To evaluate influence of endoscopic injection sclerotherapy (EIS) on hemodynamics of gastric mucosa, two wave lengths of infrared ray electronic endoscopy (IREE) was employed in this study. Alteration of blood flow level in the gastric mucosa was interpreted as variations of red element quantity curve along the time course from the point of ICG intravenous administration until 190 seconds. The value of red element in RGB was quantified based on image processing of endoscopic view. Quantity curve immediately after EIS was significantly higher than that of before EIS. There is no significant differences between quantity curve in normal control and that of before EIS. This alteration was associated with only the presentation of gastric parietal branch at EIS. It was suggested that inflow of sclerosant into the gastric parietal branch caused congestion of blood flow in the gastric mucosa. Cases were classified into the increased group which showed increased quantity curve immediately after EIS compared with before EIS and the non-increased group which showed non-increased quantity curve immediately after EIS compared with before EIS. Quantity curve was significantly increased immediately after EIS in the increased group. Quantity curve at the point of before EIS was significantly higher in the non-increased group than that in the increased group. Furthermore, the incidence of sclerosant inflow into the gastric parietal branch in the increased group was significantly higher than that in non-increased group. It suggested that the gastric parietal branch was well developed in the increased group. Congestion of blood flow in the gastric mucosa was improved at the point of after 12 months EIS observation. We conclude that two waves length of IREE would be an useful method in evaluatioh the influence of EIS for blood flow level in the gastric mucosa.

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Seventy-five severe or moderately severe patients with ulcerative colitis had been treated from 1994 to 1999 in our department. There were 49 males, 26 females with the mean age of 37 years, consisting of 38 patients with total colitis, 37 patients with left-sided colitis. Twelve patients were with first attack, 55 patients with relapsing-remitting type and 6 patients with chronic persisting type. Twelve of these 75 patients underwent emergency operation because of no response to the treatment, massive colo-rectal hemorrhage, or toxic dilatation of the colon. Extent and whether first attack or relapse may help to consider surgical indication. Presence of polypoid mucosal tag and large mucosal abrasion were the good predictive factors for evergency operation. Endoscopic severity was significant predictive factors between those responded to medication and those did not respond. Colonoscopic examination is safe and gives valuable information in deciding early colectomy of severe colitic patients.

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A 79-year-old woman developed progressively increasing vomitting during nutritional control from nasal tube. Extensive radiological and endoscopic examination demonstrated a large esophageal hiatus hernia (sliding type) and prolapse of whole stomach into the thracic cavity. A gastroscope was inserted while monitoring under X-ray fluoroscop, and the stomach was distended by insufflation with enough air until it was repositioned into the abdominal cavity. Then percutaneous endoscopic gastrostomy (PEG) was employed to fasten the gastric and abdominal wall with apparatus for gastropexy. Fistula radiography showed the stomach at an anatomically upright position, although sliding hernia was still observed. Successful employment of PEG for a patient with severe esophgeal hiatus hernia has never been reported in Japan.

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The patient was a 68-year-old male, who had performed total gastrectomy for gastric cancer. He needed an expandable metalic stent (EMS) placed in his stenotic jejunum, because of local recurrence. We succeeded in making the unfixed jejunum straight, and placing EMS in it by application of percutaneous endoscopic jejunostomy (PEJ).
This made the patient start eating food, going back to social life. This method could be applied to re-stenosis and carcinomatous ileus, and would be a useful way for terminal care.

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A 83-year-old woman was admitted with a complaint of melena. Endoscopic examination revealed a diverticulum with an exposed vessel in the second portion of the duodenum. Clipping and HSE (hypertonic saline epinephrine solution) injection were performed around the exposed vessel because it seemed to be the bleeding point. However, she developed massive melena again 2 months later. Endoscopy revealed active bleeding from the diverticulum. Since HSE and ethanol injection were failed to control the bleeding, hemostasis using Gold Probe was performed and no hemorrhage occurred thereafter. This is the first report of successful hemostasis achieved by using Gold Probe against bleeding from duodenal diverticulum.

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A 60-year-old man was admitted to our hospital, complaining of anal bleeding for a month. An elastic soft mass, which occupied half circumference of the anal canal, was palpated. Colonoscopy on admission showed a slightly dark reddish tumor, which was covered with thick viscous fluid and was surrounded by small protrusions at its base. Roentgenography revealed lobulated nodules at the anorectum. Computed tomography showed a wall thickening of the lower rectum and a swelling of lymph node in the pelvic region. Magnetic resonance imaging revealed the masses, low intensity in the T1 emphasis and high intensity in the T2 emphasis, at the lower rectum and in the pelvic region. Histology of biopsy specimens including the immunohistochemical analysis was compatible with amelanotic malignant melanoma. We treated him by surgical operation. Histopathological examination of the resected tumor, measuring 5 × 2.6 × 2.6cm, showed that the neoplastic cells had pleomorphic, large and vesicular nuclei with prominent nucleoli. Mitotic figures were frequent. Immunohistochemically, tumor cells were positive for S-100, vimentin and HMB-45 and were negative for cytokeratin (clone AE₁/AE₃) and leukocyte common antigen (CD45RB). Diagnosis of an amelanotic malignant melanoma at the anorectum with lymph node metastasis in the pelvic cavity was confirmed. He developed multiple metastasis in many organs and died after sixteen months postoperatively.

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We reported a case of Cowden's disease in a 42-year-old man who visited our hospital for screening. Endoscopic examination revealed multiple small polyps in the stomach and the colon. The histological findings of these polyps showed hyperplastic polyp. He had hepatic hemangioma, multiple cyst in the bilateral thyroid gland, small keratotic papulosis on the face and extremities, papillomatous lesions in the oral cavity and the bilateral tonsilar area. These findings were compatible to make diagnosis as Cowden's disease. Cowden's disease accompanies with malignant tumor in a high frequency. It is necessary to screen malignant tumor.

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The effect of 0.55% ortho-phthalaldehyde (OPA), has been reserved an attention as a new disinfectant of videoendoscopes for upper and lower gastrointestinal tract.
As preliminary assessment had revealed that bacteria collected in a sampling vessel attached to the suction channel showed similar species of organisms detected in the scope channel. Organisms collected in the sampling tube were used as pre-disinfection samples. Videoendoscope channels were exposed to OPA before cleansing to obviate the effect of cleaning.
Streptococcus, Neisseria, Corynebacterium and Haemophilus were predominant among the aerobic bacteria detected in pre-disinfection samples from the upper G.I. videoendoscope channel. They were shown to occur at a concentration of 10⁵/ml. Only Bacillus licheniformis was detected in post-disinfection channels of the 5 minute disinfection group. No organisms were detected in the samples from the scope channels exposed to the test disinfectant for 7-10 minutes. E. coli and Streptococcus were predominate among the aerobes bacteria detected in predisinfection samples from the colon videoendoscope channel. Concentrations of these organisms were compatible to those found in the upper G.I.scope channels. Only Bacillus subtilis and Bacillus megaterium were noted to have remained in disinfected colonoscope channels. As for the extent of decrease of Bacillus subtilis in the scope channel, the organism was detectable in all 5 samples (100%) after 5 minutes of exposure to the disinfectant and in one sample (100%) after 7 minutes of exposure, but in 2 out of 7 samples (28.6%) after a 10-minute exposure. These facts suggest that OPA completely destroyed all viable common bacteria in 5 minutes of exposure and provided partial elimination of organisms of the Bacillus, even under the organic material. Therefore, OPA is considered to be one of the high-level disinfectants.

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The self-expandable metal stent (EMS) for a malignant pyloric or antral stenosis may be considered as one of the best treatments for keeping the patients' quality of life (QOL). However, the stenting is technically difficult, because the elongation of the gastric greater curvature disturbs to lead the stent to the proper position. In this paper, we introduce a new technique with which gastrostomy is utilized as an access point to induce the EMS to the pylorus or the antrum. Twelve patients with inoperable malignant pyloric or antral stenosis were included in this study. In the initial 4 cases, Z stent or Wallstent designed for the esophageal stenosis was selected, and introduced orally. However, the procedure was technically difficult for the reason mentioned above. In the remaining 8 cases, gastrostomy was utilized as an inducing route. Concretely, after suturing the abdominal wall and gastric wall in the opposite position to the stenosis, puncture with a needle was followed. A guide-wire passed inside the needle was introduced to the pyloric or antral stenosis by manual operation and then it was passed though the stenosis. After dilation of the gastrostomy, a covered Z stent was introduced to the position of the stenosis over the placed guide-wire and then it was released. In all cases, the EMS was successfully positioned and the stenosis was relieved. The mean survival time after stenting was 2.5 months. Conclusively, the EMS for patients with inoperable pyloric or antral stenosis would contribute to improve their QOL. To apply the EMS for such patients, the gastrostomic access technique would be the most useful route.

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