We reviewed the complications of percutaneous endoscopic gastrostomy (PEG) in 75 patients. We employed the pull technique for placement in all cases. No patient suffered of complication during the procedure. Three patients (4%) died within one month after PEG, but none of these deaths were considered procedure-related. Early postoperative complications included wound infection in 13 patients (17%) and peristornal leakage in 12 patients (16%). Late complications included gastroesophageal reflux in eight (11%), accidental dislodgement in four (5%), excess granulation tissue formation in two (3%), and buried bumper syndrome, hemorr-hagic gastric ulcer, and difficulty in catheter removal in one patient (1%), respectively. Three major complications occurred; peritonitis in two patients (3%) and premature dislodgement of the catheter in one patient (1%). The most severe complication was peritonitis after replacement of the catheter due to disruption of the gastrostomy tract. Subsequently, we routinely confirmed the correct position of the new catheter radiographically by injecting contrast medium through the catheter. We conclude that PEG is safe, but that both early and late complications can occur.

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The patient was a 65-year-old woman with a compliant of epigastralgia. Endoscopic examination showed MALT lymphoma at the anterior and posterior wall in the body of the stomach. MALT lymphoma disappeared after two regimens of H. pylori eradications therapy and the patients became negative for H. pylori. Since it relapsed at a different site after 10 months, surgery was performed. This case suggested that regular examination for MALT lymphoma was required even after successful H. pylori eradication therapy.

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We experienced successfully treated case of hemorrhagic duodenal ulcer under chronic renal failure with combined therapy of TAE and endoscopic hemostasis. A 45 years old man, who had suffered from chronic renal failure and was introduced hemodialysis, had melena and had fallen in shock. The patient underwent emergency gastrointestinal endoscopy, showing multiple ulcers in the second portion of the duodenum with active bleeding. Endoscopists could not attain hemostasis with repeated local injection of hypertonic epinephrine saline (HSE) and transferred the patient to our center. The patient underwent two times of TAE resulting in slowing the blood flow around bleeding source, and, subsequently, endoscopic hemostasis was performed. After these combined therapeutic procedure, rebleeding was not detected. Endoscopic management and surgical management of hemorrhagic duodenal ulcer in patients with chronic hemodialysis are still difficult. The combination therapy of TAE and endoscopic hemostasis is thought to be an useful procedure.

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A 32-year-old woman was admitted to our hospital with high temperature and diarrhea. She was previously diagnosed with intestinal Behcet's disease after perforation of an ileocecal ulcer 4 years prior, and at that tame, she did not have pneumatosis cystoides intestinalis. Plain x-ray film of the abdomen showed lineal gas in the wall of the ascending colon. Colpnpscopy revealed multiple submucosal tumor-like, smooth and elastic-soft hemispherical elevated lesions as well as multiple small ulcers in the ascending colon. We diagnosed this case as pneumatosis cystoides intestinalis (PCI) of the ascending colon associated with intestinal Behcet's disease. Upon treatment of Behcet's disease with salazopirine, abdominal symptoms improved and radiographic findings also disappeared, suggesting a relationship between intestinal Behcet's disease and PCI. We present here the first case of PCI associated with Behcet's disease.

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We attempted an endoscopic hemostasis using a ligating device of endoscopic variceal ligation (EVL) for two cases of rectal Dieulafoy's ulcer. 73 and 83-year-old male were admitted to our hospital because of the massive anal bleeding. Colonoscopy revealed rectal Dieulafoy's ulcer. EVL was employed in these cases. Permanent hemostasis was obtained with only one procedure in both cases. No complication was observed. EVL was useful for rectal Dieulafoy' s ulcer. It is first report that EVL succeeded to hemostasis for colon Dieulafoy's ulcer.

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A 60-year-old man was admitted to our hospital due to epigastric pain and a high fever. Cholecystectomy was scheduled under the diagnosis of cholecystolithiasis and acute cholecystitis. Preoperative colonoscopy showed a fistel with granulation and round wall in the transverse colon near the hepatic flexure. Perctltaneous trallshepatic gallbladder drainage (PTGBD) visualized the gallbladder and subsequently the colon. Cholecystectotny, wedge resection of the colon and choledochodrainage were performed. 10 cases of cholecystocolic fistula due to cholelithiasis observed by colonoscopy are reported in Japan including our case. Preoperative colonoscopy for cholecystectomy should be performed in consideration of cholecystocolic fistula.

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Cholecystocolonic fistula is comparatively rare among idiopathic internal biliary fistulas. We report a case of resected cholecystocolonic fistula observed by colonoscopy. A 68-year-old man was admitted because of pyrexia, right hypochondralgia, abdominal distension and biliary vomiting. He underwent coronary artery bypass graft for angina pectoris 4 months previously. Then he developed cholecystitis without gall stones, which improved conservatively. Abdominal ultrasonography unclearly showed the wall of the gallbladder, and abdominal CT revealed a cholecystocolonic fistula. Colonoscopic findings showed a type 2'carcinoma like lesion at the hepatic flexure of the colon. On the basis of these findings, cholecystocolonic fistula, cholecystectomy and partial colonic resection were perfornled. Histological findings revealed only inflammatory change without malignancy.

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A 46-year-old man was admitted to the hospital with alcoholic chronic pancreatitis complicated by infectious pseudocysts. As multiple pseudocysts were seen, both transduodenal and percutaneous drainage of the cysts were performed to improve the general condition. The ERCP finding revealed some strictures of the main pancreatic duct in the head. It was highly suspected that multiple pseudocysts were caused by those pancreatic ductal strictures. Then we performed endoscopic transpapillary stenting of the pancreatic duct. The postoperative course was uneventful without recurrence of the pseudocysts.

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