The endoscope for gastrointestinal tract has shifted from fiberscope to videoscope(elec-tronic endoscope)and brought us great diagnostic and therapeutic yield. About pancreatoscope, the POPS(peroral pancreatoscope-fiberoptic-)is still used widely but it has some problems of low resolutioll and so on. It required a highly advanced technology to develop the electronic endoscope which could be inserted into the main pancreatic duct(MPD)and had put on the she shelf. However, we succeeded in developing the smallest peroral electronic pancreatoscope(PEPS)under the remarkable progress of electronic imaging technology in 1997 and have been doing clinical application of this instrument. The PEPS gives us extremely fine images of the MPD under various clillical conditions and we consider the PEPS is useful in the diagnosis of pancreatic diseases. It has a possibility in diagnosing early stages of pancreatic cancer. On the other hand, the PEPS is required to eguip the accessory channel and for improvement of insertion rate. Recently, to solve these problems, we developed the new PEPS with accessory channel and started clinical application. We expect that pancreatoscopy with the PEPS will become popular examination. And outline for the diagnosis of pancreatic diseases, such as standard diagnosis of chronic pancreatitis or endoscopic appearaud findings of early stages of pancreatic cancer, will be established in the future.

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A 45-year-old man was admitted to our hospital because of nausea. Endoscopic examination revealed a 0'-lla lesion, 4mm in diameter, in the columnar epithelial foci adjacent to thesquamo-columnar junction. The fine long branching vessels was shown over 10mm at the anal side of the lesion and the biopsy specimen from the lesion revealed well differentiated adenocarcinoma. Therefore, diagnosis of early esophageal adenocarcinoma arising frorn short segment Barrett's esophagus was made. Endoscopic mucosal resectiorl was performed. Pathologicalexamination of the resected specirnen showed well differentiated adenocarcinoma, depth m, 1y0, v0, margin negative. This is a rare case of Barrett's adenocarcinoma that was possibly resected completely by endoscopic mucosal resection. It suggests the necessity of checking up and careful follow up observation of Barrett's epithelium.

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A48-year-old woman who had been admitted in another hospital because of schizophreniaingested about 50ml of acid detergent(9.5%hydrochloric acid)for suicide intent and she wasreferred to ou.r hospital. Two weeks later, endoscopy revealed mild lower esophagitis andextensive redness and erosiolls of the middle stomach. In spite of conservative treatment, vomiting du.e to gastric stricture was exacerbated after 40 days. Thus, gastrojejunostomy andpartial resection of the stenotic jejunum were don on 7 months later. There are only six reportson this disease followed from the acu.te to late period by endoscopy in Japanese literature.

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A 74-year old man was admitted with a chief complaint of watery diarrhea. Barium enema examination demonstrated a segmental narrowing and saw-teeth-like appearance from the upper part of the rectum to the lower part of the sigmoid colon. Colonoscopy showed multiple small elevated lesions existing densely and annularly in the sigmoid colon, and shallow ulcers spreading annularly and irregularly in the rectum. Under the diagnosis of mesenteric panniculitis associated with ischemic proctitis, we treated him conservatively with total parenteral nutrition and antibiotics. One month later clinical symptoms disappeared and no recurrence has been observed. It is very rare that mesenteric panniculitis was complicated with ischemic proctitis, which would be precious to discuss the pathogenesis.

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A 53-year-old man was referred to our hospital for pancreatitis and found a large pancreatic pseudocyst on abdominal US, CT. Six weeks after the onset, endoscopic drainage was performed and the pseudocyst was mostly resolved, and the subjective symptoms were remarkedly improved. We consider that endoscopic drainage of pancreatic pseudocysts can be a safe and effective, and definitive treatment in selected patients.

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Surgical treatment has been generally carried out in patients with non-curative or unresectable colorectal carcinoma. Recently, use of self-expandable metalic stent (EMS) is increasing in patients with unresectable esophageal carcinoma. We reported 4 cases using EMS with obstructive colorectal carcinoma. One patient rejected operation and others had multiple liver metastasis and/or peritoneal dissemination. We inserted EMS successfully and safely in all cases and improved obstruction of colon and rectum immediately. EMS replacement contributed to shorten the duration of hospital stay and improve QOL in patient with unresectable or non-curable colorectal carcinoma.

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The case was a 73-year-old female, and admitted to our hospital with a complaint of epigastralgia based on acute pancreatitis. Abdominal CT, MRCP, and ERCP revealed a stenosis of main pancreatic duct in the body of pancreas and a slight dilation of distal pancreatic duct, but no SOL was detected in the pancreas. In addition, the telomerase activity in pancreatic juice was positive. Simultaneously, ovarian carcinoma was recognized. And then, distal pancreatectomy and ovariotomy was performed. Pathological study showed intraductal papillary adenocarcinoma with minimal invasion outside the pancreatic duct, and coexistence of the ovarian serous cystadenocarcinoma. We reported a rare case of miniature intraductal papillary adenocarcinoma coexisted with ovarian serous cystadenocarcinoma.

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We considered the training method to acquire colonoscopic insertion technique, from theviewpoint of resident. The concentrated training at the appropriate institution is necessary forresidents to acquire colonoscopic insertion techniques during a short period, while it is difficultto acquire those techniques without any training system From the viewpoint of residents, weneed more time enough for the examination per patient and, to experience many various casesunder the appropriate gu.idance. However, these requests are actually contrary to clinicalsituation. Accordingly, various devices to decrease these discrepancy are necessary at theirlstitution of education. In our institute, to insert into the cecum within 5 minutes in over 90%of patients, we needed the trai:ning for about a 5-6 monthl period and 4-500 cases, to obtainaccornplishing rate over 98%and average time necessary to instert into the cecum within 5 minutes, we needed about 15-16 months period, 9-1, 000 cases.

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