Background and Aims : Endoscopic variceal ligation (EVL) has been widely employed in recent years because of the safety and simplicity, but the high recurrence rate relatively early after the therapy compaired with endoscopic injection sclerotherapy (EIS) is problematic. Therefore, in the present study, are investigated the hemodynamic changes of esophagogastric varices before and after these treatments using endoscopic ultrasonography (EUS). One advantage of EUS is that it can distinguish the blood vessels within the wall of the digestive tract from those locating outside the wall. In this study, we compared the post-treatment changes of varicose extramural collaterals between EVL and EIS, paying special attention to the extragastric veins (EGV) at the lesser curvature of the cardiac region which receives direct inflow from the blood-supplying route for varices and paraesophageal veins (PEV). Subjects and Methods : Twenty three patients with esophageal varices treated by EVL (EVL group) and another 23 treated by EIS (EIS group) from August 1992 to April 1998 were studied. In these patients, esophagogastric hemodynamics was investigated by EUS before and after the treatments. EGV and PEV were evaluated by measuring the diameters and the total transverse areas on EUS images. Results : The change of PEV before and after the treatments was small, and was not significantly different between the EVL and EIS groups. In the EVL group, both the mean diameter and the mean total transverse area of EGV did not show significant changes before and after the treatment, whereas the mean diameter of EGV of the EIS group was significantly decreased after the treatment (from 4.71±2.19 mm to 2.90±2.01mm ; p <0.0001), and the mean total transverse area of EGV of the EIS group was also significantly decreased after the treatment (from 1.16±1.17cm² to 0.44±0.65 cm² ; p <0.0001). The rate of changes in the PEV was not significantly different between the EVL group and EIS group, whereas that of EGV was significantly greater in the EIS group than in the EVL group (p <0.0001). Conclusions : This study clarified the difference in the esophagogastric hemodynamics after EVL and EIS ; EIS could close the blood-supplying route for varices effectively and reduced the blood flow of collaterals (EGV), whereas EVL did not have significant effects on the extramural collaterals including EGV. This may be a reason why the recurrence occurs shortly after EVL but it does not occur relatively long after EIS.

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A 57-year-old man who had a history of ref lux esophagitis visited our hospital complaining heartburn afresh. Gastrointestinal endoscopic examination revealed short segment Barrett's esophagus and a small depressed lesion in Barrett's epithelium. Biopsy specimen from the depressed lesion showed differentiated adenocarcinoma histologically. Because it was thought as mucosal carcinoma, endoscopic mucosal resection (EMR) was performed. The EMR specimen showed well differentiated adenocarcinoma within the mucosal layer, intestinal metaplastic epithelium around the carcinoma and proper esophageal glands in the submucosal layer below the carcinoma histologically. So the depressed lesion was regarded as Barrett's adenocarcinoma. Then, follow-up endoscopic examination revealed expansion of residual Barrett's epithelium. Biopsy specimen from it showed no dysplasia or carcinoma but intestinal metaplastic epithelium histologically, so cauterization therapy with argon plasma coagulation for it was performed to prevent recurrence of Barrett's adenocarcinoma. Barrett's epithelium was replaced with squamous epithelium after the cauterization therapy, and we keep it under observation with prescribing proton pump inhibitor.

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We reported a case of herpetic esophagitis detected on the next day of the upper GI endoscopy and observed endoscopic findings in early stage. A 44-year-old female was performed upper GI endoscopy and gastric cancer was found out. Next day, we performed upper GI endoscopy again for the close examination. Then, many white vesicles, which were not observed at the previous endoscopic study, were detected in the esophagus. Histologically, we diagnosed that the cause of the esophagitis was due to infection of herpes simplex virus (HSV). We suggest that upper GI endoscopy for a immunocompromised host may become a cause of herpetic esophagitis.

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A 60-year-old man had a pain in the right lower quadrant abdomen with a fever up and anabdominal mass. Ultrasonogram revealed an abscess in the abdominal wall, which was openedto discharge pus. Colonoscopy which was performed to find a cause of the abscess showed apenetrating toothpick of the terminal ileum. Computed tomography also found out the penetrating toothpick of the right lower quadrant abdomen after colonoscopy was performed. After thehealing of the abscess, the toothpick was safely extracted by colonoscopy. Subsequently, therecurrence of an abscess and the inflammation did not appear. A foreign body penetrating intoadigestive tract should be considered as one of the causes for unknown origin of the abdominalwall abscess. After opening an abscess, the endoscopic extraction was safe and effective.

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A 67-year-old man was admitted to our hospital because of anemia in June 1998. He hadhad recurrent epistaxis since Forty-year-old. His grandmother, brother and cousin had hadrecurrent epistaxis since childfood. Several telangiectasia were present on the oral cavity, lips, anterior chest and palm.Endoscopic examination showed the angiodysplasia on the body and angle of the stomach.Abdominal ultrasonographic findings showed irreguler and heterogenous surface pattern of theliver. The laparoscopic findings of the liver surface showed several vasucular spider-like orspotty telangiectasia, 2-5 mm in diameter. From these findings of telangiectasia in the skin and mucous membrane, concomitant withrecurrent episodes of epitaxis and G-I bleeding, plus the family history of recurrent epistaxis, the diagnosis of Rendu-Osler-Weber disease was mede. We reported a case of Rendu-Osler-Weber disease with a characteristic laparoscopicfindings and considerated involvement of the liver, especially laparoscopic findings with Rendu-Osler-Weber disease.

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A 77-year-old woman visited our hospital because of a physical checkup. Ultrasoundexamination and computed tomography of the liver showed a mild intrahepatic bile ductdilatation without space occupied lesions. Endoscopic retrograde cholangiography showed adefect like mucin in the common hepatic duct, but there was no tumor or irregularity of the bileduct wall. Peroral cholangioscopy(POCS)revealed a granular elevated mucosa and abnormalvessels in the intrahepatic bile duct of the left lobe. As bile duct cancer was highly suspected, she underwent left lobectomy and the lesion was diagnosed as well differentiated adenocar-cinoma, histologically. POCS is very useful for the detection of early bile duct carcinoma.

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In 1990, a 39-year-old male was first admitted to our hospital for multiple stenosis anddilatations of the bile ducts on abdominal ultrasound echogram. Though his liver function wasnormal, the endscopic retrograde cholangiography showed constriction of the common bile ductalong the whole length and dilatation of the intrahepatic bile ducts. The laparoscopy showedthat the surface of the liver was smooth and had small uneven whitish spots. The histologicalfindings of liver revealed periductal fibrosis. The patient was diagnosed as primary sclerosingcholangitis(PSC)and was treated with ursodeoxycholic acid and balloon dilatation of thecommon bile duct for recurrence of cholangitis. Treatment was effective for the time being, butthe patient repeatedly showed the symptoms of acute cholangitis and was admitted to ourhospital nine times in twelve years. Endoscopic balloon dilatation or biliary drainage wasperfornled each time. In 2001, the patient had follow-up laparoscopy and liver biopsies. Thesecond laparoscopic findings showed a rounder liver surface than the previous findings and"trench-like depression"on right lobe was seen. However, there was no impression of severeprogression of liver damage. The histological findings were similar to those of the firstfindings. This case is interesting because of long-term follow-up and observation of laparoscopic findings after eleven years. Laparoscopy is useful in following up the PSC patients, because YSC can be diagnosed at an early stage, the biopsy site can be selected and prognosiscan be considered including the possibility of liver transplantation.

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