Surgical treatment or endoscopic injection sclerotherapy (EIS)with absolute ethanol or 5%ethanolamine oleate containing iopamidol(EOI)has been performed against fundal varices ofthe stomach. Recently, EIS vvrth a cyanoacrylate agent has been applied mainly to emergentcases because of the high hemostatic effect. Furthermore, balloon-occluded retrograde tran-svenous obliteration(B-RTO)has become popular because of the relatively low invasivenessand high therapeutic effectiveness. It is, however, true that each therapy has its own limitation.We performed shunt occluded EIS(SO-EIS)as the initial treatment for fundal varices of thestomach. SO-EIS with 5%EOI was performed under occlusion of the gastrorenal shunt usingaballoon catheter as done in B-RTE. We treated 10 patients with fundal varices with SO-EIS and examined the effectiveness of the treatment. Customary EIS was performed as theadditional treatment l to 2 weeks after the SO-EIS if the blood flow was observed in fundalvarices by endascopic ultrasonograpy. The number of treatment required fer each patient was2.50n average. On average, the total amount of EOI administered to each patient was 33.9mland the amount of EOI administered to for SσEIS was 18.4m1. Although the application of B-RTE appeared to be impossible or very difficult ir150f 10 patient, fundal varices wereeradicated in g cases and flattened in the remaining l cases by SO-EIS. Significant complica-ttons were not caused by the treatment. Hemodynamtc analysts revealed that the collateralroutes for blood supply to fundal varices disappeared in all g cases in which fundal varices wereeradicated. Gastrorenal shunts remained in 50f the g cases. Our results indicate that SO-EISis a useful treatment modality against fundal varices of the stomach.

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A bedridden 69-year-old man, who had suffered from cerebral infarction for 3 years a:ndbeen fed via gastrostomy, was admitted to our hospital because of melena and, shock.EIldoscopic examination revealed a hemorrhagic gastric ulcer on the lesser cuvarture of theangulus. The ulcer was improved with a H2 receptor antagonist(H2RA). However, hedeveloped massive mLelena due to the ulcer again 2 morlths Iater. Although the recurre:ntbleeding was controlled by endoscopic hemostasis, the gastric ulcer did not improve despite ofthe administration of H2RA over 3 months. Therefore, we administered an omeprazole(20mg)tablet suppository once a day, and the intractable gastric ulcer was improved successfully. Theintragastric pH monitoring during the administration of the suppository revealed a Inearlilltragastric pH value of 7. This case indicated that the omeprazole tablet suppository is veryeffective for the treatmellt of irltractable gastric ulcers. This seerns to be the first report ofintragastric pH monitorillg during the administration of omeprazole tablet suppository inJapan.

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A 14-year-old man was h, spitalized because of paraparesis caused by cervical spinal cordinjury. Since ther1, he had long been corlfined tQ a bed-ridden condition and had a sudden episode of asymptomatic rectal bleeding. Colonoscopy revealed acute hernorrhagic ulcer with irregular, geographical and circumferential features in the lower rectum. Acute hemorrhagic rectal ulcer is rare among young adults and the preserlt case is the youngest ever reportecl. The case strongly indicates tlle possibility that the reduction in the rectal mu.cosal blood flow caused by the long-standing bed-ridden condition is deeply involved in the genesis of the specific hemorrhagic u.lcerative lesion.

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A 68-year-old male was admitted to our hospital because of right lower abdominal pain. Peripheral blood examination showed leukocytosis and high CRP concentration. Pervic CT scan and ultrasonography revealed heterogenous mass in the ileocecal area. Colonoscopy showed submucosal protrusion around reddish orifice of the appendix. The mucosa showed erosion on the top of the protrusing lesion. Drainage of pus was observed by vaccume. only 11 cases have beerl reported in Japan of pericecal abscess accompanied by intraluminal drainage which was observed endoscopically. Colonoscopy may be usefull in both diagnosis and treat-ment in some cases of pericecal abscess.

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We encountered two patients with ulcerative colitis who had ulcerations and inflammation in the terminal ileum and/or at the ileocecal valve. In both patients, because the ileocecal lesions were en.doscopically atypical of ulcerative colitis, superimposition of infectiou.s ileocolitis was suggested. Followlng irnmediate antibiotic treatments, their symptoms were rapidly relieved, and their colonoscopic findihgs improved. Isolation of Campylobacter jejuni and Salmonella enteritidis by a bacterial culture of the biopsy specimens, confirmed the complication of bacterial infection. Therefore, when we manage ulcerative colitis, we shQuld bear in mind the possible superimpositiQn of a bacterial infection.

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A 74-year-old man who had a medical history of ulcerative colitis, with a chief complaintof epigastric pain was admitted. He was diagnosed as acute pancreatitis based on the findingsof the laboratory data and computed tomography. Although the causes of pancreatitis wereunknown, his syrnptoms disappeared relatively early with treatment. However, following theinitial episQde, he relapsed acute pancreatitis three times with gradually developing diarrheaand, bloody stools. CQIonoscopy demonstrateded a relapse of u.lcerative colitis. So he wastreated with corticosteroids and mesalazine. His symptoms and the findings of the colonoscopywere improved with treatnlent and there were no further relapses of pancreatitis follQwing thetreatment of ulcerative colitis. Endoscopic retrograde cholangiopancrαltography demonstratedno abnorrnal filldings. In this case, the onset and the clinical course of pancreatitis is thouglhtto be closely associated with ulcerative colitis. We should recognize that pancreatitis may beone of the extra-intestin.al complications of ulcerative colitis.

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An extremely rare case of solitary pancreatic capsule metastasis from renal cell carcinomaoccurred 9 years after nephrectamy is reported. An 89-year-old woman was admitted to ourhospital with melena. Nine years ago, left nephrectomy was performed because of renal cellcarcinonma(RCC). Colonoscopy revealed a colon cancer in the transverse colon. Abdorninalcomputed tomography demonstrated the tumor attached to the anterior side of the pancreas.Endoscopic ultrasonography revealed an extramural tumor of the stomach. Histologicalexamination of the tumor showed RCS. Long-term follow up is necessary for RFC patient afternephrectomy.

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We have performed endoscopic treatment of bleeding from gastric and duodenal tllcersusing short clips:HX-600-135S(Olympus Optical Co.). The short clip, HX-600-135S, is 2mmshorter in length of arms than the conventional hemoclip, HX-600-135(Olyrnpus), so that a'vissible vessel in the base of ulcer can be clarnped surely and tightly. This short clip therapywas used in12 patients inclu.dzng 9 with hemorrhagic gastric ulcer end 3 with hemorrhagicduodellal ulcer. When tallgα1tial approach was needea, it was technically more difficult toapply short clips to the vissible vessel, so we attached a soft transparellt hood(disposabledistant attachment)on the tip of a endoscope to take the endoscopic frolltal view of the lesior1.In all the patients, the initial session achieved permanent hemostasis and there was no episodeof recurrent bleeding. The:number of short clips required for hemostasis ranged from l to 3(mean 2.2), and the times taken for treatment from discovery of a bleeding point to achivehemostasis were within 15 minutes in all cases. This therapy did rlot enlarg the area ofulceration, and no complication associated with treatment had occurred. This study suggestedthat the arms of a short clip are so shorter than those of a conventional hemoclip that a vissiblevessel in the base of ulcer can be grasped completely and that the short clip method is quiteeffective for hemostasis of bleeding gastroduodenal ulcers.

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Background:An endoscopic study group on Helicobacter pylori was constituted in Japan Gastroenterological Endoscopy Society in 1998. This paper is a report of a multi-center trialby this study group on diagnosis of Helicobacter pylori by application of hemoglobin index(IHb). Methods:IHb values of the fundic mucosa were rneasured at 8 medical institutes. Among145cases collected, photographs of 41 cases were judged not to be suitable to measure IHb value, and 36 cases rneasured at 2 institutes showed abnormally low values of IHb. These caseswere excluded from this study. Finally, 68 cases were studied if the IHb value was or rlot usefullin the diagnosis of Helicobacter pylori infection. Results:The results of the diagnosis of Helicobacter pylori by application of IHb were sensitibity 86%and specificity 81%, when the cut off index of IHb value was determined as 60.When the cut off index was determined as 58, the same results were sensitibity 93%, specificity69%.If a grey zone of 58-60 was deterrnined sensitibity 92%, specificity 78%. Conclusions:Measurernent of IHb value on the fundic mucosa under the proper conditioncan be apPlicated to the diagnosis on Helicobacter pylori infection.

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