Solitary gastric varices are usually associated with gastrorenal shunt. Using this hemodynamic factor, we performed TAPS, a new method for eradicating solitary gastric varices. Twenty eight patients with solitary gastric varices were included in this study.Each patient received insertion of balloon catheter through internal jugular vein andballoon vvas finally located at shunt vessel as drainage route of gastric varices that is connected to greater circulation. The shunt vessel was obliterated by retrograde transvenous infusion of 5%ethanolamine oleate(EO). Injection of EO was repeatedly performed at once a day until acquisition of complete obliteration of varices and shunt vessels. Disappearance of gastric varices was recognized in 26 patients (92.9%). The number of injection per session was 2.39±0.98(mean±SD). Total volume of injected EO was 32.0±20.5ml(mean±SD). Severe complication was not seen in all patients. Cumulative survival rate of l year and 3 years was 87.6%and 73.6%, respectively. In these 28 patients there were five deaths not related to TOPS but to the hepatic failure or hepatocellular carcinoma. Both rebleeding and recurrence of varices did not occur in all patients. These results suggest that TAPS as self-retaining catheter method is useful in controlling Mood flow of shunt vessels. TAPS is highly effective method of eradicating gastric varices safety and Without recurrence.

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We have experienced the recurrent esophageal varices of superficial F0-F1 type after endoscoprc treatment. These recurrent varices have been treated by endoscoprc injection sclerotherapy(EIS)with 1%Aethoxysklerol(1%AS). We performed endoscopic variceal electrocoagulation (EVE)for the eradication of recurrent esophageal varices of superficial F0-F1 type, We discussed the therapeutic effect and usefulness of EVE compared with EIS with 1%AS. We tried to perform EVE in 8 patients with the recurrent esophageal varices of superficial F0-F1 type. Electrocoagulation was conducted with an output 30-35 Watt using the monopolar device. The 8 patients were treated 20 times using 5 sec of individual electrocoagulation. We achieved the eradication in 5(62.5%)and the slight residual in 3 (37.5%)out of 8 patients 6 months after EVE. We recognized pyrexia in 2(25.0%)and dysphagia in 1(12.5%)with the complications of patients treated by EKE. As control, we performed EIS with 1%AS in 8 patients, and achieved the eradication in 3(37.5%), the slight residual in 4(50.0%)and the mild residual in 1(12.5%)out of 8 patients 6 months after EIS with 1%AS. We recognized pyrexia in 2(25.0%), dysphagia in 3(37, 5%)and retrosternal pain in 2(25.0%)with the complications of patients treated by EIS with 1% AS. The electrocoagulation unit has been spreaded in the many hospitals. The technique of electrocoagulation has been common for endoscopic treatments and is often used for hemostasis and polypectomy. EVE is the reasonable technique using thermal therapy that we can burn directly and disappear the superficial esophageal varices. We considered that EVE was easier to manipulate than EIS with 1%AS and could cause shallow and uniform ulcerations without esophageal stenosis. EVE was achieved the better therapeutic effect and less invasion compared with EMS with 1%AS. In conclusion, EVE is the reasonable and useful therapy for the recurrent esophageal varices of superficial F0-F1 type.

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To determine the management of eolorectai nodule-aggregating lesien, we studied the relationship between endoscopic findi:ngs arld histopathological results (mainly, incidence of carcinoma and depth of invasion) in 45 lesions (44 cases)treated by endoscopic or surgical resection. Resected specimens revealed 22 adenomas and 23 carcinomas (carcinoma in adenoma; 20 lesions), which included 17 intramucosal carcinomas and 6 invasive carcinomas (sm; 5 lesions, mp; 1 lesion). The frequency of accompanying carcinoma increased significantiy in iarger lesions of the tumor size and iesions with giant noduie or depression on the tumor. And the difference in the frequency of invasive carcinoma between lesions with depression and those without depression was statistically significant. In addition, it is essential to perform endoscopic ultrasonography for the dzagnosis of depth of invasion. From the point of view of tumor size, endoscopic resection was safe and certain in lesions with the diameter smaller than 40mm. clinical management of colorectal nodule-aggregating lesions should be determined syntheticically in accordance with abovementioned results.

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Fifty patients with acute hemorrhagic rectal ulcer (AHRLT) seen at our hospital in the past ID years, are reviewed to compare the clinical features and endoscopic findings with those reported previously. The subjects consisted of 20 men and 30 women with average age of 76.3, which means a higher incidence in.wornen as well. The primary diseases on admission are mostly cerebrovascular diseases occurring in 18 patients. Fourteen patients presented with only meiena or dehydration and 7 patients with fracture of femoral neck, who showed good general conditions. This clearly indicates that AHRU should develop even in patients without serious complications. The associated disorders included hypertension in 28 patients and diabetic meilitus in 11 patients. Forty-seven of 48 patients who were evaluated with detailed information had been confined to be in a bed-ridden condition at the onset of AHRU. This suggests that arteriosclerotic factors and physical factor such as bed-ridden condition may be a closely relatied to the development of AHRU. AHRU isgenerally characterized by indolent massive hematochezia. In this study, however, 2patients presented with anal pain only and g patients with very slight bleeding. Endscopic examinations revealed that ulcers should be likeiy to be multipie and be localized in the louver rectum on the dentate line. Twenty-nine of 47 patients with detailed information had whole circumferential u.icer, which may be a characteristic finding of AHRU. In addition, this study suggests that treatment in the lateral position should be useful and effective for this disease.

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During a period of more than 10 years before December 1991, 169 gastric ulcer patientshad been followed up over one year. The 160 ulcer patients included 126 males and 34 femaies. Eleven gastric cancers were detected among the 160 gastric ulcer patients. These gastric cancer lesions were located in different sites of the stomach from gastric ulcers. These cancer cases were detected in g males and 2 female patients with gastric ulcer. Of the 11 gastric cancer patients, 10 with early gastric cancer had 13 IIc type lesions. One patient had a Sorrmann 4 type lesion. We calculated the relative risk of developing gastric cancers in other locations than the original ulcers among study subjects as compared with the risk in the general population. Nine cases of gastric cancer were observed in 126 male subjects and 1.45 cases were expected from an age-specific incidence rate obtained from MIYAGI Cancer Registry. The ratio of observed/expected number of new cases (95 confidence interval) was thus 6.19(2.2-11.76), suggesting an increased risk of developing gastric cancers in patients with gastric ulcer.

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We retrospectively studied far the relationship between the diameter of solitarygastric varices (Lg)and the amount of injected alpha-cyanoacrylate monomer(CA)in 18 patients with solitary Lg who were examined by endoscopic uitrasonography (EUS) beforeand after EIS. Endescopie findings of Lg in 18 patients were F2 in g and F3 in 9. Lg was displayed as an aechoic area in the third layer of the stomach wall by EUS.The maximum short axis of the aechoic area was measured as Lg diameter. The mean Lgdiameter of solitary gastric varices with F3 was 5mm or more and significantly larger thanthat of F2 (P< 0.05). A positive correlation was observed between the diameter of Lg andthat of vein penetrating through the stomach wall (r=0.49), However, no correlation wasobserved between F factor and the diameter of penetrating veins. Asignificant correlation was observed between the volume of CA injected into Lg anddiameter of Lg measured by EUS(r=0.65)in 14 of 18 patients. Six cases were less than5mm in Lg diameter rneasured by EUS. Three of 6(50%)cases with Lg diameter less than5mm were treated with CA and the others were treated with 5%ethanolamine oleate. Onthe other hand, 11 of 12(91.6%)cases with Lg diameter more than 5mm were treated with CA alone. Therefore, Lg of 5mm or more in diameter should be jnjected with CA. Measuring Lg diameter on EUS before EIS is useful for selection of sclerosants, especially CA and for determining the volume of CA to be injected.

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The application and clinical efficacy of three-dimensional intraductal ultrasonography, (3D-IDUS)using a three-dimensional ultrasonic probe imaging system for biliary diseaseswas assessed. For the 3D-IDUS, 12MHz or 20MHz frequency ultrasonic probes wereapplied, both radial and linear images being obtained at one scanning operation in-realtime. Three-dimensional observation was thus made possible using the tvvo image typesin combination. Sixteen patients with percutaneous transhepatic biliary drainage wereexamined 3D-IDUS, and diagnoses could be made in all cases about tumor extension, andrelations to blood vessels and surrounding organs, as well as visualization of the course ofvessels. In 3 cases with distal bile duct carcinoma, tumor volumes could be measured.Using the 3D-IDUS system, advances in the capacity of this approach far diagnosticpurposes can be expected.

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Approximately 70 cases of acute generalized pustular bacterid (AGPB) have been reported. However, esophageal lesions have not been described. A 61-year-old male had been receiving topical preparations for pustulosis palmaris et plantaris at the Department of Dermatology since October 1995. However, in early November 1995, pustules appeared throughout the body including the oral cavity after cold-like symptoms developed. The patient consulted our department complaining of a strange sensation in the esophagus. Endoseopy revealed that white round hullae, erosion where the epithelium of hullae had exfoliated, and ulcers were present throughout the esophagus. There were no abnormal findings in the stomach or duodenum. After one week, endoscopy revealed that the exfoliated mucosa appeared a white mucosal protrusion, suggesting exfoliative esophagitis, which disappeared about 3 weeps after administration of antibiotics. Biopsy specimens from the esophageal mucosa on the initial consultation suggested pustules similar to those in anthema. The present case appears to be a rare case in which AGPB caused esophageal lesions.

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We treated two cases of duodenal varices effectively by endoscopic variceal ligation (EVL) using o-rings. Case l was a 63-year-old male with liver cirrhosis of type c(Child's class, B) who was admitted due to hematemesis and melena. Endoscopic observation revealed F2 varices with positive red color sign in the esophagus and F3 varices in the posterior wall of the inferior duodenal flexura. First, the esophageal varices which was suspected as the source of bleeding was treated by endoscopie injection sclerotherapy (EIS), and, next, the duodenal varices was treated by EVL twice and was disappeared in consequence. Case 2 was a 50-year-old male with alcoholic liver cirrhosis (Child's class, C) who was admitted due to hematemesis and melena. Endoscopic observation revealed F3 varices with red fihrin plug in the posterior wall of the second portion of the duodenum, which was considered to be the source of bleeding. EIS was immediately tried for the treatment of the duodenal variceal bleeding, but it was suspended because of no evidence of varicealography. EVL was performed twice, and the duodenal Varices disappeared. In two cases, no significant complications were encountered and short-term follow up endoscopy showed no reappearance of varices. EVL using o-rings was found to be an effective therapeutic technique for duodenal varices.

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A 64-year-old male was admitted to 6ur hospital in April 1996 with the history of alcoholic liver cirrhosis and tarry stool. The endoscopic examination revealed duodenal varices at the second portion of the duodenum, showing erosion at the top of the varices. Because of the poor liver function, we tried endoscopic variceal ligation, resulting-in complete eradication of duodenal varices without any complication. Endoscopic variceal ligatian might be a safe and effective therapy for the treatment of duedenal varices.

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A 55-year-old man was referred to our hospital with hematemesis arld melena. Atemergency endoscopy, spurting ar flowing hemorrhage was noted in the second portion ofthe duodenum. Although the cause and site of hemorrhage was not clear, HS-E wasinfected topically to achieve primary hemostasis. The next day, the site of hemorrhage inthe duodenum was seen as a smooth reddened spot without ulceration. Avascularmalformation was suspected, and microwave coagulation using needle electorode wasper orme 44 watts, 15 sec×5 times. After two additional sessions of microwavecoagulation, the lesion disappeard and complete hemostasis was achieved. Abdominalangiography on the 14th hospital day showed racemose vascular network, which vvasvisualized in the region of the head of the pancreas and the duodenum as well as in the bodyand tail of the pancreas. The peripancreatic veins and portal vein were visualised in theearly arterial phase. Because the arteriovenous malfomation involved the whole pancreas, no surgical resection vas perfarrned. His stools have remained negative for occult bloodon follow up.

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A 31-year-old man with extrahepatic portal vein obstruction was admitted to our hospital because of intermittent bloody stool. He had a history of abdominal operations 2 times and endoscapic injection sclerotherapy (EIS)for esophageal varices. By endoscopic examination, diffuse duodenal varices was found from the lst portion to the 3rd portion of duodenum and bleeding variees was recognised on the 2nd portion. EVL was performed successfully for the bleeding varices. EIS with 1% aethoxysclerol was performed the next day. 2 months later, endoscopie examination showed that varices near the treated site almost disapperred and scarred. In conclusion, EVL is a safe and simple method, and it should be considered as an effective, therapy for ruptured duodenal varices.

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The patient was a 69-years-old man, who was hospitalized in the emergency lifesaving center due to heavy melena. From the results of the double contrast imaging of the small intestine, abdominal angiography and hemorrhagic scintigraphy, a bleeding lesion was suspected in the ileum on the anal side. As melena persisted, an intraoperative endoscopy was performed under an emergency laparotomy and a small elevation with erythema and erosion was detected in the ileum and resected. The lesion was diagnosed histopath-ologically as a capillary hemangioma. while the incidence of this disease is low, the patient may follow a serious and lethal course and, therefore, a quick diagnosis and treatment are needed.

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Two patients with entero-Behget's disease were observed to have formed a doublelumen ileum in the terminal ileum, during a long term follow-up period. A deep penetratingulcer of the entero-Behget's disease was supposed to have resulted in the ileo-ileo fistulato form a double lumen ileum. This is the first report of the aquired double lumen ileumsecondary to the inflammatory bovvei diseases, including Crohn's disease which often formsentero-entero fistulas.

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A 63-year old man visited our hospital for detailed examination of liver dysfunction discovered in a routine medical check-up. Abdominal US and EUS showed irregular thichening of the common bile duct, while ERCP showed stenosis and irregular rosary-like lesions in the lower bile duct. The diagnosis of primary selerosing cholangitis was made on the basis of these findings. PTCS was conducted to determine the presence or absence of cholangiocarcinoma. The biliary mucosa was rough and showed redness, scars and diverticulum-like changes. No evidence of malignant findings was noted in any examinations, including histological examination of a biopsy specimens taken by cholangioscope. The stenosed portion of the bile duct was coagulated and dilated using micro-wave under PTCS and the drainage tube was withdrawn when hepatic function tests returned to normal after creating a percutaneous drainage route. Treatment using cholangioscopy seems to have been effective, since hepatic function has remained normal for 30 months sincc the corrcction of stcnosis.

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