Background: Graft-versus-host disease(GVHD) is one of the most important complications following transplantation. Although these patients show intestinal symptoms, there are a few reports about endoscopic findings of transplantation-related GVHD. Here, we reported the endoscopic findings of GVHD developed after transplantation. Methods: Endoscopic abnormalities in ten patients with hematological disorders are reviewed to detail the spectrum of findings. Colonoscopic exarnillations were done in ten cases complained of diarrhea or melena following allogenic bone marrow alld peripheral blood stem CellS transplantation. Results: The endoscopic appearance of these patients showed exaggerated pit pattern ('tortoiseshell pattern') with edema, mucosal erythema, erosion and aphthoid ulcer of the colon. Conclusions: We consider tortoiseshell pattern is the most important characteristic finding of intestinal GVHD.

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A primary malignant melanoma of the esophagus is rare and difficult to find in it's early stage. We report a case of a 52years old male admitted due to hematemesis from Mallory-Weiss tear after drinking. The endoscopy showed a dendrit formed shaped lentigo-like lesion at the mid portion of the esophagus. Biopsy was taken and histological studies revealed spindle shaped dysplastic melanocytes with prominent nucleoli. Distal esophagectomy and cervical anastmosis with stomach was performed. In the resected specimen, the tumor was localized in basal layer of mucosal epithelium. No skipped leison nor lymphnodes metastasis was detected. Pathologic study confirmed the diagnosis of malignant melanoma in situ. Tumor cells were positive for immunohistochemical stain using S-100 protein and HMB-45 antimelanoma antibodies. The patient was given no postoperative chemotherapy and alive at 15 months after the operation without recurrence.

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Acute necrotizing esophagitis is a very rare condition in witch the esophageal mucosa turns a blackish color. This condition is most easily identified through an upper endoscopy. We report a case of black esophagus encountered during routine endoscopy. An 81-year-old woman was admitted to our hospital with complaints of multiple episodesof vomiting coffee ground substance the day before admission. The upper gastrointestinal endoscopy revealed that the distal esophagus was black in appearance. Biopsies showed necrosis of the entire mucosal layer. Due to these facts she was diagnosed with necrotizing esophagitis. Transient ischemia due to systemic hypoperfusion, reflux, infections, radiation treatmentand ingestion of chemical agents are hypothesized as important causative factors in the pathogenesis of acute necrotizing esophagitis. In this particular case the cause of necrotizing esophagitzs was unclear. Early diagnosis of necrotizin.g esophagitis is extrernely important because fatalities due to this condition have been known to occur. Endoscopy and biopsies are the gold standard in identifying this rare lesion.

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An abnormality was noted during an upper gastrointestinal series performed on a 44-year-old man as part of a screening program in December 1999. In January 2000, an endoscopicexamination showed a submucosal tumor(30mm in diameter)located at the gastric antrum.After one month, a second endoscopic examination performed at our hospital revealed asubmucosal tumor with an erosion. The tumor had decreased in size to 15mm in diameter. In October 2000, he was admitted because of melena. An endoscopic examination showed anelevated lesion with a penis-like appearance and bleeding. The size of the tumor had increasedto 20mm in diameter. The lesion was removed during a laparoscopic partial gastrectomy.Histologically, the resected specimen was diagnosed as an inflammatory fibroid polyp (IFP).

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A 70-year-old man presented with tarry stool. Endoseopic examination revealed heznor-rhage frorn Borrmann 30f type gastric cancer located at gastric antrum. Metastatic turnors inthe liver also recognized on computed tomography and ultrasorlography, Endoscopic hemostatwas performed, but the gastric tumor was not thought to be curatively resectable. To relievepyrolic stenosis due tc the gastric tumor, an expandable metal stent was successfully placedwith long over-tube developed for ileus tube placement. Compared with a conventional over-tube, the long over-tube equipped with a balloon at the tip of the tube facilitated stentplacement because the balloon prevented tube migration frorn the stenotic portion of the lesiQndu.ring insertion delivery system.

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We reported a case of cancer of the arnpulla of Vater associated with appendiceal car-cinoma detected during the diagnostic process of metastatic colon cancer. A 69-year-old malewas examined with a colonoscopy because of the positive occu.1t blood of the stool. The exarnination showed multiple polyps in the colon and the histological findings of the biopsiedspecimen from the transverse colon revealed a metastatic adenocarcinoma. Lately, two othertumors were observed in his appendix and the ampulla Qf Vater. The immunohistologicalexamination suggested that the lesion in the transverse colon was metastasis from the alnpullaof Vater.

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A74-year-old female was admitted to our hospital with abdominal pain. Barium enemarevealed a elevated tumor at the rniddle of ascending colon. Colonoscopy revealed a well-defined tumor, 2cm in size with erosion and villous part on its surface. There was a depressedarea with normal mucosa close to the tumor. We categorized it as type 5 tumorl We diagnosedit as a colon can.cer on biopsy and the right hemicolectomy was performed. On pathological findings, the tumor was arisen frorn the wall of colonic diverticulum and grew in the rnucosal layer. No lymph node rnetastasis was shown in the specimen. Thediverticulum possessed the layer of muscularis prcpria which way strectched and thinned dwvnby the tumor. Because of the existence of the layer of muscularis propria we regard thisdiverticulum as true diverticulum. Four cases of colonic cancer arising from the diverticulum, have been reported in the worldliterature since Cohn KH et a1. reported in 1993. We report herein the fifth case of colon cancerarising frorn a divertlculum.

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A 54-year-old woman underwent barium enema and sigmoidscopy at a local clinic and a protruding lesion was detected in the lower rectum. Colonoscopy at our hospital revealed a submucosal tumor and a diagnosis of MALT lymphoma was made on the biopsy studies specimens. Although the our patient was negative for Helicobacter pylori, H. pylori eradication therapy was done. Colonoscopy performed 6months after H. pylori eradication therapy con-firmed that the tumor had completely disappeared. This is a interesting case of extragastric MALT lymphoma with a negative H. pylori, which was regressed by H. pylori eradication therapy.

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The patient was a 38 year-old man. He had no history of drinking, but presented with epigastralgia after meals for 2 years. Abdominal CT showed atrophy of the whole pancreas and dilatation of the main pancreatic duct. Since endoscopic retrograde cholangiopancreatography (ERCP) showed several filling defects in the main pancreatic duct and its side branch, he was diagnosed as having radiolucent pancreatic calculi. Entracorporeal shock wave lithotripsy (ESWL) was performed 8 times under monitoring by pancreatography, while the patient was on endoscopic nasopancreatic drainage (ENPD). This treatment noninvasively eliminated the pancreatic calculi and resolved his abdominal pain. The combination of ENPD with ESWL was useful for the following reasons : (1) assistance with focusing, (2) drainage of the fragmented pancreatic calculi, (3) assessment of therapeutic effect, and (4) examination of the pancreatic juice.

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A selfexpandable metalic stenting (SEMS) was performed in 12 cases of gastro-duodenal malignant stenosis from 1998 to 2001. Expanding of stenosis was successful in all cases. Improvement of subjective symptoms and food intake, maintenance of good quality of life (QOL), and shortening of hospitalization period were noted. Furthermore as complications after stenting, one case of septic shock, two cases of migration, one case of remaining of nausea and vomiting, one case of abdominal discomfort were experienced. As a measure for complication after stenting, in infective case of antibiotics with focus infection, and in case with long stenosis section, careful consideration in selection of stenting case in neccessary. And in ineffective case of chemotherapy, it is neccessary to use covered stent. Moreover in case of remainning stenosis after stenting, aggressive expanding of stenosis (stent in stent) is neccessary.

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