Endoscopic variceal ligation(EVL)has been popular rapidly, because of usefulrless andeasy technique for the treatment of esophageal varices. But same reports described thatesophageal varices treated by independent EVL tends to recurrent, and EVL is not enough treatment. We performed the combination therapy of EVL and sclerotherapy with 1%Aethoxysk-lerol(1%AS)for esophageal varices(EVL-1%AS therapy). At first, EVL is performed forthe treatment of large varices. And sclerotherapy with 1%AS is added in the follow upstudy. We tried to perform the prophylactic treatment for 35 patients. We achieved theimprovement in 31 (89.5%)out of 35 patients, with the mean number of 7.1±1.9EVLsessions and sclerotherapy with the mean injected volume of 20.0±0.0ml 1%AS in theprimary therapeutic effect. We achieved the remission in 23(74.2%)out of 31 patients, 12months after the treatment, with the mean number of 7.4±2.5EVL sessions and sclerotherapy with the mean mjected volume of 38.4±21.2ml 1%AS. We could improve both theprimary therapeutic effect and the prevention of recurrence by EVL-1%A5 therapycompared with independent EVL. The large varices like F3 levels could be treated successfully by this combination therapy. Recurrent bleeding occurred in 3(8.6%)out of the total patient group by 12 months follow up. We didn't observe the enlargernent ofgastric varices, and recognize the severe side effects. EVL is the useful method for treatment of large and elevated varices. Sclerotherapyby extra-varieeal injection with 1%AS has the effect of mucosal fibrosis, and is theeffective method for treatment of superficial type varices including recurrent lesions. We considered EVL-1%AS therapy had the mutual merits of both methods. In conclusion, EVL-1%AS therapy is the easy and safe technique, and the less invasivemethod for the patients. EVL-1%A5 therapy is the new useful treatment for esophagealvarlces.

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Two hundreds patients were examined using upper gastrointestinal endoscopy toevaluate gastritis in relation to Helicobacter pylori infection. Histological assessment forinflammatory cell infiltration, mucosal atrophy, and frequency of intestinal metaplasia wasperformed in gastric biopsy specimens according to the "Sydney system". Serologicalmarkers of gastritis, like pepsiniogen I, pepsinogen, II, and gastrin were also measured. H.pylori status was determined by histological examionation and serum anti H.pylori IgG antibody. There was no difference in the prevalance of H.pylori in gastritis patients between those with clinical symptom and without. The frequency of inflammatory cell(mononuclear cells and polymorphonuclear cells)infiltration in H.pylori positive patients was significantly higher than that in H.pylori negative patients. The frequency of H.pylori infection did not differ in those with atrophic gastritis from those without, whereas thefrequency of intestinal metaplasia became significantly higher in those with moderate andsevere atrophy. Although there was no significant difference rn serum pepsinogen I levelsbetween H.pylori positive and negative patients, serum pepsinogen II levels were significantly increased in H.pylori positive patents. The serum pepsinogen I-II ratio was significantly lower in H.pylori positive patients. Serum fasting gastrin levels weresignificantly increased in H.pylori positive patients. These results suggest that H.pylori infection plays an important rode in the pathogenesis of chronic and atrophic gastritis andin the development of intestinal metaplasia.

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This study attempted to make certain the procedure and the accuracy of the differentiation between the red scar and the white scar of du.odenal ulcer in the conventionalendoscopic examination of the duodenal ulcer scar. Twenty-nine cases of duodenal ulcer were examined by using an endoscopic instrument for color measurernent which consists of the fiberscope(Model MT-III, Machidaendoscopic. Co., Tokyo, Japan)and the spectrophotometric colorirneter(Model CMS-1200, Murakami Color Research Laboratories, Tokyo, Japan). The patients were devided intothe red scar group and the white scar group by conventional endoscopic observation of theduodenal ulcer scar. Mucosal color of the duodenal ulcer scar and the surrounding normalduodenal rnucosa were measured. The results indicated the the procedure and the accuracy of the endosccpic differentiation between the red scar and the white scar of duodenal ulcer, which could be summarizedas follows. 1. The endoscopic differentiation between the red scar and the white scar was notperformed by the direct comparison of the mucosal color between the red scar and thewhite scar. No significant difference of the measurement values (hue, value) of the mucosalcolor were found between them. 2. The endoscopic diagnosis of the red scar was performed by the recognition that themucosal color of the scar was more reddish than that of the surrounding normal duodenalmucosa. The result of the mucosal color measurement showed that the endoscopicdiagnosis of the red scar was very accurate. 3. The endoscopic diagnosis of the white scar was performed by the recognition thatthe mucosal color of the scar was the same or mare whitish than that of the surroundingnormal duodenal mucosa. The result of the mucosal color measurement showed that the endoscopic diagnosis of the white scar was not accurate. Thirty-five percent of the cases of white scar group had more reddish mucosal color of the ulcer scar than that of thesurrounding normal duodenal mucosa.

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An attempt was made to elucidate endoscopic and histologic characteristics of benignprotruding lesions which arise at the scar of endoscopic mucosal resection(EMR)for earlygastric carcinoma(EGCa)and gastric adenoma. These benign protruding lesions developedin 70f 23(30%)lesions of EGCa and in 4 of 27(15%)lesions of gastric adenoma which hadbeen followed at least one year after EMR. The shapes of benign protruding lesions wereas follows; 6 Yamada(Y)1-2 type elevations, 4 flat elevations, and one Y-4 type polyp.The incidence of developing henign protruding lesion after EMR was 44%in the antrumand higher than the incidence of 12%in the body of the stomach. Histologic examinationof benign protruding lesions after EMR revealed hyperplasia in 6, intestinal metaplasia in 3, pyloric glands ln l and and surface epithelium with granulation tissue in 1 lesion, respectively. It may be possible that the potential of hyperplasia which may reside in apparentlynormal mucosa sorrounding EGCa or gastric adenoma might wake up during the healingprocess of the EMR ulcer and develop to benign protruding lesions.

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The muscularis mucosae of the stomach is thought to be included in the second layerof five layers of which the stomach wall consists by endoscopic ultrasonography (EUS) .Nevertheless the muscularis mucosae has still been impossible clearly to be visualized asacertain layer on EUS image. This study was aimed at devising a nevv scanning method to depict the layer of the muscularis mucosae of the stomach We tried to figure this layerby using high-resolution ultrasonoprobe With “ submucosal-injection method ” and scanning acoustic microscope (SAM) system. Ultrasound on this system penetrates into the tissuedependently on sound-speed of biological tissues and this scan differentiates each area onacertain tissue according to acoustic impedance. Fresh pieces of the human gastric wall were mounted on the cork hoard which were obtained surgically. Scanning line was determined by two steel needles which were picked by 15 mm distance. FUJINON sonoprobe-sytstem SP-101 (20MHz) was used through the forceps channel of an endoscope. Subsequently to ordinary scan, sonolucent echo-jelly was injected as an “ enhancer” into thesubmucosal layer. After ultrasound scanning, the resected stomach was fixed in 10% of formalin and cut along the marked pin-hales in order to compare the scanning image with the optical microscopic findings and with acoustic properties by SAM. Ordinary scan by SP-101 showed five layers. After injecting echo-jelly, a thin hypoechoic layer depictedbetween the second layer and the “ enhancer” . It revealed 1000μ m thick from the surface of the first layer to the thin hypoechoic layer of which the layer itself was 100μ m. This finding was identical to the muscularis mucosae an histalogical findings on their position.From SAM image, there might be enough differentiation of acoustic impedances to create an interface echo between the mucosal layer and muscularis mucosae as much as those between the muscularis mucosae and submucosal layer. In conclusion, as these ultrasonogram showed, the layer of the muscularis mucosae corresponds to the most superficial part of the third layer. This new technique devised here of the high-frequency ultrasonoprobe can depict the position of the muscularis mucosae, which will enable precise analysis when we are going to make a depth diagnosis of early gastric cancer which is invasive inside oroutside of this layer.

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The complications related to endoscopic polypectomy (EP) and endoscopic mucosal resection (EMR) were analyzed. At our hospital, EP and EMR were performed in 346 and 223 cases, respectively, from Jan. 1984 to Apr. 1994. The incidence of requiring endoscopic hemostasis was as foilows; EP: 13.0% (slight, 41 cases; moderate, 3 cases; severe, 1 case), and EMR, 14.3% slight, 23 cases; moderate, 8 cases; severe, 1 case). The incidence of perforation was EP; 0.28% (1 case) and EMR; 0.45% (1 case), respectively. The incidence of moderate and severe hemorrhage related to EMR was higher than that of EP. In the cases which underwent EP, the factors of 1) maximum length of the resected specimen and 2) lesion at the C-region were assosiated with tendency to hemorrhage. However, no relationship was noted between hemorrhage and histological diagnosis( hyperplastic polyp, adenoma, cancer). In the cases which underwent EMR, no difference was also noted in theincidence between adenoma and rnucosal cancer. All cases of hemorrhage recovered byendoscopic ethanol injection and there was no need for surgical treatment. No patient revealed rebleeding. Perforation occured due to ensnaring of the proper muscular layer in both cases.

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During the 5-year period between 1990 and 1994, we surveyed, on the basis of medical records, the rnanagement status of maintenance therapy in 2, 612 patients receivint drug therapy for peptic ulcer. The following results were obtained.1) About 90% of the patients were receiving maintenance therapy.2) A combination of drugs (an H₂-receptor antagonist+cytoprotective agents) was administered to most patients.3) There was a correlation between age and drug compliance and the duration of maintenance therapy: patients in the younger age groups tended to have poorer compliance and shorter duration of maintenance therapy.4) Maintenance therapy had an unsuccessful outcome in about 25% of patients, as demonstrated by endoscopic evidence of worsening in the process of maintenance therapy or relapse after the same therapy.5) About 60%of the patients discontinued maintenance therapy. The main reasons were discontinuation of therapy by patient's own judgement and inadequate management of maintenance therapy by physicians. These findings indicated substantial problems on the management of maintenance therapy in patients with peptic ulcer.

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A 50-year-old man with Hemophilia A was admitted for the treatment of esophagogastric varices. Endoscopic variceal ligation (EVL) was performed. Three days after theprocedure, epigastralgia developed suddenly. This was judged to be due to a gastric perforation and an emergency operation was performed, consisting of partial resection of the gastric fundus at the site of EVL and partial varicatamy around the fundus. It is generally considered EVL has an advantage over endoscopic injection sclerotherapy in the safety. Previous series of EVL cases have not involved any complications except those associated with overtube. Thus this method of ligation therapy may be as safe for gastric varices as for esophageal varices. However, the use of EVL for gastric varices has notbeen reported, yet. We describe the indication of EVL for gastric varices and the factors caused a gastric perforation to avoid such complications.

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This case study concerns an 81-year-old female patient who has suffered from anemiasince the second half of 1991. In 1993, the anemia began to become worse, and in June of 1993, an endoscopicexamination revealed blood vessel expansion spotted and mottled widely in the gastricantrum. The dilatation of capillaries in the lamina propria was confirmed by biopsy andthis lesion vvas diagnosed as DAVE. In spite of blood transfusions having been givencontinuously, the anemia was still in progress. Therefore, oral administration of 30 mg of prednisolone was started at the end of September, 1994. Subsequently, the anemia was improved. After one month, an endoscopic examination showed that teleangiectasia in the gastric antrum had disappeared and redness had also been eliminated. The amount of prednisolone had been tapired aff in six months. During this time, thepatient had not received blood transfusions. However, the anemia began to advance just before the medication was discontinued and she needed blood transfusions again. The patient died of multiple organ fallure, four months after the cease of prednisolone treatment.

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A 68-year-old man was admitted to our hospital due to lower abdominal pain and constipation. Colonoscopy showed suL-bmucosal tumor-like lesions with central ulceration showing a bull's eye sign in the transverse colon and splenic flexu.re. Histological examina-tion of biopsy specimens obtained from these lesions suggested metastasis from primary lung cancer with large cell type. On CT examination, a space occupying lesion of the spleen was highly suspected to be metastatic. The incidene of the metastasis to the coon in Lung cancer is 2.3-3.0%. However, clinically confirmed colonic metastasis is extremely rare. An unique endoseopic appear-ance shown in this case is more likly metastatic colonic cancer secondary to Lung cancer.

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We report a case of early depressed cancer in the second portion of the duodenum. A 64-year-old woman received uppergastrointestinal endoscopy and an abnormalfendings was painted out in the second portion of the duodenum. Endoscopic examination revealed an irregular depressed lesion with slight surroundingelevation and a Well differentiated tubular adenocarcinoma was highly suspected on biopsyfindings. Endoscopie ultrasanegraphy showed a slightly hypoechoic mass in the mucosa. Wedge resection of the lesion was performed. Histological examination of theresected specimen revealed a well differentiated tubular adenocarcinoma localizing only inthe mucosa, sized 7× 3 mm in diameter and the resected margins were free cf cancer. This case was the 20th case of early depressed cancer of the duodenum and wereviewed the Iiteratures reported in Japan.

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A 35-year-old man was admitted to our hospital with the complaints of right Towerabdominal pain and diarrhea. Colonofiberscopic and X ray examination revealed a swollenileocecal valve, multiple polypoid lesions with central depression and flat elevation witherosions in the terminal ileum. Bacteriological and histological examination showed nospecific findings. We made a diagnosis of Yersinia enterocolitica, because of significantelevation of antibody titer to Yersinia enterocolitica (0-3:40, 0-5b:80, 0-9:160).Colonofiberscopic and Xray examination showed significant improvement of lesions in aileocecal valve and terminal ileum by only lactobacillin. bases with consecutive endo-scopical and radiological observation of Yersinia enterocolitica have been rarely reported, we descussed its characteristic of the endoscopic appearances by the Japanese literaturereviewed.

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A case of 61 year-old male was admitted to our hospital because of the cheif complaints of epigastric fullness, constipation, body weight loss. The laboratory examinationrevealed the increase of WBC(64300/μl), CRP(11.0mg/dl)and G-CSF(152pg/ml)respecively. Barium enema found cobblestone appearance surrounding colonic mucosacircularly spreading from rectum to middle portion of transverse colon consecutively.Colonoscopic evaluation revealed no redness nor erosion but cobblestone appearance.Pathohistological findings of biopsy specimens revealed granuloma and gave the diagnosisof Crohn disease. The elementary diet, enerna of predonine(30mg/day)and oral adminis-tration of salazopyrine (4.5g/day)improved the clinical course and laboratory data.Barium enema found the lead pipe appearance and disappearance of haustra but did notreveal cobblestone-appearance. The colonoscopic evaluation revealed edematous mucosawithout capillary vessels. Pathohistolegical findings revealed slight inflammatory infiltration with eosinophil. Although we suspected ulcerative colitis because of the characteristics of laarium enema, he was diagnosed as indeterminate colitis because of the discrepancyamong clinical symptoms, images and pathohistological findings.

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Recently, angiodysplasia has been increasingly reported as a definite cause cf chronicgastrointestinal bleeding in Japan as well. Few cases of bleeding from angiodysplasia ofthe small intestine, however, have been reported. A 16-year-old male visited a hospitalbecause of lower abdominal pain and massive rectal bleeding in July 1992. Peripheralhematological examination showed marked anemia and hypoproteinemia(Hb:5.2 g/dl, TP:4.3g/dl). The patient was referred to our hospital and was admitted. Rectal bleedingranging from 300 ml to 1, 00h ml occured intermittently even after admission. RI angio poolscan and endoscepic investigations of the upper and fewer gastrointestinal tract failed toreveal the source of bleeding. Exploratory laparotomy v as then performed. Dilated, hyperplastic blood vessels were noted on the jejunum and the serosal membrane of theappendix. Intraoperative endoscopy revealed slightly swollen reddening of jejanal mucousmembrane 50 cm anal to Treitz ligament, Endoscopy at a closer distance repealed anetwork of dilated blood vessels. The appendix and jelunal lesion, 15 cm in length, wereresected. Microangiogram of the resected specimen made it possible to confirm thecomplete resection. The lesions were confirmed histopathologically to be angiodysplasia.The patient has a good postoperative course with a relief of anemia. After discharge, thepatient has been foUowed periodically at the outpatients'clinic. No bleeding has relapsedto date, 30 months after surgery.

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A 80-year-old man had undergone choledochotomy. After the operation the bile ducthad been drained by the T-tube for a long term. A small polyp developed on eontralateralside of the T-tube fistula, in the common bile duct. In this case, percutaneous endoscopic polypectomy was performed through the fistula of the T-tube. Pathological diagnosis wasan inflammatory polyp. It was considered that mechanical irritation of the T-tube chronicinflammation resulted in induction of the polyp.

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