Not only varix but also portal hypertensive gastroenteropathy(PHGE)is a characteristiclesion of the gastrointestinal mucosa in patients with portal hypertension. Bleeding from PHGEis not common, however, it is one of the important complications for the patients with portalhypertension because it could be fatal as variceal bleeding. Though PHGE is not an inflamma-tory disease, it is characterized endoscopically by redness and edema. It is also characterizedhistologically by edema and dilated capillaries and venules in the mucosa and submucosa. Increase in portal pressure is the most common etiology. Severity of hepatic disorder andportal hemodynamic change are also associated with PHGE. PHGE is referred to by differentnames depending on its location:It is portal hypertensive gastropathy(PHG)in the stomach, portal hypertensive duodenopathy(PHD)in the duodenum, portal hypertensive enteropathy(PHE)in the small intestine and portal hypertensive colopathy(PHC)in the large intestine. In this review, clinical characteristics, endoscopic classification, histological findings, etiology, pathogenesis and treatment methods are outlined on each of the above-mentionedtypes of PHGE reviewing the reported literature.

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Background:Non-steroidal anti-inflammatory drugs(NSA-Ds), including low dose aspirin, are widely used. However, they can cause gastrointestinal injury, in particular gastric orduodenal ulcers.In Japan, there have been few studies of NSAID-induced bleeding ulcers. Aim:We conducted a prospective study to determine the characteristics of NSAID-induced bleeding ulcers. Materials and Methods:Between January 2000 and December 2005, 0ne hundred ninty two consecutive patients with bleeding peptic ulcers were admitted to our hospital.On history alIpatients were asked about their use of NSAIDs, including concomitant anti-ulcer agents, andanticoagulant therapy, as well as H. pylori infection. Results:Of the 192 bleeding ulcers, 89 were NSAID-induced ulcers(46.4%). Patients with NSAID-induced bleeding ulcers, developed bleeding unrelated to the duration of tinge that they took NSAIDs. Compared to patients with non-NSAID-induced ulcers among NSAID-inducedb/eeding ulcer patients there were statistically significantly more females and elderly(p<0.01, p<0.001, respectively), smokers and drinkers(p<0.01, p%lt;0.001, respectively). Bleeding ulcers were most frequently located in the middle of the stomach. In addition, multiple plural lesions, including non-active bleeding ulcers were statistically significantly observed more often in NSAID-induced ulcer patients than in non-NSAID-induced ulcer patients(P<0.001). Therewere no significant differences in:H. pylori infection, history of peptic ulcer disease, hemoglo-bin level on admission, presence of exposed vessels, and success of endoscopic hemostasisbetween the two groups. Most of the patients were successfully treated with endoscopic hemostasis:88/89 or 98.9% of the NSAIDs-induced ulcer group 102/103 or 99.0% of the and non-NSAIDs-induced ulcer group. However, the NSAID-induced ulcer group had a significantly higher mortality(11/89 or12.4%)compared to the non-NSAID-induced ulcer group(3/103 or 2.9%)(p<0.05). The 11 patients with NSAID-induced bleeding ulcers died due to the aggravation of anunderlying disease or serious complications. Conclusions:The occurence of an NSAID-induced bleeing ulcer is unrelated to the dura-tion of time that the drug was taken. Compared to the non-NSAID-induced bleeding ulcergroup, the NSAID-induced bleeding ulcer group had a higher proportion of:elderly, females and multipled plural ulcer. Endoscopic hemostasis was very successful in both groups. The NSAID-induced bleeding ulcer group had a 12.4% mortality rate due to the aggravation of anunderlying disease or serious complications.

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Background: Capsule endoscopy (PillCamTM SB, Given Imaging, Yoqneam, Israel) is the first line tool for the examination of the small bowel. However, it is not approved yet in Japan. The first multi-center study of capsule endoscopy in Japan was conducted to investigate its clinical outcome and usefulness for obscure gastrointestinal bleeding (OGIB). Methods : Between February and October 2004, 197cases of 185 patients were examined by capsule endoscopy in 9 hospitals in Japan. Results : The main indication of examinations was OGIB (135/185 patients, 73%). Gastric and small-bowel transit time was 39.3±38.1 and 304.7±103.3 minutes, respective-ly. Capsule retention that required endoscopic or surgical retrieval occurred in 3 cases (1.62%). Clinical outcome was obtained 70 of 135 OGBI cases (ulcer or erosion: 34.3%, vascular: 25.7%, neoplasia : 17.1%, Crohn's disease: 10%, and others). Capsule endoscopy is useful for early diagnois of OGIB and it may contribute to shorten admission period. Conclusion: Capsule endoscopy is safe and useful examination for Japanese patients.

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A 54-year old male underwent an upper gastrointestinal endoscopy and a computed tomography (CT) scan test for dysphagia and was diagnosed as having advanced esophageal cancer. Despite a chemoradiation therapy to the lesion, he complicated refractory esophago-pleural fistula and pulmonary suppuration, and received a drainage via esophageal fistula using an Naso-Biliary tube endoscopically. With a significant improvement of his inflammatory response, an esophageal bypass operation was performed. As a result, he was discharged from the hospital to receive home care and became to intake orally. A drainage via esophageal fistula using an ENBD tube could be a beneficial method to improve QOL (Quality of life). This is a report that performed successful drainage via esophageal fistula using an Naso-Biliary drainage tube for esophagopleural fistula and pulmonary suppuration.

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A 44-year-old man was hospitalized due to diabetic ketoacidosis. Intravenous administra-tion of saline along with insulin led to the amelioration of his general condition with a negativity of urinary ketone as well as improved blood sugar. On the 12th hospitalization day, he had a massive hematemesis. Emergent endoscopy revealed reflux esophagitis with spurting bleeding classified as grade D of Los Angels classification. Endoscopic hemostasis was successfully done using tip forceps with soft coagulation mode of a high frequency generation ICC200, leading to the successful prevention of sequent rebleeding with acid-suppressive therapy using proton pump inhibitors (PPIs). On the 37th hospitalization day, Endoscopic ultrasonography revealed a blood vessel in the submucosal area of post-treated lesion, which was considered a bleeding origin. This is the rare case of reflux esophagitis with spurting bleeding that was successfully treated by endoscopy and of which origin was identified using endoscopic ultrasonography.

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We reported a case of penetrating esophageal foreign body (dental prosthesis with sharp clasp). A 76 year-old-man was treated with endoscopic removal using following horizontal rotation technique ; we grasped the clasp by endoscopic forceps, pulled the forceps near the tip of endoscope, and rotated endoscope with forceps in the direction opposite to insertion of the clasp, resulting in successful romoval from the esophageal wall. Although post-romoval endoscopic examination revealed esophageal perforation, we can treated the patient with non -surgical procedure because of little mediastinal emphysema in CT. In endoscopic removal of dental prosthesis with sharp clasp from the esophagus, horizontal rotation technique is throught to be useful.

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A 33-year old woman with HIV infection was admitted to our institute because of diarrhea and general malaise. Endoscopic examinations revealed that duodenal mucosa was faded and that micro villis were ruined. Blood vessels were mut transparent and many nodules with yellowish white color existed in the transverse and ascending colon. Endoscopic findings of Mycobacterium avium complex infection in gastrointestinal tract with AIDS were considered important.

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The patient was an 11-year-old boy who suffered from acute lymphoblastic leukemia. After the chemotherapy with L-Asparaginase, he developed pancreatic pseudocyst after acute pancreatitis that showed rapid growth in size enough to suppress his stomach. On the 87 th day after the onset of pancreatitis, we have successfully performed cystogastrostomy for external drainage of the cyst with ultrasonic endoscopy in succeed. This is the first case report of endoscopic cystgastrostomy in a child patient in Japan. Endoscopic puncture seems to be useful as a treatment of pancreatic pseudocyst in a child with severe disease.

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Percutaneous transhepatic cholangioscopic lithotomy (PTCSL) is effective, but we ofen took time on removing fragments of stones from the common bile duct. Then, we attempted to perform PTCSL with papillary balloon dilation in 10 cases. We slowly dilated the papilla under X ray observation with balloon, 8 mm in diameter. We destroyed the stones to fragments using electro -hydraulic lithotriptor under percutaneous transhepatic cholangioscopic observation, and removed fragments of stones to duodenum with the tip of scope. Complete clearance from the duct was obtained in all cases. In 7 cases of 10 cases, we could perform complete removal of stones by only one examination, without any other instruments. But complications, such as mild pancreatitis and hvperamvlasemia, occurred in 2 cases. Then, 4 to 7 days before PTCSL, we attempted to perform papillary balloon pre-dilation in other 10 cases. Complete clearance from the duct was obtained in all cases. Especially, in 9 cases of 10 cases, we could perform complete removal of stones by only one examination. And no complications occurred. In conclusion, PTCSL with papillary balloon pre-dilation was evaluted to be speedier, easier and safer than PTCSL with papillary balloon dilation.

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Peroral cholangioscopy under duodenoscopic assistance can allow direct visualization of the bile duct. At present, however, fragility of the f iberscope equipment and technical difficulty disturb its popularity. Preliminary data by using a new videoscope, which provide excellent quality images, are encouraging. Compared to percutaneous transhepatic cholangioscopy which requires insertion of transhepatic biliary drains, peroral cholangioscopy is a safer, faster and less invasive procedure. Although several clinical studies suggest the efficacy of peroral cholangioscopy for management of various bile duct lesions, its diagnostic accuracy needs further clinical controlled studies. Intracorporeal lithotripsy under peroral cholangioscope may be a safe and effective method for difficult-to-treat bile duct stones including intrahepatic stones. Furthermore, it is expected that a videoscope has longer durability of optical images and better manipulation.

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