulcer evaluated by USP. The accumulative healing rate of U1-III ulcers was better than that of U1-IV for all term. Thus, we conclude that USP with the jelly infusion method was useful in follow-up of duodenal ulcer.

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Endoscopic variceal ligation (EVL) has been developed as an alternative to endoscopic sclerotherapy. During a 6-month period, EVL therapy followed by endoscopic sclerotherapy was employed in 30 patints, all of whom had liver cirrhosis. Seventeen were classified to child A, 6 Child B, 7 Child C. And 6 cases had active hemorrhage. The size of varices was evaluated by endoscopic ultrasonography (OLYMPUS EU-M20), and graded from 0 to IV, Grade 0 was defined as nondetectable case, grade I as varices with 3mm diameter or less, grade II as varices with 4-6mm, grade III as varices with 7-10mm, and grade IV as varices with llmm or greater in diameter. The varices were graded 0 in 2 cases, graded I in 10 cases, graded II in 8 cases and graded IV in one case. The maximum of their diameter was 13mm. The mean diameter was 4.2 mm. Twentynine among of the 30 cases underwent EVL teratment, and resulted in the reduction of varices from grade I-IV to 0-II or less. Only one case had failed to be ligated due to fibrosis on the esophageal wall, because of previous consolidation therapy. It was concluded that EVL with sclerotherapy was an effective treatment for esophageal varices with no limitation of the size, as an alternative to sclerotherapy except for case with perior consolidation therapy that had fibrosis on the esophageal wall.

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Since 1991, we have used total colonoscopy and barium enemas on the same day for colorectal examinations during physical check-ups by the human dock system. We studied the incidence of overlooked colonic polyps in these examinations. Subjects for total colonoscopy comprised 300 men who were 50-56 years of age and prior to retirement. A laxative was administered the day before examination based on a modification of Brown's method and barium enema examination was carried out about 2 hours after total colonoscopy. Cases in which polyps were overlooked, received the re-examination of total colonoscopy using 2, 000 ml Golytery solusion in after days. In 142 subjects, 266 lesions were found. 17 polyps were overlooked in 15 cases. About one half of the overlooked polyps were present in the rectum or the sigmoid colon. The rate of overlooked polyps was 6.4%.

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A very rare case of 58-year-old female with an esophageal pedunculated lipoma was reported. The chief complaint was retrosternal discomfort after eating. An upper GI endoscopic examination and an esophagography were performed, and a pedunclated fatty tumor was found in the lower portion of the esophagus (Ei). This tumor was confirmed to be a lipoma by CT examination and the endoscopic polypectomy was performed. The fresh specimen was 3.0×1.7×1.7 cm in size, and was diagnosed as lipoma by the microscopic examination.

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A solitary gastric varix which was cured by the use of two B-RTO catheters is described. The patient was a 48-year-old male who was found to have Lg-cf, F2, RC (-) on endoscopic examination. PTP revealed that a route of blood supply formed by a thick left gastric vein and a short one opened into the left renal vein after forming a gastric varix. As two drainage veins were found opening into the renal vein, they were avascular-ized with two B-RTO catheters. When a contrast medium was injected retrograde, it did not come to a complete stop, indicating that 5% EOI was not effective. Because of this, an SP catheter was introduced through a B-RTO catheter up to near the gastric varix. After the injection of 20m1 of 50% glucose and 8ml of absolute alchohol, the SP catheter was left there untouched for 30 minutes. Endoscopic examination 2 weeks later showed thedisappearance of the site of nodulation and reduction of the varix, and ultrasonic endoscopic examination disclosed a slight reduction of the varix and sporadic hyperechoes in the low echoic area of the varix. After 8 weeks of catheterization the varix was almost completely gone.

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A 73-year-old woman visited our hospital with a complaint of epigastric pain, and a small elevated lesion was pointed out in the anterior wall of the angular part of the stomach. Immunohistochemical staining of a biopsy specimen proved that the lesion was plasmacytoma. EUS examination revealed invasion of the tumor cells to submucosal layer. Serum M protein or Bence Jones protein was not identified. Myelogram and Ga scintigram showed no abnormal findings, indicating a diagnosis of extramedullary plasmacytoma of the stomach. Subtotal gastrectomy was performed on August 2, 1991. In the resected specimen, the elevated lesion was 14 × 11mm in size, and tumor cells invaded into sub-mucosal layer, compatible with the EUS finding.

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A 19-year-old man was admitted to our hospital because of severe vomiting on 5th day after motorbike accident. Upper gastrointestinal roentgenogram showed obstruction of the second portion of the duodenum. CT and MRI demonstrated a cystic mass in the duodenum. He was diagnosed as traumatic intramural duodenal hematoma and treated by conservative treatment. Endoscopic ultrasonography demonstrated a hypoechoic cystic mass in the submucosal layer of the duodenal wall. On 90th day after the onset, disappearance of the mass was confirmed by endoscopic ultrasonography. Endoscopic ultrasonography was useful for the diagnosis and follow-up of this disease.

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We treated two cases of bleeding duodenal varices by endoscopic injection sclerotherapy (EIS) using 5 % ethanolamine oleate and found that it effectively induced hemostasis. Case 1 was a 57-year-old male with liver cirrhosis who was hospitalized for hematemesis and melena. Endoscopic observation revealed nodular varices with fibrin plug in the descending portion of the duodenum, which was considered as the source of bleeding. Angiography revealed thrombosis in the main portal vein ; and that a collateral circulation route developed from the right colic vein, forming duodenal varices and bypassing into the inferior vena cava. The duodenal varices of case 1 was thought to be caused by portal hypertension due to both liver cirrhosis and portal vein thrombosis. Duodenal varices disappeared after 5 times of EIS. Case 2 was a 60-year-old male with liver cirrhosis who was hospitalized for melena. Endoscopic observation revealed nodular varices with fibrin plug in the horizontal portion of the duodenum, which was considered as the source of bleeding. Angiography revealed arteriovenous malformation (AVM) in the primary ele-ments of the jejunal artery. The duodenal varices of case 2 was thought to be caused by portal hypertension due to liver cirrhosis and AVM in the jejunal artery. Jejunectomy was performed ; however, bleeding persisted. After performing EIS twice, bleeding stopped. EIS was found to be a usuf ul therapeutic method for bleeding duodenal varices.

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A case of a solid cystic tumor of the pancreas with no cystic area in a 45-year-old woman is reported. Endoscopic ultrasonography showed spotted high echo in a hypoechoic mass with partially unclear margin in the body of the pancreas. Intraductal ultrasonogra-phy of the pancreas showed a hypoechoic mass with central echogenic area and peripheral aechoic area. Color doppler flow imaging showed color in the rim of the mass. C02 angiography showed the mass with enhancement from the rim to the center in early phase and with retention of enhancement of the rim and the center of the mass in late phase. Pathological sections showed the small tumor (25××20×20mm in diameter) composed solid area with no cystic area. The tumor in the microscopic features exhibited pseudopapillary structures and invaded into the normal pancreas tissue. The vessels in the tumor spread from the rim to the center. Immunological staining for alpha-l-antitrypsin, chymotrypsin and non-specific enolase showed positive tumor cells.

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