Images were processed with EVIP-230 to determine the extent of superficial spread ofdepressed type early gastric cancer in 41 patients. Capillary networks and gastric areaswere clearly visualized by adapted enhancement. Color tone and depressed margins wereclearly visualized by IHb color enhancement. The concurrent use of low-level enhance-ment most accurately defined the extent of early gastric cancer. Real-time image processing using both enhancements correctly diagnosed the extentof cancerous invasion in 15 (71%) of 21 cases that were difficult to diagnose preoperatively.Furthermore, image processing was effective in cases unable to be diagnosed by dyeendoscopy. Pathologically, diffuse and superficial mucosal infiltration was well defined incases of undifferentiated adenocarcinoma, and middle-layer infiltration was correctlydiagnosed in 56%. As, for the evaluation of stationary pictures, diagnostic accuracy afterimage processing improved regardless of color tone and'experience of the endoscopist. Weconclude that image processing is effective for diagnosis of the extent of cancerousinvasion in depressed type early gastric cancers.

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We developed a new endoscopic method to incise the gastric mucosa by diode laserablation to support the endoscopic mucosal resection (EMR) for large lesions, Submucosalinjection of lmg/ml indocyanine green (ICG) solution was used to absorb the diode.laserlight at the submucosa and protect the musclaris propriae. When we applied this methodendoscopically to incise the canine gastric mucosa with non-contact method, we obtainedcircumferential incision and placed the snaring wire, although it was wide and bluntincision. However, we sometimes failed to cut the mucosa because of gastric movementand/or trangential irradiation and/or wide laser beam spot. With conical contact probe, continuous and sharp incision was obtained in most cases. Gastric movement and/ortangential irradiation made it difficult to gain stable cutting in some cases. By improvingthe laser probe tip and using the transparent hood, smooth cutting might be easily obtained.We think our laser incision method may be available to enhance the efficacy of EMR forlarge cancer lesion.

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Evaluation of the layer structures of the rectal wall delineated by ultrasonic probeswith a frequency of 20MHz was carried out in 20 patients. The rectal wall was scannedunder two different degrees of distension of the bowel wall (high and low) by both of theprobes;an Olympus UM3R and a Fuj inon SP501. The second, third and fourth layers in theconventional 5-layer structure were devided into 3 layers each and were designated 2a, 2b, 2c, 3a, 3b, 3c, 4a, 4b, and 4c, respectively. The results were as follows: 1) The 2b layer was visualized best by a SP501 with low distension in 25%. 2) The 3b layer was visualized best by a UM3R with low distension in 55%. 3) The 4b layer was visualized much better than the 2b and 3b layers, and it wasvisualized best by a SP501 with low distension in 95%. 4) The layer structure was demonstrated better in low distension than in highdistension.

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A 49-year-old woman was admitted to our hospital because of abdominal distentionand anorexia. She complicated hypothyroidism, mental retardation, and albinism. A hard.mass was palpated on the upper abdomen. Abdominal CT showed a heterogenous mass inthe stomach and the duodenum. Endoscopical examination revealed a gigantic tricho-bezoar. Since Our trial of extraction of the bezoar by the endoscopy was unsuccessfull, thebezoar was extracted by an operation. The trichobezoar was 890g in weight. lt's shapewas like the stomach with a long tail extended to the duodenum. Since then, we have continued treatment of hypothyroidism and done endoscopicalexaminations periodically. Aiso, recurrence of trichophagia has not been found. There-fore, it is suggested that her hypothyroidism related to the trichobezoar. On the other hand, underlying emotional stress is often a factor in the trichophagia. Therefore, psychiatric evaluation and therapy are essential to diminish the frequency ofrecurrences. In this case, we should continue psychiatric treatment in addition to drugtherapy and endoscopical examination.

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A 70 year-old Japanese man with liver cirrhosis was referred to our hospital becauseof tarry stool. He had been taking hemodialysis for two years due to chronic renal failurefollowing lgA nephropathy. The patient had an iron-deficiency anemia with 7.9 g/dl ofserum hemoglobin concentration. Upper gastrointestinal endoscopic examination revealedcharacteristic erythematous diffuse spots in the gastric antrum. Biopsy specimen obtainedfrom the lesions demonstrated a pattern of vascular ectasia and fibromuscular hyperplasiain the erythematous mucosa, which was consistent with gastric antral vascular ectasia(GAVE). We used a heater probe treatment in this case. Follow-iup endoscopy performedfour months after several sessions of the heater probe treatment revealed multiple polypoidlesions arosen from the treated sites, The histological examination of the lesions showedhyperplastic polyps. These benign protruded lesions were considered to have occurred inassociation with the healing process of gastric ulceration. ln our knowledge, this is the firstreport on multiple hyperplastic polyps arosen after heater probe treatment for GAVE. H₂ blocker which had been administered might have caused some effects.

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We report three cases of Yersinia enteritis. Definite diagnosis was made by microbiologic confirmation of colonoscopically biopsied mucosal specimen. All cases presented low grade fever and intermittent abdominal pain with right lower quadrant tenderness. Only one case had watery diarrhea with fecal occult blood. Abdominal ultrasonography showed marked thickening of the terminal ileal wall and enlarged regional mesenteric lymph nodes, and normal appendix. Yersinia enteritis was suspected by clinical course and ultrasonographic findings. Colonoscopy revealed multiple small elevated lesions and irregular shallow ulcers covered with white coating in diffusely reddish and swollen mucosa of terminal ileum. Positive culture for Yersinia enterocolitica from mucosal biopsy specimen confirmed the diagnosis of Yersinia enteritis.

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A 59-year-old male was admitted to our hospital because of the right gingival tumor, which was diagnosed as metastatic cancer secondary to large cell lung cancer by the histological examination of the extirpated specimen. He received colonoscopy for bloody stools, which showed easily bled multilocular sub-pedunculated tumor in the sigmoid colon. Histological examination of biopsy specimens suggested metastasis from primary lung cancer. This tumor was regarded as indicative of endoscopic resectien by its figure and resected endoscopically. Because bloody stools had disappeared, we thought that endoscopic resection was effective.

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A 74-year-old woman visited our hospital with upper abdominal discomfort. She had elevated hepatobiliary enzymes and endoscopie retrograde cholangiopancreatography wasperformed. A solitary pedunculated polyp with lobulation was seen in the second portion of the duodenum, sized in 25mm in diameter. It was successfully removed by endoscopicpolypectomy with a detachable snare. Histologically, the polyp was composed of a core ofbranching smooth muscle folded into fronds and lined by normal intestinal epithelial cells. Because she had neither muco-cutaneous pigmentation nor family histery of intestinal polyposis, the case was diagnosed as a solitary Peutz-Jeghers type hamartomatous polyp of the duodenum, and we reviewed the literature.

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A 75-year-old woman was admitted to our hospital for further examination of hepatic tumor. Abdominal computed tomography and angiography demonstrated a 5cm solitary mass in the lateral segment of the liver with left portal vein thrombosis. She was diagnosed hepatocellular carcinoma(HCC)and treated with transcatheter arterial embolization. In March 1996, endoscopy revealed extrinsic compression over the lesser curvature of theupper body of the stomach. The lesion changed to the huge ulceration in February 1997, and to the large irregular tumor in March 1997. One month later, the tumor ruptured and she died of bleeding from the lesior1. At autopsy, it was confirmed that HCC in the lateral segment of the liver invaded directly to the anterior wall of the upper body of the stomachand projected inside of the stomach.

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We reported a case of DU-PAN-2 producing focal nodular hyperplasia of the liver (FNH), which was not stained following ICG infusion under laparoscopic observation. A 28-year-old woman was pointed out a liver mass by an ultrasonographic examination and admitted to our hospital. There were no remarkable findings in physical examinations and laboratory data except elevated serum level of DU-PAN-2. Ultrasonography, CT, MRI and angiography showed a hypervascular tumor(13×12×8cm3)with central stellate fibrosis in the left hepatic lobe, suggesting FNH. To differentiate from hepatocellular carcinoma, laparoscopy was performed. A white-reddish tumor covered with networks of fine vessels was observed. The tumor was not stained following intravenous injection of ICG(3mg/kg body weight). Because we could not exclude fibrolamellar hepatocellular carcinoma, the extended left lobectomy was performed. FNH was histologically con-firmed. Elevated serum level of DU-PAN-2 returned to a normal value after the resection. Immunohistochemical staining of the resected specimen revealed that proliferating ductular hepatocytes and some hepatocytes near the ductules in the FNH produced DU-PAN-2.

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We reported a case in which endoscopic pancreatic stenting was effective for the postoperative stenosis of the main pancreatic duct. A 59-year-old female who had a retroperitoneal tumor(Schwannoma), firmly adherent to the pancreas, underwent resection of the tumor. Soon after the operation, abdominal pain, fever, and elevation of the serum amylase level appeared, which resisted medication. Endoscopic retrograde pancreatogra-phy showed a stricture of the main pancreatic duct in the head of the pancreas, and dilatation of the distal pancreatic duct. The stricture was considered to be the cause of abdominal pain and endoscopic pancreatic stenting was performed. Pain was relieved soon after treatment, and serum amylase level was normalized. The stent was removed 210 days later. She has been free from complaints after the stem removal.

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A 53-year-old male had been treated in our center because of chronic relapsing pancreatitis with stricture of the rnain pancreatic duct. A plastic stent(8F)was used to manage this stricture. This pancreatic stent migrated into the distal pancreatic duct, but it was successfully removed with Soehendra stent retriever. The stent retrieval divice has a metal spiral tip with a central lumen allowing it to be fed over a guide wire. This technique is effective in the retrieval of migrated pancreatic stem.

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