Endoscopy has worldwidely prevailed in consequence of the study of Japanese gastroenterologists. However, endoscopy is for knowing the inner surface of the lumen of digestive organs fundamentally and it is difficult for us to observe the inside structure of the digestive organs and tissues. Accordingly, we could not understand the localized lesion as a whole, preoperatively. Therefore, to complete this imperfection, Endoscopic Ultrasonography (EUS) has been developed in 1980's. Since then, the indication of EUS has rapidly extended from the gastrointestinal tracts to the bile duct and the pancreatic duct by the improvement of endoscopy and ultrasound. Furthermore, measurement of the blood flow and vessels, puncture and three-dimensional expression have become possible under EUS. In the near future, treatment of the localized lesions of the digestive organs including gene therapy will be widely performed by using EUS.

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SF-25 is a monoclonal antibody which recognizes a 125 kDa glycoprotein SF-25 antigen highly expressed on the cell surface of the FOCUS human hepatoma cell line. Using this antibody, SF-25 antigen was reported to be expressed with high frequency in colon cancer cells. We investigated the expression of SF-25 antigen in tumorous and non-tumorous change of gastric mucosa. All of differentiated adenocarcinoma (n =14) and adenoma (n = 5) specimens expressed SF-25 antigen. However, one of three undifferentiated adenocarcinoma specimens did not express SF-25 antigen. All specimens of normal gastric mucosa (n=24), gastric intestinal metaplasia (n=10), gastric regenerative mucosa (n=10) and gastric hyperplastic polyp (n= 6) did not express SF 25 antigen. These results suggest that expression of SF-25 antigen is highly specific for malignant and benign gastric tumorous lesions. The monoclonal antibody SF-25 might be useful clinically in the histologic diagnosis of gastric lesions.

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The purpose of this study was to evaluate the effectiveness of endoscopic submucosal saline injection method (injection method) in diagnosing the infiltration degree of early colorectal cancer and in planning therapeutic method. The degree of elevation by injection method was evaluated for each lesion : a case in which the lesion was completely elevated was defined as a positive lifting sign, a case in which the lesion was incompletely elevated or not elevated was defined as a negative lifting sign. We investigated the relationship between lifting sign and the depth of cancerous invasion. Furthermore, we also examined lifting sign by endoscopic ultrasonography (EUS). We performed injection method for 66 lesions of mucosal cancer (m-cancer), 37 lesions of submucosal invaded cancer (sm-cancer) and 5 lesions of muscularis propria invaded cancer (mp-cancer). Sm-cancers were divided into two groups (sm-slight and sm-massive cancer), according to the degree of cancerous invasion within the submucosal layer. The results were as follows : 1) Positive rates of lifting sign were 97% in m-cancers, 100% in sm-slight cancers, 48% in sm-massive cancers and 0% in mp-cancers, respectively. In 27 lesions of sm-massive cancer, lifting signs were positive in 13 lesions and negative in 14 lesions. 2) On the assumption that positive lifting sign suggested the indication of endoscopic therapy (m-cancer and sm-slight cancer), and negative lifting sign suggested the indication of radical operation (sm-massive cancer-), overall diagnostic accuracy by injection method was 86% (93/108 lesions). 3) EUS findings after injection method were well correlated with lifting sign. It is concluded that the evaluation of lifting sign by injection method is useful in diagnosing the infiltration degree of early colorectal cancer and in planning therapeutic method. But in cases of sm-massive cancer, positive rate of lifting sign was high, so it is necessary to use other diagnostic methods (such as EUS) with injection method in diagnosing the depth of cancerous invasion.

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The patient was a 58-year-old male. Upper gastrointestinal endoscopy revealed an esophageal cancer, l0mm in size, which was slightly depressed. Since his hepatic function was markedly impaired, the endoscopic mucosal resection using an O ring for endoscopic variceal ligation (EMR-L) was indicated. Chemotherapy was performed, because the depth of tumor invasion was m3. No recurrence has been observed for 36 months since the operation. This report describes efficiency of EMR-L.

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A 58-year-old male was admitted to our hospital with epigastric pain and hematemesis after eating Chinese noodles. Emergency panendoscopic examination revealed erosions and ulcerations from the middle esophagus to esophagogastric mucosal junction, and circular erosive and ulcerative lesions with bleeding in the lower esophagus. It is thought that the cause could be thermal burn of the esophageal mucosa due to Chinese noodles from history. He had been given a proton pomp inhibitor and antacids and his esophageal mucosa improved to almost normal without stenosis after one week.

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A46-year old man was admitted with an epigastralgia. Barium swallow and upper GI endoscopy showed an active gastric ulcer in the angulus of the stomach. After the medication with H2 receptor antagonist, examinations showed a mucosal bridge adjacent to the ulcer. Endoscopic examination revealed the gastric mucosal bridge complicated with ulcer healing. Although mucosal bridge in the esophagus after the endoscopic variceal injection and in inflammatory bowel disease have been reported in Japan, gastric mucosal bridge is considered to be very rare. We herein reported a case of gastric mucosal bridge following ulcer healing of the stomach.

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A 60 year-old man was admitted to our hospital for melena. He was received aortic resection and grafting 9 years ago. Upper gastro-intestinal fiber scopy revealed no abnormality on admission. Abdominal ultrasonography and computed tomography showed abdominal aortic aneurysm. At 4 days after admission, melena was seen again and Upper gastro-intestinal fiber scopy showed a pulsating elevated lesion with ulceration at the third portion of the duodenum. On operation, the fistula was found between abdominal aortic aneurysm and the third portion of the duodenum. The diagnosis of the primary aorto-duodenal fistula was established. Closing the fistula and grafting were performed. He is living well 17 months after operation.

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A 67-year-old man who complained tarry stools was admitted to our hospital. Upper and lower endoscopic examination did not show abnormal findings. Small intestinal X-ray examination showed a polypoid lesion in the jejunum. Endoscopic examination revealed a red lobullar polyp, and then we resected this polyp by endoscopic polypectomy. Histopath-ologic study showed hyperplastic mucosal layer without atypia and tree-like proliferation of the muscularis mucosa. Since he did not have family history, mucocutaneous pigmenta-tion or polyposis, we diagnosed this case as a solitary Peutz-Jeghers type polyp of the jejunum. Endoscopic examination of small intestine was useful in detection of responsible disease causing tarry stools. Endoscopic polypectomy has an advantage of reducing stress in comparison with surgical resection. Gene mapping studies must be under way to identify the chromsomal location of the responsible DNA abnomalities of the solitary polyp and the polyp of Peutz-Jeghers syndrome.

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The patient was a 40-year-old female who was examined in our hospital for a complaint of rectal bleeding. Colonoscopy revealed diffuse, circumferential, continuously yellowish white opacification in the entire colon, and numerous slightly depressed very small brown spots several millimeters in diameter. The color of the opacity was whiter in the rectum and sigmoid colon than in the cecum and ascending colon, and the brown spots were smaller and sparser. In addition, a yellowish opaque surface was observed on one of side terminal ileum. A biopsy showed clusters of foamy cells in the lamina propria. Lipid studies showed a marked decrease in HDL-Ch, α-lipoprotein, and apo A-I, and a diagnosis of Tangier disease was made. Small yellow spots were also present on the patient's palatine tonsils, and the cornea was opacif ied. A family study was performed and the patient's 37-year-old sister was found to exhibit a similar lipid profile and colonoscopic findings.

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Cholecystogastric fistula is rarely encountered among internal biliary fistulae. A 62-year-old woman, who had been pointed out to have cholecystolithiasis for the past 16 years, complained of epigastrial discomfort and underwent upper GI series at a local clinic, which suggested pyloric stenosis probably due to gastric cancer. Endoscopic examination revealed an elevated lesion with irregular surface and central ulceration at the anterior wall of the antrum. Additional diagnostic imaging techniques, such as CT scanning, endoscopic ultrasonography, and drip infusion cholangiography, showed that the gastric lesion might be associated with cholecystitis and the gallstone. Surgical findings included marked cholecystitis and a large stone in the gallbladder. Cholecystogastric fistula was found after removal of the impacted gallstone. From these findings it was made clear that the peculiar elevated lesion in the stomach represented the gastric orifice of the cholecystogastric fistula. Cholecystectomy and repair of the gastric wall was performed, followed by an uneventful postoperative course. This case is very interesting in that the fistulous orifice with an impacted gallstone endoscopically showed a unique elevated lesion different from the typical appearance of submucosal tumor or gastric cancer.

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