Vascular disorders and neuropathies are well-known chronic systemic complicationsof diabetes mellitus. In diabetics, the gastrointestinal tract may also be adversely affected, and ill these cases not only is gastrointestinal function affected, but as has experimentallybeen demonstrated, gastric rnucosal blood flow is also depressed. Furthermore, acutegastriic lesions caused by oral hypoglycemic agents(OHA)have been reported. In theprese:nt stu.dy, gastric mucosal blood flow and hexosamine content in gastric mucosa ofdiabetic patients were investigated with endoscopy. Studies were carried out on 85diabetics. In diabetics, especially receiving FHA, gastric mucosal lesions were revealedfrequently. Using a laser doppler rheometer, gastric mucosal blood flow was measured at3points. The flow was generally lower in the DM group than controls. Blood flow at lpoint was significantly lower in the diabetics. when bland flow was cflmpared between 49diabetics receiving OHA and controls, it showed significantly lower value at 2 points in theformer group of patients. 16 diabetics receiving OHA and with diabetic complicationsshowed the lowest value of blood flow among all measured groups. With 10 diabetics on OHA, hexosamine content in gastric mucosa and gastric mucosalblood flow were studied. They received teprenone for 2 months and then hexosaminecontent was measured in the biopsy samples at 3 points. Hexosamine content wassignificantly increased at l point after teprenone teatment, and blood flow had a tendencyto increase at all points. Teprenone was considered to effectively prevent the patientstreated with FHA from gastric mucosal lesions.

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To evaluate the efficacy of endoscopic ultrasonography (EUS)in diagnosing the depthof invasion of early colorectal cancer, 85 lesions were analyzed. Carcinomas which showedinvolvement of the submucosal layer are divided into two groups according to the degreeof submucosal invasion:agroup in which the depth of invasion was 1/3 of the subrnucosal layer or less(sm1)and the other in which the tumor had invaded the submucosa moredeeply(sm2, 3). The results were as follows; 1) Evaluation of early colorectal cancer by EUS was possible in 82.4%(70/80)of thecases:68.1%(32/47)in protruding esrans, 100%(33/33)in superficial lesions and 100%(5/5)in nodule-aggregating lesions. 2) Diagnostic accuracy of depth of invasion in early colorectal cancer by EUS was 85.7%(60/70);87.5%(28/32)in protruding lesions, 84.8%(28/33)in superficial lesions and80%(4/5)in nodule-aggregating lesions. 3) Accuracy of EUS as to the degree of submucosal invasion was 97.1%(34/35)in mcancer, 0%(0/5)in sml cancer and 86.7%(26/30)irl sm2, 3 cancer. 4) Diagnostic accuracy of EUS far the superficial lesions was satisfactory. However, it was difficult to evaluate protruding lesions more than 16mm in height. In such cases, thefive-layer structure of the colonic wall by EUS was not fully visualized due to theattonuation of ultrasound. Based on our findings, it is concluded that EUS is useful for the diagnosis of the depthof invasion in early colorectal cancer. However, diagnosis of the depth of invasion inprotruding type cases requires further improvement.

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Solitary gastric varices were treated with B-RTO or TJO. Endoscopic utrasonography with UMP(ultrasonic miniture probe), the ordinary B-mode rnethod and color dopplermethod with extracorporeal ultrasound by waterdrinking method were performed on thelesion before and after the treatment to observe the progress. Pre-treatment UMP showednonechoimage in all variceal cases. The B-mode method with extracorporal ultrasoundrevealed echogenic area protruding into the gastric lumen which was believed to bethegastric varices in a patient with F3, but the variceal lesions were not visualized in the other4patients(3 cases with F2 and l case with F2). The extracorporeal colar doppler methodshowed blood flow at sites believed to be the varices in 4 patients(2 cases with F2 and 2cases with F3). However, no blood flow was visualized in a patient with F2. UMP imagesimmeddiately after the therapy showed dotted high echa appearing ail over the echo-freeluminal areas. The B-mode method immediately after the therapy failed to visualize thevaricose areas clealy, no detecting changes in internal echo. The UMP and color dopplermethod were useful in defining judging the efficacy of therapy.

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We evaluated residue, recurrence, and prognosis of 65 intramucosal gastric cancerstreated by endoscopic mucosal resection(EMR), including piecemeal resection or additional use of laser irradiation. Clinical features of 651esions were histologically differentiated type, intramucosal Ul(-), ly(-), and v(-). They were all tried to treat with curativeendoscopic therapy. Twelve lesions of them were more than 20mm in diameter. Twenty five lesions resected once for all had no residue and recurrence in the follow-up period(range, 3-118 rnonths;mean, 32 months). Ten lesions resected piecemeal hadresidue of 1 lesion(operated additionally), and no recurrence(range 4-60 months;mean, 27months). Thirty lesions treated by EMR with additional laser irradiation had residue of 21esio:ns(operated additionally), and recurrence of l lesion(21 months after)(range, 4-92months;rnean, 25 months). Twelve lesions more than 20mm in diameter had:no recu.rrence.There were no cases who died of gastric cancer. Regarding end.oscopic treatment for earlygastric cancers, both piecemeal EMR and additional use of laser irradiation are consideredto be curative as well as EMR once for all. Furthermore, it is suggested that even lesionsmore than 20rnrn in diafneter can be curatively treated except for the case in condition ofendoscapically technical difficulty.

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Two cases of superficial carcinoma in the middle esophageal(parabronchia1)diverticulum and the other one in the Tower esophageal(epiphrenic)diverticulum are reported.The case l was a 54-year-old female who was pointed out to have a superficial carcinomaof type O-IIa in the middle esophageal(parabronchial)diverticulum on the right side. Thecarcinoma was considered to invade into the submucosal Layer. Therefor, total thoracicephagectorny through a right posterolateral thoracotomy and a median laparotomy wascarried out. in additon, adjuvant chemotherapy was performed. The case 2 was a 74-year-old female who was pointed out to have a superficial carcinoma of type O-I in the loweresophageal(epiphrenic)diverticulum, who was treated with radiation therapy before. Onthis admission, recurrence of type O-IIc lesion was noted. Therefor, lower thoracicesophageal and cardial resection through a left thoracotomy and a median laparotomy wascarried out. The occurrence of carcinoma arising in an esophageal diverticulum is rare.We reported the problems of endoscopic diagnosis and treatment.

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We have recently encountered two cases of srnall hyperplastic polyp, smaller than lcmin size, in which malignant transformation was recognized. Case 1; Semi-pedunculated hyperplastie polyp, about lem in size, in the antrum partially protruded during a period of six years. biopsy of the prutruded lesion showed well differentiated adenocarcinoma. base 2; The first endoscopic finding showed three hyperplastic polyps in the antrum and two inthe body. A sessile polyp of the antrum increased in size and changed in shape to be semipedunculated after nine years. Microscopic finding of the resected specimen bypolypectomy showed well differentiated adenocarcinoma in the surface of hyperplasticpolyp. It is unusual that the two interesting cases of hyperplastic polyp with focal cancer, less than lcm in size, were recognized by serial endoscopy.

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A 60 year old female admitted to our hospital under the diagnosis of submucosal turnor of the stomach. Ten years ago, the submucosal tumor was detected in the posterior wallof the body by the u.pper gastrointestinal X-ray examination. She had been followed upwithout any symptom. Endoscopical and radiological examination showed slight enlarge-meat of the submucasal tumar at this time. A partial gastrectamy v as perfarmed.Histological examination of the frozen section revealed benign glomus tumor.Since theglomus tumor of the stomach commonly behaves in a benign fashion, partial gastrectomymust be performed instead of radical resection.

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A65-year-old female was advised to undergo further examination at a mass examlna-tion of the stomach. Endoscopy at our department showed granular changes in the mucosa with redness and unclear margins at the gastric angulus. Macroscopic examination revealed morphological resemblance to a superficial type malignant lymphoma or reactive, lymphoreticukar hyperplasia of the stomach. Peripheral blood examination and myelo-grams showed no abnormality. A diagnosis of plasmacytoma was made by biopsy, and surgical operation was performed. The tumor was histopathologically gastric plas-macytoma and irnmunohistochemically the IgA/λtype. A part of the tumor extended to the submucosal layer, but no abnormality in the regional lymph nodes Was observed.

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A25-year-old man with advanced HIV disease was admitted to our hospital withabdominal pain and watery diarrhea for three months. Gastroendoscopy found multiplewhite nodules in the second portion of the duodenumL. Histological study revealed extensive nlucosal infiltration of histiocytic infiltrates in the lesions. These histiocytes werefilled with Acid-fast bacilli and PCR analysis with M. avium-intracellulare. This paper reports the first case of duodenal MAI associated with AIDS in Japan.

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A case of diverticular bleeding in the second portion of duodenum was described. A62-year-01d female who had been suffered from systemic lupus erythematosis and pulmonary fibrosis, was admitted to our hospital with complaints of hernatemesis and tarry stool.Laboratory data showed anemia and endoscopic examination revealed an intradiverticulum ulcer with an eroded vessel in the second portion of duodenum. Endoscopicinjection therapy with pure ethanol and hypersaline was successful and 3 days later, theeroded vessel was disappeared. Bleeding from the diverticulum is rare and difficu.lt to bediagnosed. This is one of rare cases which showed the usefulness of endoscopy in bothdiagnosis and treatment of intradiverticular ulcer in the duodenum.

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We reported a case of vascular ectasias in the cecum treated with endoscopic heaterprobe. A 58-year-old wornan was admitted to our hospital with general fatigue and severe anemia. Bleeding source was not discovered by the various examinations, including upper GI endoscopy, small intestinal X-ray examination and barium enema. Endoscopic exarnination revealed a flat protrusion with redness and dilated abnormal vessels in the cecum. Oozing source was observed from a site of the lesion. These lesions were treated endoscopically. Saline containing epinephrine was injected first into the submucosa around thelesions in order to elevate the target lesions. Heater probe treatments were performed in each lesion. The procedure was performed easily and safely withou.t complications.: Follow-up colonoscopy showed scars, and rebleeding has not seen. This disease usu.allyoccurs in the aged people often with cardiac or pulrnonary diseases. Therefore, the colonoscopic hemostasis with heater probe is an useful treatment for bleeding vascular ectasias as an application of standardized endoscopic techniques instead of undertaking surgical therapy. And the injection of the saline containing epinephrine was an effective procedure to prevent complications.

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A 50-year-ld male potator had taken cyanamide 150mg daily as abstinence therapyfor 5 months. Eighteen months after discontinuation of cyanamide, he was admitted to ourhospital because of abnormal liver function tests despite continuing abstinence. Laparosocopic finding ob admission showed a whitish liver with irregu.lar surface. Biopsy specimensof th.e liver showed a typical ground glass appearance leading to a diagnosis of cyanamide-induced liver injury. Sixteen months later elevated aminotransferases returned to normalwithout treatment, and liver biopsy revealed marked regression of ground glass apperance.

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The patient is a 13-years-old girl and her lip has a melanine pigmentation. In September, 1989, when she was 9-years-old, she had the first gastrointestinal examinationbecause her mother died of a carcinoma in the colon due to Peutz-Jeghers syndrome. Sincethe gastrointestinal X-ray examination revealed a few polyps in the stomach, she wasdiagnosed Peutz-Jeghers syndrome. In August, 1992, she had a polypectomy of a pedun-cu.lated polyp, 3cm in size, in the lower portion of the discendlng colon. Its histopatho-logical diagnosis was hamartoma. However 7 months later, a subpedunculated polyp(about 1 cm)grew at the almost same position previously polypectomized. After 5 monthslater, this polyp grew to be 1.5cm. Further 7 months later, this polyp rapidly grew td be4cm. Then she vvas admitted to our hospital and had partial colectomy in April, 1994. Inthis case the doubling time of the polyp was 110.3days according to the Collins'equation.

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Adetachable snare was used for 24 polyps in gastrointestinal tract of 22 patients;211esions for prevention of hemorrhage after polypectomy and 31esions for endoscopichemostasis. We were able to prevent hemorrhage easily in 191esions but not in 21eSionsand to cease bleeding completely in all of 31esions. In addition, we introduced a successfulcase, who suffered from chronic lymphocytic leukemia with thrombocytepenia and bleeding tendency, in whom a polypectorny with the detachable anare was performed safely. On the other hand, since a few troubles about a detachable snare were experienced, thebenefits and problems of the detachable snare were discussed.

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