I reviewed usefulness of endoscopic treatment for pancreatic stone and pancreatic ductal strictures. The complete stone-clearance rate after ESWL alone or in combination with interventional endoscopy was reported as 76 to 88%, and symptom relief was achieved in 93 to 100%. However, long-term prognosis after removal of pancreatic stones is still unknown. High rate of stone recurrence is another problem, and pancreatic ductal stricture may influence it. Pain relief rate by pancreatic stenting is reported as 74 to 94%. In addition, pancreatic stenting is useful as assistance of stone clearance by ESWL, and expected as prophylaxis of stone recurrence. More number of patients is necessary to make sure the usefulness of pancreatic stenting.

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In 74 patients with aphthoid intestinal lesions who were treated in our hospital during the past 6 years, we investigated the endoscopic morphology of these lesions. There were 37 males and 37 females, with a mean age of 51.4 years. The aphthoid intestinal lesions were endos-copically classified into 3 groups (Groups A : hyperemic, B : aphthoid, and C : verrucous appear-ance or small ulcers). Concerning the distribution, the lesions were mainly located in the rectum to the sigmoid colon in Group A. In Group C, the lesions were most frequently located in the transverse colon or deeper areas. Aphthoid lesions were seen in association with infectious enteritis in 12.2% of the patients, ischemic enteritis in 8.1%, ulcerative colitis (including a tentative diagnosis of ulcerative colitis) in 12.2%, Crohn's disease in 5.4%, and other diseases in 2.7%, whereas the etiology was unclear in 59.4%. Endoscopically, the etiology was unclear in 68.0% in Group A and in 74.2% in Group B. In Group C, infectious enteritis and ischemic enteritis were frequently observed (66.7%). With respect to inflammatory intestinal diseases, 50% of the patients with Crohn's disease were assigned to Group C, whereas all patients with ulcerative colitis were assigned to Groups A or B. In conclusion, this classification can be useful for the differential diagnosis of aphthoid lesions.

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A 67-year-old female was admitted to our Center because of upper abdominal pain. Serum amylase levels were elevated and abdominal CT showed gallstones and swelling of the ampulla of Vater. Clinically a diagnosis of acute biliary pancreatitis was suspected. Emergency ERCP was performed. It showed a pediculated tumor at the duodenal papilla causing pancreatem-phraxis. We performed endoscopic naso-pancreatic drainage to relieve the obstruction of the pancreatic duct. Temporarily the pancreatitis worsened, but then improved by conservative therapy. From EUS and histological findings of forceps biopsy, we diagnosed this tumor as adenoma of the ampulla of Vater without extension into the bile duct or pancreatic duct. We performed endoscopic papillectomy without complication.

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A 66 year-old woman was admitted to our hospital because of progressive quadriplegia and anemia. Upper GI endoscopy revealed a pedunculated submucosal tumor with ulceration in the duodenal bulb. We supposed that the cause of melena was due to bleeding from the tumor because no lesions were demonstrated on small-intestinal radiography. Endoscopic ultrasono-graphy showed an echogenic mass, supporting the diagnosis of a duodenal lipoma which was treated by endoscopic polypectomy after obtaining an informed consent. It was measured 13× 12mm in size and the pathological diagnosis was also the same as lipoma. Thereafter, melena and anemia disappeared with complete remission.

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A Case 1 was 62-year-old man with intractable and cryptogenic ascites. Laparoscope was revealed several white nodules at peritoneum. The result of the biopsy was the malignant mesoepithelioma of the peritoneum. A case 2 was 64-year-old man with intractable and cryptogenic ascites. Laparoscop showed the intra-abdominal organs were coated with white thick membrane. The result of the biopsy was the non-specific chronic inflammation. So we diagnosed encapsulating peritoneal sclerosis. We dispensed antibiotics according to the culture and sensitivity. Antibiotics was effective and accites was decreased. Laparoscopic examination for the patient with intractable and cryptogenic ascites was useful.

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Soft coagulation has units of dehydrating slowly and evaporating fluid in tissue without generating spark compared to the conventional radiof requency coagulation. Therefore, comple-tion of coagulation can be judged by vapor generation. We developed 4 + 1 contact method which coagulated the 4 sites around the blood vessel initially and coagulated the blood vessel itself as a procedure of hemostasis. The method was applied in 76 patients with bleeding gastric ulcers. We obtained good results that the rate of initial hemostasis was 100% (Soft coagulation alone ; 75.0%) with no case of recurrent bleeding and perforation and that the rate of hemostasis alone within 10 minutes was 92.2%. It is considered that 4 + 1 contact method using soft coagulation is a safe and easy hemostatic method which can be done in a short-time with excellent processing ability for blood vessels.

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We have reported usefulness of an oblique-viewing endoscope for ERCP and associated procedures in patients with Billroth II gastrectomy. Bileduct stone removal with an oblique-viewing endoscope was attempted in two patients with Roux-en-Y gastrectomy. In those patients, because the afferent loop was too long to reach the papilla of Vater, an overtube for an enteroscope was used to avoid an extension of the jejunum, then stones were removed with balloon dilation. It was suggested that an oblique-viewing endoscope with an overtube may facilitate Bileduct stone removal in patients with Roux-en-Y gastrectomy.

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Tumors of the duodenal papilla include hyperplasia, adenoma, carcinoma in adenoma and carcinoma. As the duodenal papilla has special anatomical characteristics and treatment involves major intervention and correct preoperative diagnosis. In patients with adenoma, or early carcinoma of the papilla, various endoscopic snare excision techniques are indicated for complete removal the tumor. Pancreatitis and cholangitis are major complications caused by endoscopic techniques. In the present study, endoscopic snare excision of the tumor located at the major papilla was carried out in two cases with early carcinoma or adenoma patients using a therapeutic duodenoscope, a spiral snare for the colon, and pure cutting current. The patients who underwent insertion of a 5-Fr pancreatic stent and a 7-Fr biliary stent inserted immediate-ly after endoscopic tumor resection did not develop either pancreatitis nor cholangitis. This seems to be a safe technical method to prevent complications of endoscopic snare excision of the major papilla tumor.

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