Background and Aims:Endoscopic variceal ligation (EVL) is superior to endoscopic injection sclerotherapy (EIS) with respect to the simplicity and safety. However, indication of EVL should be carefully determined because long-term effectiveness of EVL remtains controversial, though a small number of patients. are experienced to be free from recurrence after EVL. The relationship between the findings on endoscopic ultrasonography (EUS) and recurrence rate was studied to elucidate the portal hemodynamics in long-term recurrence-free patients after EVL. Materials and Methods:The subjects consisted of 22 patientg. who were followed-up for more than 2 years after FVL. EUS obgervation of hemodynamics was performed at the paraesophageal vein (PEV), extragastric vein (EGV) and esophageal perforating vein (EPV).PEV consititutes collateral blood flow in the esophageal outer wall. EGV is located in the lesser curvature of the cardia as a direct inflow route for the blood supply to the esophagogastric varices. EPV penetrates the esophageal wall to connect outer and inner blood flows. Analyses were performed on the relationships (1) between the size of PEV and EGV before EVL and the recurrence rate, (2) between the visibility of EPV and the recurrence rate, and (3) between the visibility of EPV and the change in the size of PEV after EVL. Results:(1) The recurrence rate wag. significantly higher (p < 0.01) in the patients with more dilated EGV before EVL on EUS. In contrast, no significant relationship was noted between the dilatation of PEV and the recurrence rate. (2) The 2-year recurrence rate was 93.8% in the patients with visible EPV, which was significantly higher (p<0.05) than that in the patientgs without visible EPV (50%), Excluding patients with severe dilatation of EGV, varices recurredin 11 of 12 patients (91.7%) with visible EPV. In contrast, no recurrence was noted for more than 2 years after EVL in 3 patients without visible EPV. Irrespective of the visibility of EPV, varices recurred within 1 year after EVL in all patients. with severe dilatation of EGV. (3)Compared with the patients without visible EPV, the increase in the total PEV area was significantly (p<0.05) higher in the patients with visible EPV. It wag. suggested that PEV increased in size after EVL in the patients without visible EPV. Conclusions:Based on the present results, it was considered that mild dilatation of EGV and invisible EPV may be favorable hemodynamic factors for good prognosis. after EVL. In the patients who show conditions, a long recurrence-free period is expected because such preferable hemodynamic changes, that is a development of drainage of blood supplying the esophageal wall to PEV, would occur after EVL. EVL should be the first-choice treatment in such cases. Preoperative EUS is an important method for determining the indication of EVL.

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A 15-year-old man was hospitalized because of chest pain post trauma. Chest X-ray and computed tomography revealed pneumomediastinum. Endoscopic examination showed two longitudinal linear tears about 3 cm in length at the 2 and 8 o'clock position in the cervical esophagus. We diagnosed traumatic esophageal rupture. He was conservatively treated by fasting and administration of antibiotics. Endoscopic examination showed the longitudinal linear ulcer scars fourteen days after the onset. A case of traumatic esophageal rupture is rare.

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A 15-year-old girl was diagnosed with H. pylori-associated chronic gastritis complicated with anorexia nervosa. Binge eating, vomiting, amenorrhea and body weight loss were observed one year after epigastralgia developed. After successful H. pylori eradication therapy, epigastralgia and amenorrhea disappeared. Binge eating, vomiting and weight loss subsided. In addition, the endoscopic appearance of the stomach remarkably improved. For patients with anorexia nervosa, who are complaining of severe abdominal symptoms, H. Pylori infection and its eradication therapy should be considered.

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A86-year-old female was adrrlitted our hospital to examine an ulcerative disease of thedescending portion of the duodenum. Upper gastrointestinal X-ray and endoscopic examinations showed a circular ulcer and the diverticula, which was adjacent to the ulcer and 25×21mm in size. Histopatholegical study of biopsied specimens from the ulcer bed demonstrated noncaseating granuloma containing epitheloid cells and Langhans'giant cells. An anti-tuberculosis therapy was effective and the patient was diagnosed to have tuberculosis of the duodenum. Thiscase suggested that a duodenal diverticula influenced the infection of tuberculosis.

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A 55-year-old man presented with epigastric pain and melena. He had a history of genital ulcer and psoriasis vulgaris. Endoscopy revealed punched-out ulcers in the descending part of the duodenum and the terminal ileum. Duodenal ulcers were not related to Helicobacter pylori infection and not responsive to omeprazole. The diagnosis of intestinal Behcet's disease was made. His symptoms and intestinal lesions were improved with 5-aminosalicylic acid, prednisolone and total parenteral nutritiorL Intestinal BehGet's disease should be considered when duodenal ulcer is refractory to conventional antiacid therapy.

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In a health survey, a 54-year old man was pointed out a depressed lesion in the duodenum on endoscopy, and was referred to our hospital. Endoscopy showed a depressed lesion, 4mm in diameter, in the 2nd portion of the duodenum. We performed endoscopic mucosal resection with ligating device(EMR-L method)for this lesion. Histological diagnosis was well differentiated adenotubular carcinoma. Considering the indication, EMK-L was safe and certain method for a small depressed duodenal carcinoma. This method may be one of the surgical treatment for depressed type of duodenal carcinoma.

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A41-year-old man visited a local physician for fu.rther examination because of positive fecal occult blood the colonoscopic examination indicated a cecal ulceration, and he was referred to our department. He was otherwise healthy without complications from the ulceration. The colonoscopic examination revealed relatively well-defined ulceration covered with a white furry and dirty layer in the cecum. The biopsied samples ebtained trophozeites cf Entamoeba histolytica from the u.lcerated cecal floor histologically demonstrated. A diagnosis of axnehic colitis was made. The ileocecal section is the frequent site of this infection but confined localization to only cecum is rare. With the rnore frequent use of colonoscopy, one may encounter cases of asymptomatic amebic colitis in healthy people lime this case.

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Endoscopic injection selerotherapy (EIS) is a very potent therapy for esophageal varices, However, its effect can only be achieved if done by an experienced endoscopist. It is difficult to ensure the placement of needle at varices for sufficient duration using the present therapeutic regimen. This is mainly due to an involuntary movement of the esophagus. As it is difficult to fix the endoscope at a variceal point, the needle may be fallen off even after entering into the varices. The aims of the study was to develop a new device for EIS so that the following purposes can be achieved 1) proper maintenance of expanded visual field, 2) fixation of the endoscope at a vaiceal point. We modified a commercially-available'straight type.. of transparent hood. We made a concave groove in this hood measuring 6.5 × 5.0 mm. This groove was adjusted to the endoscope so that it remains at 80'clock position. The groove of the hood remain. aligned to the variceal point perfectly after the entry of the endoscope, Then 5% ethanolamine oleate iopamidol(EOI) was injected into the varix. EIS using this new device showed better therapeutic effects. For example, it was possible to introduce EOI in 89% of the supplying vessels by this new device compared to 30% by the previous method(p<0.05). This new device is cheap, easy to use, has no complication and ensures better EIS.

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