Two hundred twelve cases of serrated adenomas of the colorectum were examined by endoscopy, light microscopy and by molecular biological method in order to evaluate endoscopic feature, histogenesis and carcinogenesis. The frequency of serrated adenoma was 0.9% of the tubular adenoma. The patients with serrated adenomas were 145 men and 48 women, ranged in age from 26 to 85 years (mean 57.3 years). The characteristic feature of serrated adenoma was reddish, scaled or petaloid appearence, and detected in 76.8% of these lesions. 16.8% of serrated adenomas were hyperplastic polyp -like whitish, small, flat elevation, 5.0% were nodule-aggregating lesion like, 3.0% were juvenile polyp like. 3.3% of serrated adenomas contained areas of carcinoma. The frequency of carcinoma in serrated adenoma was the same as that of tubular adenoma. On the examination of histologic component, pure serrated adenomas were detected only 29.7% (63/212). Serrated adenomas combined with hyperplastic polyp were found 42.5% (90/212). The frequency of K-ras codon 12 point mutation in 22 serrated adenomas and 6 tubular adenomas was investigated by polymerase chain reaction-preferential homoduplex formation assay (PCR-PHFA). K-ras codon 12 point mutation was detected three of the 22 (9.1%), which is a significantly lower frequency than that in polypoid adenomas (4/6, 66.7%). The expression of p53 was investigated immunohistochemically, using anti human p53 protein (clone D07), with avidin-biotin peroxidase method. Nuclear p53 was focally positive in 11% (3/26) of serrated adenomas, diffusely positive in 50% (3/6) of carcinomas in serrated adenoma. We concluded that serrated adenoma was different from tubular adenomas in its genetic pathway because of lower frequency of K-ras codon 12 point mutation.

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A 73-year-old woman who was admitted because of gastric ulcer 10 months previously was referred to our hospital for endoscopy. Endoscopy revealed a slightly elevated lesion measuring about 5 mm in diameter in the middle portion of the esophagus. We performed endoscopic mucosal resection for the lesion. Histological examination of the specimen yielded a diagnosis of small cell carcinoma of the esophagus with the invasion depth of m3. After mucosal resection, chemotherapy with carboplatin and etoposide was given, and there has been no recurrence for 28 months. To our knowledge, this is the first repoted case of esophageal small cell carcinoma that was discovered at the stage of mucosal carcinoma and resected endoscopically.

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A 48-year-old man was introduced to our hospital with a history of hematochezia 6 days after left nephrectimy. The emergency endoscopic examination revealed a huge coagulated mass and massive bleeding in the stomach and a lucent trumpet-shaped-hood was attached on the tip of the endoscope for the purpose of removing the blood and coagula. Compareing to the usual examination, the power of suction became much stronger and the disturbance of observasion was removed Immediately. Bleeding caused by the Dieulafoy ulcer in the fornix was controlled by endoscopic hemostasis. The use of this hood was very effective for endoscopic examination in cases with massive gastric bleeding.

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A 80-year-old woman was admitted to our hospital with a complaint of appetiteloss. Endoscopic examination showed multiple SMT-like lesion on the greater curvature of the lower gastic body. A biopsy specimen from the lesion indicated adenocarcinoma. By upper GI X-ray and EUS examination the patient was diagnosed as having advanced gastric cancer and underwent an operation. The lesion was located within the limited area of the gastric body, 8 cm in diameter. Of the several elevations over the lesion, only the one nearest to the anal side showed a central depression and therefore was thought to be a primary. Histological findings disclosed poorly differentiated adenocarcinoma with severe lymphocytic infiltration. The depth of invasion was se (Serosa-exposed). The multiple SMT-like lesion was formed as the result of gastric cancer with severe lymphocytic infiltration metastasizing through lymphatic invasion. This case is very rare so we report.

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A 69-year-old male with liver cirrhosis and chronic renal failure was admitted in August 1998 because of tarry stools. Urgent esophago-gastro-duodenoscopy revealed ruptured varices at the descending portion of the duodenum which had been treated with endoscopic variceal ligation (EVL) two months before. The varices were treated with endoscopic injetion sclerotherapy (EIS) using n-butyl-2-cyanoacrylate (Histoacryl) and no further bleeding occurred after the EIS. Histoacryl polymer was detected in varices by X-ray and 3D-CT of abdomen. His clinical course was uneventful without bleeding or embolism of other organs related to this therapy. Thus EIS with Histoacryl is considered to be useful choice for the treatment of duodenal varices.

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We describe a patients, 66-year-old woman, with solitary nonspecific colonic ulcer of transverse colon and the ulcer healed without specific therapy. She had painless rectal bleeding. There were no other symptoms. Findings from rectal examination were normal. Laboratory tests revealed normal hemoglobin level, white blood cells and platelet counts. Colonoscopic examination showed a round ulcer with smooth edges located at the antimesentric wall of the transverse colon. Multiple biopsy specimens from the lesion revealed benign ulcer with acute inflammatory infiltrates and no granulomas. She recovered without specific therapy. Barium enema examination and colonoscopic study one month later from the initial endoscopy showed that the regenerating epithelium completely covered the floor of the ulcer. Since then, she had remained well.

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A 39-year-old woman was admitted to our hospital with complaints of bloody diarrhea and abdominal pain. Colonoscopy revealed edematous, and reddish mucosa and multiple ulceration in the descending colon. Barium enema examination showed the thumb printing sign. At first, ischemic colitis was suspected, but the stool culture revealed positive for Salmonella montevideo. After timely treatment with appropriate antibiotics, symtoms were improved and barium enema and colonoscopic examination showed disappearance of ulcers and edema in the descending colon.

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A 63 years old man, having been hospitalized and treated because of acute pancreatitis in62years old, re-hospitalized complaining of right upper abdominal pain. Abdominal ultrasonography showed three hyperechoic lesion in the liver, but CT and FRCP could not show anyabnormalities of the biliarytract including intrahepatic bile duct, similar as previous examina-dons. PTC under ultrasonography revealed the filling defect in B6. Intrahepatic cholesterolstones were succesfully removed by PTCS.

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A 65-year-old man was admitted to our hospital because of chronic pancreatitis withpancreatic stones. He received hepatico-jejunostomy and pancreatojejunostomy 16 years ago.ERCY showed a fistula on the posterior side of the major papilla from the main pancreatic duct(MPD)and abnornlal pancreatico biliary union. The bile and pancreatic ducts in the majorpapilla were extremely marrow. The stones were observed in the residual bile duct and MPD.These stones were treated by extracorpo shockwave/ithotripsy(ESWL)and endoscopicsphyncterotomy. These stones were composed of 93%calcium bicarbonate. A plastic stent wasplaced through the fistula for drainage of MPD. After drainage he has been asymptomatic andthe urinary C-peptide titer increased 3 months later.

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Hemorrhage from hepatocellular carcinoma(HCC)directly invading the gastrointestinaltract is uncommon. A 61-year-old man, who had been treated HCC in our hospital since 1993, was admitted complaining of hematemesis in June 1996. On endoscopic examination, werecognized bleeding in the duodenal bulb and successfully stopped the bleeding by directinjectionor hypersodium epinephrine solution. Simultaneously, the findings of abdominal computedtomography showed recurrent HCC in S₆. We performed transcatheter chemo-lipiodolizationagainst the recurrent HCC. Since 5 days after the chemo-lipiodolization he had had tarry stoolsfor 3 days. The second endoscopic examination showed tumor emerging in the duodenal bulb.Biopsy of the tumor revealed moderately to poorly differentiated hepatocellular carcinoma.Further computed tomography and ultrasonography confirmed direct invasion to the duodenumof the HCC. The duodenal tumor gradually reduced its size by the chemo-lipiodolization.However, computed tomography showed recurrence of the HCC in May 1997, and endoscopicexamination also showed a relapsed tumor in the duodenum. Therefore, we performed transcatheter arterial embolization and percutaneous ethanol injection therapy against the HCC.Soon after, the duodenal tumor transformed from Borrman type l into Borrman type 2, andfinally disappeared. He had had no gastrointestinal bleeding from the duodenum invaded byHCC since the initial therapy in June 1996 until he died of hepatic failure with tumor thrombosisof portal vein in January 1998. There have been few reports of chronological endoscopicobservation of HCC invading the duodenum. Furthermore, it was shown that endoscopicinjection of hypertonic sodium epinephrine solution directly to the tumor could stop its bleeding.

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To improve the maneuverability and safety of ultrasonic probes for intraductal ultrasono-graphy in biliary and pancreatic diseases, we designed a new wire-guided ultrasonic probe(XUM-G20…29R)in corporation with Olympus Corp. Ltd. and assessed its usefulness in compari-son with those of ordinary type probes. To assess the maneuverability and safety of the newprobe compared with those of the ordinary ones, the following factors were evaluated:(1)therate of successful insertion into the target ducts, (2)the rate of passage through stenosis causedby bile duct cancer, (3)elevation of the serum amylase level after-DUS, and(4)complications.In the group which underwent-DUS with the new probe(Guidwire group), the successful rateof insertion into the bile duct and the pancreatic duct was 100%in each, and 86%and 96%, respectively, in the group which underwent-DUS with the ordinary probes(Ordinary group).The rate of passage through stenosis in bile duct cancer patients was better in the Guidwiregroup than in the Ordinary group with statistical significance.The elevation of the serumamylase was not different between the two groups. No serious complications occured amongthe two groups;however, acute pancreatitis was seen in 5.3%of the Guidwire group and 4.1%of the Ordinary group. This new probe is considered to be useful for IDUS because of itsimproved maneuverability and safety.

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