Endoscopic mucosal resection (EMR) is a technique used to simplify the resection of sessile colonic polyps. However, there have been no ex vivo studies which confirm the safety of EMR, the location and form of pooling of fluid into the submucosa after injection, the depth of the cutting line or the optimum volume for the injection. We carried out submucosal injection ex vivo and in vivo to investigate these issues. Initially, up to 10 ml saline was gradually injected into the submucosa of ten resected colonic wall samples. Ultrasonography were taken after injecting every 1 ml of saline to determine the height and width of the resulting bleb. In a second study, the resected specimens were frozen in liquid ammonia, cut into tissue blocks and examined under a microscope. In a third study, 29 adenomas were resected by EMR and the relationship between the diameter of each lesion and the thickness of the submucosal layer was measured. As a result, the ratio of height to width reached a maximum at saline volumes of 4-7 ml. Histologically, injected submucosal layer was not separated, but the solution percolated downward through it. A correlation was found between the size of the tumor, the area of resection and the thickness of the submucosa. In conclusion, 1) the optimum volume for the injection was 4-7 ml, and 2) the larger the lesion was resected by EMR, the deeper it was resected.

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We investigated the hemodynamics in 30 cases (untreated group) with esophageal varices before EVL, AS-EIS combined therapy and in 18 cases with long-term obserbation after therapy (long-term follow-up group), using color-Doppler endoscopic ultrasonogra-phy (CD-EUS). 1. Flow direction of left gastric vein (LGV) was hepatofugal in most cases of both groups, and its velosity was not significantly different. 2. In long-term followed-up group, poterior branch dominant type (type PD) was more increased in the branch patterns of LGV. 3. The size of the paraesophageal veins was significantly larger. 4. Detection rate of enlarged perforating vein (EPV) was significantly lower, as compared with untreated group. It is suggested that the reccurence prognosis may improve because posterior branch and paraesophageal veins may develop after long-term follow up and function as an extravariceal shunt, while anterior branch and EPV may disappear. These findings are important for the reccurence factor after topical treatments of esophageal varices.

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A 53-year-old woman was admitted with complaint of nausea and vomiting. Endo-scopic examination of the upper gastrointestinal tract revealed multiple lesions mimicking ha +IIc at the antrum. Biopsy specimens of these lesions showed gastric mucosa with diffuse infiltration of eosinophils. Laboratory data on admission showed peripheral eosinophilia. The patient was diagnosed as eosinophilic gastroenteritis (EGE). With oral prednisolone therapy, mucosal lesions on endoscopic studies disappeared shortly after the relief of the clinical symptoms and peripheral eosinophilia. By reviewing the 55 Japanese cases on gastric lesions in EGE, no reports were available concerning gastric lesions mimicking IIa+IIc. It could be important to differentiate EGE from gastric cancer.

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We reported a case of Cowden's disease accompanied by ganglionerofibroma and protein-losing enteropathy. A 48-year-old male visited our hospital for the examination of edema. He had iron-deficiency anemia and low-proteinemia. The examination of the gastrointestinal tract revealed polyposis of the esophagus, stomach and small and large intestines. The pathologic diagnosis was that the lesions were mainly hyperplastic. There was a large polyp in the cecum. It was a ganglioneurofibroma. Small facial papules and palmoplantar keratosis were also observed. 99mTc-DTPA binding human serum albumin Scintigraphy revealed protein losing in the colon from the cecum to the transverse colon.

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Carcinoma of the ileum is a rare disease. It is extremely difficult to make a difinite diagnosis of ileal carcinoma prior to surgery. A 69-year-old woman was admitted to our hospital because of ileus. CT examination revealed intestinal obstruction due to a ileal tumor. The subsequent colonoscopic examina-tion and retrograde ileogram found complete obstruction caused by an annular constricting tumor in the ileum. Ileocecotomy was performed. A histological examination of the resected specimen revealed well differentiated adenocarcinoma with invasion to the serosa containing adenoma component.

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Case 1 was a 79 year-old male with multiple cystic lymphangioma and early-stage cancer in the transverse colon and with advanced cancer and early-stage cancer in the sigmoid colon. Case 2 was a 54 year-old female with cavernous lymphangioma in the ascending colon and with advanced cancer in the transverse colon. Twelve cases with lymphangioma of the colon accompanied with colon cancer have been reported in Japan including our two cases, with a ratio of male to female of 7 : 4 and an average age of 71.3 years. Cavernous lymphangioma was frequently observed. Colon cancer was observed at sites other than prevalent sites and early-stage cancer was also frequently observed. There were no symptoms caused by lymphangioma and the coexistence of colon cancer seemed to be coincidental.

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A case of multiple granular cell tumors of cecum is reported. A 44-year-old female was visited to our hospital because of the necessity of further examination of the cecal polyp. Colonoscopic examination revealed a yellowish-white submucosal tumor about 7mm in diameter at the cecum. Endoscopic ultrasonography revealed a uniformly low-echoic mass in the third to second layer. It was difficult to make differential diagnosis from other submucosal tumors such as carcinoid. Complete resection was unsuccessful on strip biopsy. Seven month later, the Colonoscopic examination was performed again. There was residual tumor under the scar of strip biopsy, and there was the other submucosal tumor close to the resudual tumor. Laparoscopic partial resection of cecum was performed. The tumor was present in the colonic submucosa and muscularis mucosae. HE staining of the tumor showed fine granules in the cytoplasm. Granules of cytoplasm of tumor cells showed positive periodic acid-Schiff (PAS) reaction. Immunohis-tochemical analysis revealed positive for S-100 protein. The diagnosis of granular cell tumor was made. Granular cell tumor was first described by Abrikossof f as granular cell myoblastoma in 1926. It is benign neoplasms and is considered Schwann-cell origin. It occurs every-where in the soft tissues, mostly in the skin, esophagus, and tongue. But, it occurs rarely in the large bowel. In Japan, only 39 cases including our case were reported. We discussed the characteristics of our case comparing to them.

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A 73 year-old woman developed mucous evacuation lasting a week. She had not received antimicrobial agents for the past 8 months. Sigmoidoscopic examination at another hospital showed small whitish elevations densely in the rectum and sigmoid colon. The patient visited outpatient department of our hospital because of not making a diagno-sis. Stool culture yielded Clostridium dif f icile, and she was diagnosed to have pseudomem-branous colitis. This case was rare and interesting in the point of non antibiotic-associated colitis, which had been followed up by endoscopic examination without treatment.

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Mesenteric panniculitis is a nonspecific inflammatory disease rarely induced in the mesenterium. A case of mesenteric panniculitis of the rectosigmoid and descending colon seen in a-66-year old man was reported. He complained of lower abdominal pain and diarrhea, and was admitted to our hospital. Physical examination revealed a hard fist-sized mass in his lower abdomen. Barium enema examination demonstrated narrowing of the sigmoid and descending colon and serrated appearance on its mesenteric side. Colonoscopy revealed narrowing and edema without erosions, ulcerations nor masses of the rectosigmoid and descending colon. Abdominal ultrasonography and computed tomography revealed the diffuse thickened mesenteric adipose tissue and walls of the sigmoid and descending colon. These findings made a diagnosis of mesenteric panniculitis of the rectosigmoid and descending colon. After treatment with conservative therapy, the patient had mucous stool about 40 days later. Colonoscopy and Barium enema examination were performed again and showed longitudinal ulcer of the rectosigmoid and descending colon. He was treated with TPN after the examination and the longitudinal ulcer was healed about 80 days later.

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A thin echo-video-endoscope for upper GI tract (GF-UMP230) has been newly devel-oped by OLYMPUS Co. Ltd.. As this instrument has one ultrasound scanner of 7.5 MHZ and a smaller CCD, the diameter and lenght of the tip is designed to be smaller and shorter than that of the former model of echo-video-endoscope (GF-UM200). In order to evaluate the clinical use of this new echo-endoscope, 705 cases (246 of upper digestive diseases, 298 of pancreatic diseases and 161 of biliary diseases) were studied in 6 hospitals from March to November of 1997. The endoscopic images of GF-UMP230 were satisfactory for diagnosing small lesions as well as observing the whole GI-tract though it projected a smaller view field on a TV monitor. The ultrasonic images of this eco-endoscope were almost the same as those of 7.5 MHz images of GF-UM200. The diagnostic accuracy of EUS with this scope in detecting the depth of gastric cancer invasion was 77.9%, which was almost equal to that obtained by the former model (79.6%). The advantages of this scope was a good manuevarability, especially easier insertion to the second portion of the duodenum as well as to the esophagus because of its smaller diamter of the shaft and shorter length of the tip. It is concluded, therefore, that this new echo-endoscope will make the EUS study easier and manywidespread as a body imaging diagnotic method.

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Endoscopic sphincterotomy (EST) has become increasingly safe because of establishment of its technique and improvement of its device, and the indication has become wider. But complications related to EST still occasionally occur, and minimising complica-tions of sphincterotomy is a very important issue. We have designed a sphincterotome whose proximal cutting wire is covered with fluorine (made by Olympus). We used either this sphincterotome or regular type sphincter-otome, and assessed their advantages and disadvantages. In 14 pations, EST was perrf or-med with this covered type sphincterotome, and the regular type sphincterotome was employed in 17 patients. As a result, no complication relevant to sphincterotomy occured, and EST was successful in all patients. With the use of the covered type sphincterotome, we could prevent contact of cutting wire with either the endoscope or the duodenal wall oral to the papilla. In addition, EST with only the distal part of the cutting wire contributed to reduction of complications. This device appeared to provide safe EST without fail.

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