The author discussed several points which were focussed during routine endoscopic exami-nation of many peptic ulcers, and also reported results of our pathophysiological studies associated with these problems. The contents of this paper were as follows: 1. duodenal ulcer scars (S'2), 2. gastric ulcer scars which had not been recognized by endoscopy, 3. association of ulcer size and the healing rates, 4. maintenance therapy and recurrence of ulcers, 5. maintenance therapy and tolerance to H2RA, 6. NSAID-associated ulcers, 7. production of prostaglandin in mast cells, 8. ulcers in elderly, 9. H. pylori and ulcer recurrence, 10. H. pylori eradication and the changes of the endoscopic feafures of gastritis, 11. H, pylori and interleukin-8, 12. mecha-nism of interleukin-8 release, 13. natural history of peptic ulcers.

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Since the development of the high-resolution electric endoscope, minute points with rednesscan be observed throughout the gastric body, and close observation suggests that these pointsare blood vessels which penetrate the non-atrophic gastric mucosa. The minute points withredness are considered to be collecting venules of Helicobacter pylori(HP)-negative normalmucosa, and accordingly have been termed RAC(regular arrangement of collecting venules).We studied 242 cases of closed-type atropy to clarify the correlation between RAC(+)and HP-negative. In C-0, 67 cases were diagnosed as RAC(+)and all were HPnegative(100%). InC-1, 20cases were diagnosed as RAC(+)and 180f them were HP-negative(90%). In C-2, 4cases were diagnosed as RAC(+)and 30f them were HPnegative(75%). In C-3, 1cases wasdiagnosed as RAC(+)and was not HP-negative(0%). Among the total of C-o, C-1, C-2 andG3, 95.7%(88/92)of cases diagnosed as RAC(+)were HP-negative. These results show thatRAC can be evaluated as endoscopically as non-HP normal gastric mucosa. To clarify theseminute points with redness, RAC were observed by magnifing endoscopy. These pointscorresponded to collecting venules and true capillaries showing reticulation were observed.This shows a magnified view of an HP-negative normal gastric body. Neither collectingvenules nor true capillaries were observed in RAC-negative cases with HP infection. Histological study suggested that in the magnified view, the HP-negative normal fundic gland iscomposed of normal gastric pits, a regular arrangement of surface mucosal epithelia and asurface venular mesh. In conclusion, minute points with redness are collecting venules, and theregular arrangement of collecting venules(RAC)is a finding peculiar to the corpus in the HP-negative normal stomach.

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A 50-year-old woman was admitted to our hospital because of poorly differentiatedadenocarcinoma of the stomach and total gastrectomy was performed. Nine months later, there was a irregular ulcer at the right side radix linguae and the histological examination ofthe biopsised specimen revealed poorly differentiated adenocarcinoma. There were alsocervical lympnode swellings and a giant liver nodule. The diagnosis was metastases of gastriccancer to the radix linguae, cervical lympnodes and the liver. Systemic chemotherapy by CDDPand 5FU was done and the effect of the chemotherapy was CR to the ulcer of radix linguae, PRto the lymphnodes of cervicals and PD to the liver metastasis. Metastasis of advanced gastric cancer to the radix linguae is very rare and so far only 2cases have been reported in the Japanese literature except for us.

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A 79-year-old woman was admitted to our hospital for severe anemia. Endoscopicexamination revealed diffuse vascular ectasia and bleeding which were distributed mainly in thegastric body. Diffuse antral vascular ectasia(DAVE)was diagnosed and Endoscopic microwavecoagulation therapy(EMCT)was carried out. She had recovered from severe anemia afterEMCT. It was suggested that EMCT was very safe and effective therapy for DAVE. On theother hand, DAVE was in general, restricted in the antrum, but in this case vascular ectasia wasmainly observed in the gastric body.

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We report two cases of bleeding from duodenal diverticula successfully treated with a side -viewing endoscope. Case 1. A 70-year-old man who had been suffered from cerebral infarction and taking aspirin was admitted to our hospital with a complaint of hematemesis. Emergency endoscopic examination with a side-viewing endoscope revealed a bleeding point from a diverticulum of the 2nd portion of the duodenum. Endoscopic injection therapy with hypertonic saline epine-phrine (HSE) was performed successfully and no rebleeding has since occured. Case 2. A 82-year-old woman who had been suffered from rheumatoid arthritis and taking NSAID (Loxoprofen Sodium) was admitted to our hospital with a complaint of hematemesis. Emergency endoscopic examination with a side-viewing endoscope revealed a bleeding point from a diverticulum of the 2nd portion of the duodenum. Endoscopic injection therapy with HSE was performed successfully and no rebleeding has since occured. Sometimes it is difficult to detect bleeding from duodenal diverticulum with a forward-viewing scope. But a side-viewing endoscope is often useful to detect and treat it. Including our two cases, only four cases of bleeding from duodenal diverticula diagnosed and treated successfully with a side or oblique viewing endoscope have been reported in Japan.

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A 68-year-old man. Colonoscopy was done to confirm the diagnosis for SMT (3cm in diameter) of the sigmoid colon. The histopathology of the biopsy specimen taken from the sigmoid colon demonstrated mucosa-associated lymphoid tissue (MALT) lymphoma. ha +IIc type cancer was located in the transverse colon and EMR was not possible to perform. Therefore pertial resection of the sigmoid colon and the transverse colon was done. Looking reports, the surgical tumor resection including endoscopic mucosa resection, is done to treatment for MALT lymphoma at a present. Investigation of the long term of prognosis is necessary to be assessed. Histopathological diagnosis including PCR method as a subsidiary procedure is important for diagnosis of colonic MALT lymphoma.

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So far, stent therapy has been less used for colorectal stenosis than for esophageal or biliary stenosis because of the anatomical tortuosity of the large intestine. We evaluated the clinical efficacy of self-expandable metallic stent (Wallstent or Ultraflex) in 5 patients suffering from ileus caused by malignant colorectal diseases. The metallic stent was introduced successfully under colonoscopy and the ileus was resolved promptly without any serious complications in all patients. Two patients with resectable lesions in the rectum and the descending colon, respectively, received the resection of the tumor with preoperative cleaning of the total colon after the examination for the oral side of the lesion. Three patients with unresectable lesions in the rectum, the sigmoid colon, and the transverse colon, respectively, were able to maintain bowel activity without colostomy until they died. These results suggested that the metallic stent retention may be regarded as a primary therapy for malignant colorectal stenosis.

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Metastasis of cancer to the stomach is quite uncommon. Especially, the incidence from renal cell carcinoma is extremely rare, and such metastasis are usually found in autopsy study. Recently, we experienced a case manifested six years after radical nephrectomy. A 47-years old male was diagnosed as having a right renal clear cell carcinoma, and underwent curative nephrectomy in 1992. Afterwards he received interferon (INF) therapy as postoperative therapy. In 1996, pulmonary metastasis was recognized and partial lung resection was done. He has received INF therapy in our hospital. In April 1998, he visited our hospital for epigastralgia. Gastrointestinal endoscopy showed a small solitary polypoid lesion about 8 mm in diameter, with a depressed lesion at the center of the tumor in the middle body of the stomach. Microscopic findings from biopsy specimen were adenocarcinoma and no evidence of sub-mucosal invasion was detected on endoscopic ultrasonography (EUS). Endoscopic mucosal resection (EMR) was performed and showed histologically as renal cell carcinoma, clear cell subtype, which was same as the histology primary tumor and that of lung metastasis. We considered this as an exceedingly unusual case of "late recurrence" to the gastric wall. Late recurrence is characteristic of renal cell carcinoma, so long term careful follow-up is needed.

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A 42-year-old man was referred to our hospital since conservative treatment for acute pancreatitis done elsewhere failed in treating a pancreatic pseudocyst. Percutaneus aspiration was performed for the pseudocyst of the body and tail of the pancreas, 70mm in diameter. However, the cyst tended to increase the size, and, therefore, endoscopic drainage, through the stomach was performed afterwards. Since there was a communication with the pancreatic duct, the cyst was not reduced in size below 30mm. Then, the cyst rapidly disappeared when octreotide acetate was administered. It was effective to use octreotide acetate jointly for the treatment of the pseudocyst with the drainage in this case.

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In order to decrease complications and to improve the bile duct cannulation success rate, we have a pre-cut papillotome for trial. The instrument has not merely a lumen for contrast medium but also an independent lumen for guide wire. This papillotome has an advantage that the operation of its guide wire and the injection of contrast medium carried out simultaneously with the incision of the papillary roof make the bile duct cannulation easier. Its tapered tip with the diameter of lmm is able to control precisely the incision. When the papillotome is used for two patients who needed the therapeutic ERCP, its deep cannulation into the billiary tract becomes easier without any complications.

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