In this paper, the relationship between the medical effectiveness and cost-effectiveness of endoscopic treatments such as injection hemostasis with pure ethanol and endoscopic mucosal resection (EMR) was evaluated by analyzing the average length of hospital stay and the medical cost. The clinical use of injection hemostasis and intravenous H2 blocker antagonists for bleeding peptic ulcers has remarkably decreased the number of operative cases, the average length of hospital stay and overall medical cost. The cases of EMR for superficial esophageal cancer and early gastric cancer at the endoscopy center of Tokai University Hospital from January 1991 to December 1995 were analyzed. The number of cases treated by EMR increased about 10 times during the five year period, while surgical cases did not increased in the same period. Recently, because EMR is a minimally invasive procedure, inoperative cases with severely complicated diseases can be treated by EMR. In cases treated for superficial esophageal cancer, the average length of hospital stay is about 75% shorter compared with surgical cases. In addition, the treatment cost of EMR in much lower than the surgical operation. In cases of EMR for patients with severely complicated diseases and/or patients over 65 years of age, the average length of hospital stay after EMR is longer. Inevitably, the average length of hospital stay in the EMR cases for early gastric cancer retreated is longer than that of superficial esophageal cancer. Considering the economical decline and aging society in our country, the standardization of JCAHO (Joint Commission on Accreditation of Healthcare Organization) and DRG (Diagnosis Related Group)/PPS (Prospective Payment System) in the USA would be necessitated. The clinical standardization of gastrointestinal endoscopy by JGES (Japan Gastrointestinal Endos-copy Society) would be useful and socially acceptable in the renewal of the national health insurance system in Japan.

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The purpose of the present study was to determine the relationship between Helicobacter pylori (HP) infection and ref lux esophagitis which we diagnosed with Los-Angeles classification by panendscopy. In this study, 173 cases which we diagnosed as ref lux esophagitis were examinsed. HP infection was present in 86 cases (49.7%) of these patients. HP infection rate was lower in reflux esophagitis group compared with the referred group, and it got lower as the grade of reflux esophagitis became severer. The hypothesis that HP infection may inhibit ref lux esophagitis is supported by our data.

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We report 3 cases of candida esophagitis, diagnosed during treatment with a proton pumpinhibitor, lansoprazole. Before treatment, all of them had gastric ulcer but none had candidaesophagitis. Candida esophagitis was diagnosed at the end of initial treatment with 8 weeks oflansoprazole in two cases. In the third case, diagnosis of candida esophagitis was made at theend of maintenance treatment of weekly administration of lansoprazole for 6 months. No casehad symptoms referable to candida esophagitis and all of them recovered from it simply bystopping to take lansoprazole. Lansoprazole may have caused candida esophagitis throughmechanisms other than acid inhibition. Because, it was unlikely that acidity in stomach andesophagus was continuously suppressed for one week in the last case.

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A71-year-old female previously diagnosed von Recklinghausen's disease was introduced toour hospital for dilatation of the common bile duct and the main pancreatic duct. Endoscopicexamination showed a pedunculated polyp of 30mm in size and a protuberant lesion of IOmmin size on the medial wall of the descending part of the duodenum. Because the latter wasdiagnosed as adenocarcinoma by biopsy specimen, pylorus-preserving pancreatoduodenectomywith regional lymph node dissection was performed. The former was proved carcinoma inadenoma of the papilla of Vater and the latter was proved carcinoid tumor of the accessorypapilla with regional lymph node metastasis by the resected specimen. We reported this casebecause carcinoid tumor of the accessory papilla is very rare and only 10 cases including ourcase have been reported in Japan.

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A39-year-old man was admitted to our hospital for upper abdominal pain. Abdominaultrasonography, CT and MRI studies demonstrated the presence of a mass which adjoinpancreatic head. Similary, duodenoscopy showed an ulcer in the second portion of the duodEnum. Biopsied specimen from the ulcer bed revealed a caseating granuloma containin, Langhans'giant cells. Ziehl-Neelsen positive tubercle bacilli were recognized in the biopsiespecimen from the ulcer bed. The patient was diagnosed to have tuberculosis of the duodenumWe think the mass was lymph node swelling with granuloma of tuberculosis.

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A 51-year-old female without symptoms consulted an urologist because of microhematuria. Computed tomography showed a round mass lesion measuring approximately 2cm in the right lower abdomen. Colonoscopy revealed a pedunculated polyp on the lower lip of the ileocecal valve. The surface of the polyp was smooth and the color was slightly reddish in appearance. Magnifying colonoscopy revealed normal villae of the small intestine and the polyp was diagnosed to be a submucosal tumor originated in the small intestine. The polyp was removed endoscopically and was diagnosed histologically to be a cavernous lymphangioma. Lymphangioma is rarely encountered in the small intestine. We reported a case of lymphangioma on the ileocecal valve incidentally found upon computed tomography and treated by endoscopic polypectomy. Although the most cases of lymphangioma originated in the small intestine were sessile, the present case showed a pedunculated configuration. The reason for the pedunculated appearance may be attributed to the frequent peristaltic movement of the small intestine.

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A 54-year-old man was admitted with severe right flank pain on emergency. Laboratory data showed that fecal occult blood was positive and serum CEA and CA19-9 levels did not elevate. CT scan and barium enema showed intussusception of the ascending colon. Colonoscopy revealed a mass at the site of the appendix. Ileocecal resection was performed, and the histological diagnosis of the resected specimen was mucinous cystadenoma of the appendix.

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We report our successful experience of the treatment of pancreatic pseudocyst with a combined method of endoscopic naso-cystic catheter drainage and somatostatin analogue. The Somatostatin analogue octreotide, with half-lives of 2h or more and full biologic activity, binds to pancreatic acinar cells, reduces their synthesis of cyclic AMP, and blunts the secretion of secretin and cholecystokinin. Therefore, it has been used with success for the treatment of pancreatic disorders. We performed endoscopic catheter drainage in a 21-year-old woman with symptomatic pancreatic pseudocyst caused by the distal pancreatectomy for Pancrease Solid and Cystic Tumour. The naso-cystic catheter placed in the pseudocyst drained pancreatic fluid secretion with high amylase content, but without the evidence of infection. The patient's clinical codition improved dramatically after drainage, but 30 to 50 ml fluid continued to be drained every day. We then started a long-acting somatostatin analogue (octreotide) at the dose of 100pg twice a day subcutaneously. On the third day of the treatment, no further secretion was drained. 2 weeks after procedure, the drainage catheter was removed and somatostatin was discontinued. No side effects occurred during this period. No sign of recurrence has been observed for 3 years. Somatostatin analogue and endoscopic catheter drainage are very safe and effective method to control pancreatic pseudocyst.

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The sliding tube has been recognized as an effective instrument for facilitating insertion of the colonoscope. However, when the sliding tube is intubated violently or roughly, endoscopic examinations can be hazardous. We have experienced the hazard of the sliding tube slipping into the descending colon, during a colonoscopy performed on a 35-year-old female. Fortunately, we were able to draw it out through the anus with a balloon-attached endoscope and another sliding tube. This method has the merit of not requiring laparotomy.

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