Gastrointestinal diseases, especially reflux esophagitis and colon cancer, in the elderly were investigated based on endoscopy results. The incidence of reflux esophagitis increased over a five-year period from 3.1% to 8.1% due to an increase in the elderly population and changes in dietary lifestyle among Japanese, and due to endoscopic advances. Subjective symptoms of reflux esophagitis often include heartburn, and tend to be accompanied among the elderly by atypical symptoms such as asthma or chronic cough. Based on endoscopic findings, the prevalence of grades C and D according to the Los Angeles Classification System tends to increase with age. In the elderly, the gastroesophageal flap valve (GEFV) was often graded highly at 3 and 4, which was consistent with the incidence of esophageal hiatal hernia. Each year more and more people are being treated with PPI agents for reflux esophagitis, and PPIs are now being prescribed from the initial stage of treatment. However, the prevalence of colon cancer is increasing as the Japanese dietary lifestyle becomes more westernized, and the morbidity rates of colon cancer are on the rise. The fiveyear colon cancer rate was 7.3% among the elderly compared to 3.9% among non-elderly. There is an increasing tendency for colon cancer to occur in the right colon in the elderly. In terms of chief complaint at the initial visit to hospital, 84% of elderly/non-elderly patients were asymptomatic, while among the elderly more than 55% with a chief complaint had symptoms such as melena, defecation abnormality, and abdominal pain, so the ratio of ileus symptoms is increasing. Early colon cancer should be treated aggressively with polypectomy or EMR. If the colon cancer is advanced, the colon should be aggressively resected if surgery is possible. Aging varies enormously among individuals. Bearing in mind that "calendar age" and "biological age" can differ, it is important to understand the characteristics of gastrointestinal disease in the elderly, and reflect this in one's daily medical practice.

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To clarify clinical characteristics of synchronous and metachronous multiple laterally spreading tumors (LSTs), we examined the clinicopathological backgrounds of 315 cases including 403 LSTs, which had been treated endocsopically or/and surgically at Akita Red Cross Hospital from 1993 to 2002. Clinicopathological characteristics of multiple LSTs were summarized as follows : (1) the ratio of macroscopic type of non-granular (NG) was higher in cases of multiple LSTs than in those of single LST ; (2) Multiple LSTs were located more frequently on the right side colon than on the rectum ; (3) The incidence of cancer was higher in multiple LSTs than in single LST. These results show that colorectal endoscopy examinations should be performed more carefully to detect malignant lesions especially in multiple LSTs.

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A 67-year-old female had noticed loss of appetite and nausea but refused treatment. She visited a local hospital due to hematemesis, and endoscopy showed esophageal stricture and multiple gastric ulcers. She was referred to our hospital and admitted. Endoscopy showed detachment of the entire circumference of the esophageal mucosa accompanied by severe stenosis in the area lower than 25 cm from the incisors, as well as multiple ulcers in the middle gastric body. Biopsy revealed only granulomatous tissue and fibrous tissue, but no atypical cells at the esophageal or gastric lesions. The cause of esophagitis and gastric ulcers was unclear, and the diagnosis was initially difficult. However, detailed inquiry of the patient and family revealed that she has the habit of eating hot rice gruel. Esophageal balloon bouginage was applied repeatedly. At present, 3 years after onset, slight stenosis is observed, but oral intake can be done adequately. After prohibition of the intake of hot rice gruel, no recurrence has been observed. These findings suggest that repeated burns may have induced those pathologic conditions in this patient.

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A 84-year-old female visited our institution because of melena and anemia. Upper GI endoscopy showed multiple punched out ulcers in the middle and lower esophagus. Histologically, the biopsy specimens taken from the marginal site of ulcers showed "ground glass" nuclei, and were positive for anti-herpes simplex virus Type 1 (HSV-1) antibody. We supposed that cause of the esophagitis was due to infection of herpes simplex virus (HSV). After administration of acyclovir for 7 days, symptom and endoscopic findings were improved immediately. Frequency of Melena in herpetic esophagitis is comparatively high. Since there is possibility of severe gastrointestinal bleeding as a complaint of hepatic infection of the esophagus, early diagnosis and appropriate therapy is indispensable for herpetic esophagitis.

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A 61-years-old male had a right upper abdominal pain and palpable tumor. An operation was performed based on the diagnosis of malignant disease, as suggested by clinical features and the findings of several examination including barium enema, colonoscopy, CT scan, ultrasound guided aspiration biopsy cytology, and others. Transverse colectomy and partial abdominal wall resection was done. Microscopic examination of the resected tissues revealed abdominal actinomycosis, showing actinomycosis granules in the abscess. Abdominal actinomycosis is a rare disease and very difficult to make diagnosis preoperatively. However, its diagnosis may be able to accomplish by various examination.

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A 61-year-old woman with neurogenic bowel (severe constipation) after operation of ossification of posterior longitudinal ligament was admitted for control of defication. Percutaneous endoscopic cecostomy with introducer method was performed for antegrade continence enema (ACE). Her symptoms (constipation and abdominal pain) were improved by ACEs. The patient can do the ACE procedure by herself. At an 8-month follow-up, the patient was well without recurrent constipation.

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A 34-year-old healthy man consulted a local physician due to fever, general malaise and epigastric pain. A week after, he was referred to our department because of hepatic injury. Serum IgM antibodies to CMV increased and serum antigen of CMV were positive, therefore a diagnosis of CMV infection was made. Upper gastrointestinal (GI) endoscopy showed multiple erosions which located on hypertrophic folds in the corpus. Colonoscopy showed multiple ulceration in the ileocecal valve and the terminal ileum. CMV-DNA were detected by PCR method in both biopsy specimens from an erosion of the stomach and ulceration of the ileum. Without anti-viral medication, clinical symptoms and endoscopic findings were improved. It is important to perform GI tract examination in the patient who complains GI symptoms due to CMV infection. And to investigate serum antigen of CMV is available for diagnosis.

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Rectal variceal bleeding is rarely encountered, but can be massive and life-threatening. We report here a case of successful treatment of rectal variceal bleeding with endoscopic variceal ligation (EVL) and injection sclerotherapy (EIS) in a patient with idiopathic portal hypertension. Five years after EIS for esophageal variceal bleeding, the patient developed massive bleeding of rectal varices. EVL was performed to occlude the bleeding site, and the rectal varices were completely obliterated by EIS. No recurrence of rectal bleeding was observed after one year follow-up. EVL may be effective in controlling acute bleeding from rectal varices, while EIS may be beneficial in the eradication of the varices.

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A 86-year-old female who received endoscopic sphincterotomy (EST) because of a common bile duct (CBD) stone in 1990. A CBD stone was recurred, however, treatment was not done because of the absence of symptom and abnormal labolatory data. In July 2000, abdominal pain and fever appeared. She received the percutaneous transhepatic biliary drainage (PTBD), and a CBD stone was extracted with electrohydraulic shock wave lithotripsy (EHL), using percutaneous transhepatic cholangioscope (PTCS). After lithotripsy a bile duct tumor was recognized in the intrahepatic bile duct. We performed Nd ; YAG laser irradiation and remote after roading system (RALS) theraphy. After ten months, PTCS showed a bile duct scar and no residual tumor.

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Foreign bodies in the upper gastrointestinal tract often injure the esophageal and gastric mucosa during endoscopic removal, so that careful manipulation is necessary. Although the removing method using an over tube has been reported until now, it has possibility of injuring the esophageal and gastric mucosa. We used the Long overtube (R) (SUMITOMO BAKELITE Co., Ltd.) for placing an ileus tube with an endoscope, as an auxiliary device. The Long overtube was inserted along the endoscope beforehand. After introducing the endoscope into the patient, the sharp foreign body was grasped and the tube was advanced along the scope into the stomach. We applied this method to following two cases : a 28-year-old man with epilepsy swallowing a needle and a 53-year-old carpenter swallowing a nail accidentally. The foreign bodies were contained in the tube within the stomach and they were removed safely without injury to the mucosa. No accidents were encountered with this procedure. The Long overtube-method can remove foreign bodies simply and safely. This method is especially suited for removal of sharp foreign bodies in the upper gastrointestinal tract.

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Background : Endoscopic color Doppler ultrasonography (ECDUS) is a method for detecting color flow images in blood vessels. In the present study, electronic radial ECDUS in cases of esophageal varices is described. Methods : Thirteen patients with esophageal varices were studied. The technique of ECDUS was performed using a Pentax EG3630-UR (forward-view) with a distal tip diameter of 12 mm. The instrument (electronic radial array) has a curved array scanning transducer with variable frequency (5.0, 7.5, 10.0 MHz) and B mode/color Doppler/power Doppler capability. A Hitachi EUB 6500 was used for the display, providing a 270°images. We monitored the color flow images of esophageal varices, paraesophageal veins, and perforating veins using this technique. Results : Color flow images of esophageal varices and paraesophageal veins were obtained in 13 of the 13 patients, whereas color flow images of perforating veins were obtained in four of the 13 patients (30.8%). Thirteen esophageal varices exhibited velocities raging between 3.0 and 11.7 cm/s (mean= 6.3 cm/s). The forward-viewing optics facilitated insertion, but the stiffness of the distal tip limited the flexibility of the scope, especially when attempting J- or U-turn view. Conclusion : Electronic radial ECDUS provides color flow images similar in quality to those of convex-type ECDUS with the additional advantages of forward-view optics and extended 270°views.

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