We conducted a epidemiological survey in 2, 595 patients who underwent endoscopy for the first time, confirming that Barrett's mucosa was observed in 536 (20.8%) of 2, 577 patients. The length of Barrett's mucosa was significantly longer in female patients than that in male patients. No correlation was observed between the prevalence of Barrett's mucosa and age group. Meanwhile, correlations were observed between the presence or absence of Barrett's mucosa and heartburn, and between the length of Barrett's mucosa and the severity of ref lux esophagitis or esophageal hiatus hernia. In addition, atrophic gastritis affected length of Barrett's mucosa. These findings suggested that ref lux esophagitis played an important role for the occurrence of Barrett mucosa. However, the prevalence of typical Barrett's esophagus was markedly low in the Japanese compared with Westerner. It is necessary to standardize the definition of Barrett's mucosa and accumulate the evidence based on the diagnostic criterian.

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We conducted a nation wide epidemiological study to investigate the prevalence of hiatus hernia and correlation with gastroesophageal reflux disease. Hiatus hernia was observed in 1, 263 (49.3%) of 2, 560 patients on the Makuuchi classfication. The prevalence was significantly higher in females than in males. There was a significant correlation between the severity of hiatus hernia and ref lux esophagitis but no correlation with age and heartburn frequency. A significant correlation was shown between the Makuuchi classification (four stages) and the classification of J-turned observation in the cardiac region (three stages). However the latter showed a slightly lower correlation coefficient with reflux esophagitis. Further researches will be needed to elucidate the developmental mechanism of hiatus hernia and to establish the diagnostic criteria. The results of this first nation-wide survey provide useful evidence of the epidemiology of GERD in Japan, and should help facilitate a better understanding of the differences in the pathophysiology of GERD between countries.

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We experienced a rare case of submucosal basaloid-squamous carcinoma of the esophagus with liver metastasis. A 72-year-old woman was admitted to the hospital for the purpose of operation for intrathoracic carcinoma that was diagnosed at another hospital. Esophagography revealed a lesion in the abdominal esophagus, and endoscopic findings demonstrated an elevated lesion 6.5cm in longer diameter on the anterior wall of the esophagus 28cm from the incisors. A squamous cell carcinoma was diagnosed by a biopsy. A total thoracic esophagectomy was performed. The resected material showed a 4.2 X 2.5 cm type 2 lesion with an uneven surface and a 1.6 X 1.3 cm type 0-I lesion. The histological diagnosis was double cancer of the esophagus, with squamous cell carcinoma and basaloid-squamous carcinoma. The patient was doing well 3 weeks after surgery. Basaloid-squamous carcinoma of the esophagus has been reported to have a poor prognosis on the whole, but the patients with the disease in an early stage (superficial cancer type) have been known to have less lymph node metastasis with consequent long-term survival.

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Emphysematous gastritis is a rare form of infectious gastritis characterized by intramural gas production with gas forming organisms. Although rare in the incidence, it has a fulminating course with a high mortality rate. A 41 year old male was admitted with high fever, sore throat and epigastric pain. Endoscopy revealed mucosal necrosis in the esophagus, stomach and duodenal bulb. Computed tomography showed diffuse wall thickening and intramural gas in the esophagus, stomach and duodenal bulb. Cultures of gastric juice revealed Peptostreptococcus micros and etc. We reported a case of emphysematous esophago-gastro-dueodenitis successfully treated by conservative therapy.

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A 85-year-old female visited our hospital with the chief complaints of a weight loss and epigastralgia after food. Upper endoscopy revealed a stenotic pyloric channel and normal stomach, however, the endoscope could be inserted into the duodenum. The biopsy specimen from the mucosa of the pyloric canal was negative for malignancy. Barium meal showed narrow pylorus with "Kirklin's sign" and an enlarged and elongated pylorus was identified on ultrasonography. Then adult hypertrophic pyloric stenosis was diagnosed. Oral atropine therapy was done, but this treatment was not effective for the patient. A distal gastrectomy was performed. The postoperative course was uneventful, and the patient has remained symptom-free.

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We report a case of incarcerated stone of communicating accessory bile duct. A 48-year-old woman referred to our hospital for incisional hernia. There was a previous history of acute cholecystitis with gallbladder stone. We examined the biliary tree. The gallbladder stone and atrophic gallbladder was found on computed tomography. The communicating accessory bile duct originating from right hepatic duct to cystic duct was found on endoscopic retrograde cholangiography. It is important to perform a procedure with recognition of anomalous biliary tract to prevent intraoperative bile duct injury. The case of incarcerated stone in the communicating accessory bile duct rarely has been reported in this country. Review of literature was done and reported.

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A 26-year-old woman during pregnancy was admitted to our hospital due to upperabdominal pain. We diagnosed as pancreatitis but it cloud not find out the cause of pancreatitis, for example, gall bladder stone and alcohol. Her mother also had been followed aschronic pancreatitis since her youth. The gene analysis was performed, and the point mutation(R122H) on third exon of the cationic trypsinogen gene on chromosome 7q35 was detected. Herelder daughter and second daughter also had the same point mutation (R122H). The eldestdaughter was diagnosed as chronic pancreatitis at the age of six.

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Obj ective: To investigate the possibility of preventing post-ERCP pancreatitis by pancreatic duct stent placement. Patients and methods: Pancreatic duct stenting using a 5-Fr stent was performed in 15patients at high risk of post-ERCP pancreatitis. The prevalence of pancreatitis was investigated. Results: Pancreatitis occurred in none of the patients. Spontaneous migration of the stentwas observed in 73% of the patients. Conclusion:Pancreatic duct stent insertion after ERCP may reduce the frequency of post-ERCP pancreatitis in patients at high risk.

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Oro-and hypopharynx is the orifice of gastrointestinal tract. In this article, the methods of endoscopic examination and treatment for superficial carcinoma in these regions are introduced. On the basis of detailed anatomical knowledge, oropharynx, hypopharynx, pharyngoesophageal junction and larynx are systematically examined with high-resolutional electronic panendoscopy, in order to detect small and superficial carcinomas. Selected patients as the high-risk group of pharyngeal carcinoma are beneficial targets of above-mentioned endoscopic surveillance. Mucosal redness, pale thickened mucosa, white deposits or loss of normal vascular pattern are sufficient findings for superficial carcinoma. Under mucosal anesthesia and sedation, close observation without iodine staining followed by a biopsy is suitable for screening. Special attention must be paid to the extension and the multiplicity of lesions. Magnifying endoscopy or narrowband imaging will be useful in some cases. The endoscopic treatment for pharyngeal carcinomas is still a trial, and should be applied to the lesions not invaded into the muscular layer, smaller than 4cm in maximum diameter and not accompanied with lymphnode metastasis. The treatment is performed under general anesthesia, and the carcinoma is clearly identified with iodine staining. The procedures of EMRC or APC are used solely or in combination. In oro-and hypopharynx, small-sized and mufti-cessional mucosal resection is rather safer and easier than one-block resection. Aspiration pneumonia and laryngeal edema must be prevented during and also after the procedures. Sore throat is an inevitable complaint and patient requires analgesia. After the endoscopic treatment, the pharynx and larynx are preserved and QOL of the patient can be maintained much better, however, there remains the risk of recurrence.Therefore, long-term follow-up is essential, and if any doubts about curability, it is important to switch immediately to the standard modalities of treatment, such as radical operation or irradiation.

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Background:Endoscopic color Doppler ultrasonography (ECDUS)is a useful modality for obtaining color flow images of esophageal varices. The direction of blood flow in passageways is fundamentally hepatofugal flow according to ECDUS. This study is designed to evaluate the alternate direction of color flow image of passageways via ECDUS in esophageal variceal patients. Methods:The study involved 125 patients with esophageal varices using ECDUS. The grades of red color(RC)were as follows:RC(+)in 79 cases, RC(++)in 35 cases, and RC(+++)in ll cases. We investigated the alternate direction on color flow images of the left gastric vein, the palisade vein, and the perforating veins via ECDUS. Results:Color flow images of the esophageal varices and the left gastric vein were obtained in all 125(100%)of patients by ECDUS. Color flow images of the perforating veins were obtained in 90(72.0%)of the 125 patients. Vessel images of the palisade veins were detected in 33(26.4%)of the 125 patients. The alternate direction on color flow images was detected in 7(5.6%)of the 125 patients with ECDUS, in three patients, left gastric vein and in three patients, perforating veins, and in one patients, left gastric vein and palisade veins. This phenomenon was observed periodically at regular intervals. The endoscopic findings were RC(+)in all seven patients. Conclusion:The alternate direction of blood flow in the passageways was observed in a few cases of RC(+) esophageal varices. We can observe the hemodynamics of esophageal varices non-invasive and in real-time with ECDUS, and clarify the frequencies of the alternate direction of blood flow in RC positive esophageal variceal patients.

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