The analysis of gastrointestinal functions using endoscopic system such as"Congo redmethod"is tried for many years. The congo red(pH indicator)method was developed tovisualize and clarify the acid secreting area and is now using in human. Thus, the analysisof G-I functions using endoscopic systern is so called as"the functional endoscopy". In thisreview about the functional endoscopy, the analysis of G-I hemodynamics by reflectance spectrophotometry under gastrofiber scope and by the electronic endoscope system wasintroduced. The gastric mucosal blood flow was measured by reflectance spectro-photometry and the mucosal blood distribution was displayed as a color graphics with anaid of computer. Furthernnore, using the principle of reflectance spectrophotometry in theelectronic endoscopy system, the color graphics of mucasal blood distribution was obtainedin the real time and with microinvasiveness. with this system, the functional informationof G-I mucosal hemodynamics was obtained as the two dimensional color graphics. On theother hand, an electronic endoscope has a chargecoupled device(CCD)that is sensitive toinfrared radiation. when the infra red light as a light source of electronic endoscopysystem is used, the submucosal vessels of stomach were clearly visualized. Thus, thesimultaneous analysis of mucosal and submucasal hemodynamics using the electronicendoscopic system has been shown. Many other functions of the G-I tract should beanalyzed and visualized using an endoscopic system with new techniques. Theseapproaches are helpful to investigate and diagnose the various G-I diseases.

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The cardiopulmonary function during insertion of a gastrointestinal endoscope was investigated in 210 exarninees. Continuous systolic blood pressure(BP)was measured byarterial tonometry, and pulse rate(PR)and oxygen saturation(SaO2)were measured bypulse-oxynmetry at pre-insertion, at the point when the endoscope reached the pharyngoeso-phageal junction, esophagocardiac junction, pyloric ring, second part of duodenum, fornix, body and when the endoscope was removed. The examinees were categorized into 2 groupsbased on the grade of distress and vomiting reflex as follows, none or slight was considered 'slight', and moderate or severe was considered 'severe'. The subjects were furthercategorized based on BP(under or over 160mmHg)and PR(under or over 100/rnin). The results were as follows; 1) The BP and %change in BP relative to pre-insertion were greatest when theendoscope reached the pyloric ring, and PR and %change in PR relative to pre-insertionwere greatest when the endoscope reached the esophagocardiac junction. SaO2 changedlittle during examination. 2)The group categorized as 'severe'based on vomiting reflex had a greater %changein BP relative to pre-insertion than the group categorized as 'slight'. The group categor-ized as 'severe' based on vomiting reflex and distress also had a greater %change in PR 3) The groups of subjeCts with BP under 160mmHg and PR under 100/min hadgreater %change in BP and PR relative to pre insertion than those with BP and PR over160mmHg and 100/min, respectively.

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Case reports cf ulcerative colitis with skipped lesions at the orifice of the appendixhave recently been reported. we investigated ulcerative colitis with skipped lesions at theorxfice of the appendix by colonoscopy. Colonoscopy showed redness and erosions at the orifice of the appendix. The lesionwas found in nine(27%)out of 33 cases of ulcerative colitis excluding total colitis andskipped colitis. These lesions were more common in maces, patients with left sided colitisand more severe in cases with higher Matts grades. The lesions at the orifice of theappendix had occurred at the same time as the main lesions of the colon. In three patients, the lesion at the orifice of the appendix disappeared at the same time as the main lesionof the colon. Therefore, it was suggested that total colonoscopy is necessary in all the patients withulcerative colitis.

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We attempted endoscopic papillary balloon dilatation (EPD) for bile duct stones in 63patients. The mean age was 57 years with a range of 14 to 86 years (32 men and 31 women) . Method l was EPD without isosorbide dinitrate (ISDN) in 25 patients. Method 2 was EPD with ISDN in venous drip infusion in 38 patients. Relationship between serumamylase and function of minor duodenal papilla was statistically significant. Patients withgood function of minor duodenal papilla had normal score of serum amylase, and withhypofunction of minor duodenal papilla had high score of serum amyrlse. Acute pan-creatitis was recognizes in 2 patients of nonfunctioning minor duodenal papilla in method 1.To determine the function of minor duodenal papilla may prevent the acute pancreatitisafter EPD.

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A18-year-old male who had a ten-year history of recurrent aphthous oral ulcers wasadmitted to our hospital because of vomiting of blood and retrosternal pain. Physicalexamination revealed no remarkable change except for oral aphthas. Laboratory exami-nation showed positive anti-nuclear-antigen(×80). Herpes-virus titeration gave negativeresult. An esophagogram showed punched-out-ulcer in the middle esophagus. Uppergastrointestinal endoscopy revealed three shallow punched-out-uicers with bleeding andfour aphthaid lesions at a distance of 35cm from the incisor teeth. Investigation of thestomach and intestine showed no abnormalities. The esophageal lesions were improved byantiacids therapy including PPI for two months, although oral ulcers remain much thesame up to nova. Reflux esophagitis, herpetic esophagitis, Crohn's disease, and Behcet syndrome werenot likely by the studies shown above. Etiology of this aphthoid esophageal ulcer wasunknown. Thus, a follow-up study is necessary to clarify this disease, because there is nocase report of esophageal ulcer like this which was observed for a Long germ. When patients with aphthous oral ulcer complain of upper GI symptoms, the esophagusshould be carefully examined.

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Acase of hemorrhagic Dieulafoy-like lesion of the distal esophagus which endoscopicvariceal ligating device(EVL)was useful was reported. A65-year-old man was admitted to our hospital because of massive hematemesisfollowed by melena on June 29, 1995. On emergency esophagogastroduodenoscopy wefound two elevated lesions with a central red purplish discoloration in the esophagus 3 cmabove the esnphagogastric junction. Diameters of each lesion were 3 mm and l rnm, respectively. The adjacent mucosa was normal. The stomach and duodenal hulh, andsecond portion of the duodenum were normal. These findings suggested that this case wasaDieulafoy-like lesion Both lesions were ligated with EVL kits, and control of thebleeding was accomplished. Thirteen reports including ours of esophageal Dieulafoy-likelesion have been reported in the literature. This paper reports the first case in which EVLdevised kits procedure was useful for hemostasis.

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A 62-year-old female had suffered from a leg ulcer complicated by rheumatoidarthritis, systemic lupus erythematosus, and Sj 6gren syndrome. She took prednisolone forher collagen disease and diclofen.ac sodium for pairl in her leg. Endoscopic examinationperformed due to worsening of anemia revealed a circumferential, shallow, and well-demarcated gastric ulcer at the antrum. Due to a high degree of cicatricial constrictioncaused by ulcer healing, she complained of abdominal pain and vomiting. balloon dilationwas offered to her to avoid significant surgical risk because of her collagen disease. Sheagreed, and-balloon dilation was done using a Rigiflex balloon dilator with good results, which allowed her to cat ordinary mcal. Since balicon diiaticn is a tcchnically easy, effective, and repeatable rnethod it is considered to be an alternative to surgical interven-tion in benign stricture of the gastrointestinal tract for the aged and candidates compli-sated by associated diseases. The formation of a circuxnferential gastric uleer wasspeculated to have been caused by administration of diclofenac sodium, in addition toprednisolone.

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A 54-year-old male was endoscopically diagnosed with a peduncu.lated hyperplasticpolyp, about 10mm in size, in the greater curvature of the lower gastric body. Theendoscopic examination following year revealed a IIa-like lesion, about 12mm in size, atthe same place. The histological exarnination of the biopsy specimen disclosed welldifferentiated tubular adenocarcinoma, and endoscopic mucosal resection was performed.Macroscopically, no tumor was observed on the cut edge. Microscopically, cancerremained within the mucosa, and most of the lesion was occupied by carcinomatouscomponent but hyperplastic lesion remained peripherally. The early gastric cancer(type IIa) was thought to be derived from the hyperplastic polyp, because of the followingreasons: 1) they were located just in the same place of the stomach metachronously, 2) there was no other polypoid lesions, and 3)hyperplastic change around carcinomatouscomponent v as partially observed.

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A 58-year-old man was pointed out to have an abnormality by the screening upper GI X-ray examination in general health check up. Endoscopy revealed an irregular ulcer at the pyloric ring and granular elevations in the first potion of the duodenurn. The diagnosis was made as advanced gastric cancer and the patient underwent an operation for the cancer. Macroscopically recognized was a IIa+IIc-like lesion on the posteriorwall of the prepyloric antrurn with widely spreading granular changes on the surface of the adjacent duodenal mucosa. Histological finding showed the predominance of papillary aclenocar-cinoma and rernarkable lymphatic invasion to the subserosa. This case is interesting because the granular change of the duodenal mucosa was caused by lymphatic invasion of gastric canccr.

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A 57-year-old male who had a polypoid lesion of the colon was referred to ourhospital. Barium enema showed a peduncu.lated polyp with thick stalk in the sigmoidcolon. Colonoscopy revealed a pedunculated and reddish tumor with white coat. The stalkwas covered with normal mucosa and had flexibility. A Ip type colonic cancer wassuspected and the depth of invasion was estimated as sm1. Polypectomy was perforrned.The resected specimen was 15×8×8mm in size. Histological examination of the resectedspecimen revealed poorly differentiated adenocarcinoma with massive invasion to th.esubmucosal layer (sm2) and moderately adenocarcinoma in the mu.cosa. This lesion wasaccompanied by venous and lymphatic invasion. Therefore, partial sigmoidectomy withlymph node dissectian was perfarmed. No residual cancer was seen in the resected talonand lymph node metastasis was not detected. Ip type cancers resernbling the penis arefrequently accompanied by rnoderate to severe invasion to the submucosa a:nd vesselpermeation frequently. We suggest that these lesions should be surgically treated exceptfor poor-lick patients.

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A 61-year-old man, with chronic renal failure due to polycystic kidney having receivedaregular treatment as outpatient at the department of nephrology in our hospital wasadmitted with a suspicion of multiple liver tumors on abdominal ultrasonography. ERCrevealed a filling defect in a gross cystic-dilated intrahepatic bile duct. PTCD and PTCSwere performed in order to get further information of this lesion. PTCS showed many funicular structures, a large amount of dark green alga-like stuff, and cystic lesions withvarious endoscopic images in the lumen of dilated bile duct. From these findings and theresult of liver biopsy specimen, we eventually diagnosed as Caroli's disease with liverfibrosis.

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We evaluated the improvement of dysphagia and complications with metal stentsplaced in patients suffering from incurable malignant esophageal strictures. Four kinds cfmetal stents (covered and uncovered Ultraflex and wallstent) were placed 12 times in llpatients (9 primary cancer, one metastatic cancer, and one mediastinall lymph nodemetastasis). Improvement of dysphagia was achieved in 4 of 7 patients with Ultraflexplacement and 2 of 5 patients with wallstent piaeement. Feur of 5 patients treated withWallstent suffered from esophageal ulcer and one of them died of esophageal perforation.Growth of granulation tissue within stmt occurred at bath the proximal and distaff ends ofthe covered Ultraflex in a patient. He underwent laser therapy repeatedly. The Ieft mainbronchus of a patient was obliterated by pressure of Wallstent. Metal stents for eso-phageal strictures were not so successful as expected, and Wallstent is no longer used atour hospital because of these serious complications.

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