We reviewed 14 cases of esophageal leiomyoma treated by endoscopic lumpectomy asto their clinicopathological features. The results were as follows: 1) Esophageal leiomyomas were frequently found on the anterior wall of the upperand middle intrathracic esophagus. Endoscopically, they were characterized as white, ovalshaped submucosal tumors, the overlying mucosa of which did not show iodine stain. 2) EUS enabled us to diagnose the location of the tumor in the esophageal wall andto determine th indications for endoscopic lumpectomy. 3) Endoscopic aspiration lunpectomy was safe and sufficient materials for histological evaluationwere obtained. 4) As dysplastic changes are sometimes observed on the surface epithelium coveringesophageal leiomyomas. It is desirable to remove them irrespective of the size.

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To validate the standerized ¹³C-urea breath test(¹³C-UBT)for the detection ofHelicobacter pylori(H. pylori)infection both before and after antimicrobial treatment inJapanese people, we investigated a simple ¹³C-UBT method in total 110 patients most ofwhich consisted of peptic ulcer patients before and after antimicobial therapy. Patientswere given 100mg of ¹³C-urea at fasting, and keep sitting position after mouth washingwith water. Breath samples were taken before and every 10 minitues(10-90)afteradministration of ¹³C-urea. In the simple two point analysis of ¹³C-UBT, the best breathsample point was 30 min. and the best cut-off value for a positive test was 2.5%, determined by using receiver operating characteristic(ROC)curve. Its sensitivity was98.3%, its spesificity was 96.0%, accuracy was 97.3%. And, then, we investigated the clinical meaning ofΔ¹³C-value and the pattern of timecourse of Δ¹³C-value, because of UBT reflects the total intragastric urease activity, theoretically. We compared UBT results with endoscopic findings(distribution of ulcers, activity of ulcers), histological findings(H. pylori density, activity of gastritis, atrophy ofgastric mucosa)and serological findings(pepsinogen 1, 2, 1/2, HPIgG)in 46 H. pyloripositive peptic ulcer patients. UBT results was significantly correlated with only the H.pylori density(r=0.37-0.43). ¹³C-UBT reliably reflected the total intragastric urease activity and H. pylori densityon the time of examination, but not reflected neither endoscopic, histological findings norserological findings in peptic ulcer patients.

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A 79-year-old man complaining of hematemesis with hypovolemic shock after havingplayed with his grandson was admitted. Endoscopic examination on admission revealed adeep laceration without bleeding just above the esophagogastric junction. This patient was suspected of Mallory-Weiss syndorome raised in abrupt abdominal pressure. Immediately, we performed clipping hemostasis at the laceration. The clinical course was uneventful. This patient was discharged from our hospital on the 25th day.

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A 65 year-old-man with portal thrombosis was admitted to our hospital because of general fatigue and iron deciciency anemia. He had a past history of Miles operation at the age of 60. On admission, he presented with massive ascites, splenomegaly, and esophageal varices. Endoscopic examination revealed multiple elevated lesions in the duodenum Endoscopic findings of these lesions were unusal and microscopic findings of biopsied sample of the duodenum revealed lymphangiectasia. In review of 18 Japanese articles on duodenal lymphangiectasia, we noted that these lesions may cause increased pressure in the lymphatic duct due to portal hypertension.

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A 70-year-old man was admitted urgently to our hospital because of shock from massive hemorrhage via the anus. Laboratory studies on admission showed severe anemia. Emergency endoscopic examination showed a submucosal tumor like elevation in the duodenum without over bleeding. We suspected bleeding from the duodenum due to ruptured aneurysm of gastroduodenal artery by ^99mTc-HSA, CT scan and EUS, and confirmed it by angiography. After then, the patient was gotten hemorrhagic shock again and underwent an emergent operation. His postoperative course has been uneventful.

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A 68-year-old man presented with a four-week history of appetite loss and body weight loss of 8 kilograms. Gastroduodenal endoscopic examination demonstrated a stomal ulcer and innumerable fine granules all over the duodenum. Colonoscopic examination demonstrated multiple polypoid protrusions with redness and erosion especially in the sigmoid colon and rectum. Biopsy specimens obtained from them revealed amyloid infiltration of the submucosal layer of the stomach, duodenum and colon. These materials were stained orange with Congo red. When the tissue was examined under polarizing microscope, Congo red produced a green birefringence of amyloid. Blood chemistry showed hypoproteinemia. Serum and urine protein electrophoresis revealed a monoclonal gammopathy which on immunoelectrophoresis proved to be κ light chain. No evidence of multiple myeloma was noted in bone marrow examination. The diagnosis of primary amyloidosis was made. Stool analyses revealed fatty stools and the average α₁-antitrypsin clearance was very high. Primary amyloidosis caused malabsorption syndrome and proteinlosing enteropathy. Autopsy showed multiple polypoid protrusions with redness and erosion in the small intestine.

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A 57-year-old man, with a slightly elevated CEA underwent barium enema and colonoscopy. A pedunculated lesion was found in the sigmoid colon. It appeared as a dumbbell. Sigmoidectomy was performed. Histologically, the lesion was a carcinoma in adenoma with mucus nodules in the submucosa, which contain with a large volume of mucus. The peculiar shape was attributed to this. The occurrence of pseudo invasion in the pedunculated lesion is considerably rare. Particularly, such a peculiar shape as in the present case is very rare.

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A 41-year-old male was admitted to our hospital for further examination of submucosal tumor at the orifice of the appendix. Although barium enema study and colonoscopy revealed mucocele, abdominal CT and endoscopic ultrasonography showed solid tumor suspected of leiomyoma. Laparoscopic ileocecal resection was performed. A 20mm elevated lesion was found at the orifice of the appendix. Histological finding showed the tumor consisted chiefly of f ibroblasts and collagen fiber accompanying eosinophillic infiltration. Thus, it is diagnosed as inflammatory fibroid polyp (IFP). IFP of the appendix is rare and this is the third case in Japan.

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A 67-year-old woman was admitted with complaints of right hypochondralgia and vomiting. Computed tomography of the abdomen on admission showed atrophic gallbladder with slightly thickened wall. Endoscopic retrograde cholangiography revealed a gallstone, 1 cm in diameter, and a cholecystocolic fistula. Cholecystectomy and fistulectomy were performed under laparoscopy. Histological findings of the tissue around the fistula showed inflammatory granulation with marked fibrosis.

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A 88-year-old woman who complained of general fatigue and jaundice was admitted to our hospital. Abdominal ultrasonography revealed three stones in the common bile duct (CBD) and dilatation of the intrahepatic bile duct (IHBD). Endoscopic retrograde cholangiography showed many radiolucent shadows in the CBD which was unique in shape. Extraction of stones in the CBD used by electrohydraulic lithotripsy with percutaneous transhepatic cholangioscopy (PTCS) was performed. After three session of extraction, multiple ulcer scars, pseudodiverticulums and severe stenosis were observed in the CBD. Cholangiography revealed longitudinal ulcer scar and diverticulum-like deformity which looks like a sea tangle. Profile of each diverticulum was very smooth. Biopsied specimen of bile duct mucosa revealed no malignant cell except for immf lamation cells. Liver biopsy showed no fibrosis surrounding intrahepatic bile duct. Intraduetal ultrasonography (IDUS) showed a thickend second layer of the CBD wall at the part of scars and stenosis, but thickness of the wall at diverticulum was in normal range. On the results of cholangiography and IDUS, we guess that these stenosis of CBD may be caused by ischemia of choledochal plexus. Therefore, bile duct stones may formed secondarily. Analysis of the cholangiography was important in differential diagnosis between this case and primary sclerosing cholangitis.

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A 67-year-old woman was admitted to our hospital because of bleeding from the orifice of the major papilla. Abdominal US and CT taken after admission revealed tumor in the pancreatic head. Endoscopic retrograde cholagiopancreatography showed the stenosis of the main pancreatic duct and the dilataition and tortuosity of the accesory pancreatic duct. Cmmon bile duct was normal. Cytology of the pancreatic juice was class IV. We diagnosed pancreatic cancer. Pancreatic cancer with bleeding from the orifice of major papillais is very rare. Only 1 case have, to our knowledge, been reported on the Japanese literature.

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