Since 1960, on the progression of gastric cancer, using endoscopy we have conducted aclinical study which later led to basic studies cn the development, growth and metastasis of gastric cancer, Following the discovery of Helicobacter pylori, the relations to gastritis caused by H.pylori and well differentiated adenocarcinoma of the stomach have been paged a great deal of attention. In our study, early gastric cancer of comparatively small size less than 2 cm, was found to have the relation in both well differentiated and undifferentiated adenocarcinoma. The study also indicated that H. pylori infection possibly determined the environmeat of the mucosa in which cancer developed. Our study on gene abnormality, relative to the development of gastric cancer, found that multiple gene abnormalities played a role in the development. Some of gastric cancers seemed to develop through the stages of intestinal metaplasia and adenoma. Many factors also play a part in infaltration of gastric cancer. Important factors in the region of cancer lesion were weakening of intercellular adhesion factors and destruction of the interstitial matrix around cancer cells.

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Recently elldoscopic mucosal resection(EMR)of early gastric cancer has been performed cornmollly. Now it is very important to clarify the local and life prognosis of patientswith early gastric cancer treated by EMR. Materials and Methods: Two hundred and sixearly gastric cancers(183 cases), including 13 cases with additional surgical resection afterEMR, were analyzed on the view of local recurrence and prognosis after EMR using"Strip biopsy"methods at Hiroshima university Hospital between 1986 January and 1996 June.Follow-up examination was performed by endoscopy and average observation periods were23.7±18.9months. Results: Rate of local recurrence was 5.2%(10/193). Regardingresection methods, local recurrence rate in one-chance and piecelneal resection were 5.6%(6/107)and 4.7%(4/86), respectively. For lesions with absolute illdication(20mrnge;, intestinal type, Ul(-), and no vessel involvelnent), local recurrence rate was 4.6%(6/130).Even if we broade:ned the absolute indication up to 21mm in diameter, the local recurrencerate was 4.6%(7/152). In lesions without absolute indication, local recurrence rate was6.3%(4/63)and it showed no significan.t difference in comparison with that of lesions withabsolute irldicatioll. All recurrent lesions were completely cured by additional treatmentand there were no patients who died of the gastric cancer treated endoscopically. Rate oflesions completely cured by first EMR, including 13 cases with additional surgical resectionafter EMR, was 91.3%, and that was 85.1%even in lesions without absolute indication.Conclusion : EMR is very useful in treatment of early gastric cancer including lesiollswithout absolute indication. Piecemeal EMR planed ahead may be able to broaden theabsolute indication of EMR for early gastric cancer concerning its size.

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Endoscopic variceal ligation (EVL) combined with partial splenic embolization (PSE) was performed in 35 cases of esophageal varices, from Janu.ary 1994 to December 1997. Analysis was carried out on the cumulative recurrence rates of ‘ EVL combined with PSE’ on 31 cases where comLplete eradication of varices was achieved (F₀ and negative Red colorsign) . We compared these rates to those of ‘ EVL only’ . The 6-month, ryear, and 2-yearrecurrence rates of ‘ EVL combined with PSE’ group were 21.1%, 37.2% and 58.1%, respectively. On the other hand, the 6-month, 1-year, and 2-year recurrence rates of ‘ EVL only’ group were 58.1%, 70.7%, and 80.4%, respectively. For all 3 time periods, recurrencerate of ‘ EVL combined with PSE’ group was significantly lower than that of ‘ EVL only’ group (log rank test, P=0.042) . Further analysis was made on the comparative recurrencerates of the two groups according to Child's classification. In Child A, the curnu.lativerecurrence rate of the ‘ EVL combined with PSE’ group was not significantly lower thanthat of ‘ EV:L only’ group. However, in Child B, the cumulative recurrence rate of ‘ EVLcombined with PSE’ group was significantly lower than that of ‘ EVL only’ group (log ranktest, P=0.032) . Lastly, in Child C, the same tendency as in Child B was seen between thesetwo groups. We conclude that ‘ EVL combined with PSE’ is a very effective therapy forachieving long term complete eradication of varices.

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An 80-year old man came to our hospltal complaining of dysphagia and abdominaldistension. Endoscopic examination showed that he had gastric cancer of Borrmann type3 at the cardia and carcinomatous peritonitis, which were considered inoperable. Afterobtaining an informed consent, we placed a flexible esophageal prosthesis with an anti-reflux valve at the esophagogastric junction stricture. A surgical silicone penrose drainwas attached to the flexible esophageal prosthesis as an anti-reflux measure prior to theplacement. The patient could not even eat fluid diet before the placement, but he becameable to eat rice gruel after the placement. No signs of reflux esophagitis or aspirationpneumonia were observed. we reported this case to show the usefulness of the esophagealprosthesis in improving the QOL of such patients

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A case of 73 year-old man with anaplastic large cell lymphoma in the stomach isreported. In 1993, the patient who was admitted to our hospital with cervical and mediastinallymph Hades swelling, was initially misdiagnosed as Hodgkin's disease. Then he receivedchemotherapy and achieved complete remission. In 1994, endoscopic examination revealedadepressed lesion grossly mimicking a IIc type early cancer on the Iesser curvature of thecorpus. In the histologic findings of the biopsy specimens, it was difficult to distinguishbetween poorly differenciated adenocarcinorna and malignant lymphoma. Immunohisto-chemical examination was underwent both biopsy specimens of cervical lymph Wade in 1993and stomach in 1994. Both of these:neoplastic cells revealed CD30(Ki-1)positive and CD15negative. Therefore, this case Was diagnosed anaplastic large cell lymphoma. We reportarare case of this lymphoma involving the stomach.

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An inflammatory fibroid polyp (IFP) is a su.bmucosal granulorna with the infiltrationof eosinophils. The IFP is a rare disease and there are few reports about the findings ofendoscopic ultrasonography (EUS) of IFPs. We found an IFP in 75-year-old female andexamined it by EUS. An ordinary endoscopic study showed the type 2 polyp (classificationof Yamada) at the gastric antrum. It had reddish surface and an erosion on the center.ELTS indicated a hypoechoic mass lesion mainly located in the 2nd and the 3rd layers of thegastric wall. The border of it was unclear. The echo pattern of the lesion was heterogene-ous and some high echoic spots were recognized. in it. The polyp was removed byendoscopic mucosal resection. The histological examination of it revealed that it iscompatible to the IFP. In this case report, ire compared the EUS findings of the IFP in thiscase to those in other ll cases reported in the previous papers. The characteristic findingsof EUS in IFPs are followings; 1)The lesions are located in the 2nd and/or 3rd layers ofthe gastric wall. 2)The border of the lesions rs not clear. 3)The echo pattern of the lesionsis homogeneous. 4)The echo Ievel of the lesions is law.

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The patient was a 72-year-old man. He had been followed up at a hospital withdiagnosis of submucosal tumor in the antrum of the stomach for one year. He hoped thefurther examillation ill our hospitaL The tumor was larger with a multinodular surface foron.e year. Endoscopic ultrasonography showing the tumor located mainly in the third layer.The tumor had a clear boundary with low echoic resions and consisted of various sizedhoney-comb forms. The biopsy performed by the upper digestive endoscopy revealed amucinous adenocarcinoma and, thus, the patient was operated on. It was a gastricmucinous adenocarcinoma showing su.bmucosal tumor morphology and the depth of tumorlnvasion Was sm.

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A 61-year-old man urgently adrnitted with a chief complaint of sudden rnelena.Labolatory data on admission showed an anemia. Colonoscopic exarnination showed apedunculated polyp in the hepatic flexure, which had fresh oQzing from an erosion on thereddish head of the polyp. We regarded this lesion as the cause of hemorrhage, andtherefore, colQnoscopic polypectomy was performed. The lesion was resected successfullywithout complication. Pathologically, the patient was diagnosed with an angiodysplasia ofthe colon. Thirty Inonths after polypectomy, there is no sign of rebleeding. Pedunculatedangiodysplasia of the cQlon is rare, and colonoscopic polypectomy is useful for the diagnosis and treatment;of scach lesions.

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A39-year-old male was admitted to our hospital with the symptomes of abdominalfullness and thin stool. Barium enema demonstrated stricture of the sigmoid-colon, 5cmin length. Endoscopic examination revealed circumferencial stricture covered withedematous mucosa at the same portion of the colon, but no cancerous tissue was obtainedwith endoscopic biopsy. Pyeloureterography demonstrated a left hydronephrosis associated with severe stenosis of lower portion of the left ureter. Surgery was indicated with asuspect of malignant abdominal tumor invaded to the colon and retroperitoneum. Onsurgery, the terminal ileum was severely adhered to the sigmoid-colon and to the retroperitoneum, and the tumor resection with partial resection of the colon was performed.Pathological diagnosis revealed Crohn's disease of the ileum. This paper presents a case of the Crohn's disease of the ileum associated with stenosisof the colon and ureter, because of its rarity in the literature.

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A73-year-old female was adrnitted to a hospital due to all inability of takillg foodorally. Her conditions had been followed up after the peritoneal recurrence of the gallbladder cancer operation. The result of her uper gastroi:ntestinal series indicated pyloricstellosis and all expandable Inetallic stent(EMS)was indwelt. Since no complicationsrelated to the indwelt EMS was experienced, she was discharged from the hospital withimproved ability of taking food orally. She could eat orally until she died of advancedcarcinomatous peritollitis about four months later. There is a possibility that an EMSimproves quality of life of patient with stenosis of gastroilltestinal tract caused by inoper-able callcer.

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The present study was performed to evaluate the incidence of hemorrhagic andthromboer:nbolic complication aftercolonoscopic polypectomy in 8 patients taking warfar-in at Ryukyu University Hospital between November 1995 and October 1997. Using International Normalized Ratio (INR)value as a guide for therapeuticantlcoagulation, patients were divided into the following two groups;the heparin group(6patients)was given heparin intravenously after discontinuation of oral warfarin 4 to 7 daysprior to the day of polypectomy and the warfarin group(2 patients)continued to have oralwarfgrin du.ring perioperative period. Although no bleeding during and after polypectomy was noted in bQth groups, cerebralinfarction occurred irl one of 6 patients receiving heparin therapy, who had a prostheticheart valve in the mitral position with long-standing atrial fibrillation. As to hemorrhagic complication, hemorrhagic tendency and postprocedure bleedingwere not o-bserved by the decision following a target INR As to thrornbQernbolic complication, cerebral infarction occurred in one patient.Therefore we found it important that a careful countermeasu.re, such as postoperativecontinuous use of heparin., is recornmended to reduce the incidence of postoperatlvethromboembolic events in patients at high risk of thromboembolism.

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There is danger that severe or fatal complications would occer in patients with ahistory of adverse reactions to contrast media, when contrast media are used again. Incases with Jaundice due to choledocho-lithiasis or malignant biliary stenosis, contrast:media. are often Ilecessary for the diagnostic and therapeutic prQcedu.res. Recently, thereare many reports on the usefulngss of intraductal ultrasonography(IDUS)for the diagnosisof biliary tract diseases. We reported two cases with a history of an allergy to contrastmedia in which the diagnosis and treatment were carried out under IDUS guidance withoutusing contrast media. IDUS instead of using contrast media provides impQrtant andsufficiellt information for endoscopic procedure in jaundiced patients with a history ofadverse reactiorls to contrast media.

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