Autoimmune pancreatits is highly associated with sclerosing cholangitis. We call these sclerosing cholangitis as autoimmune sclerosing cholangitis, which can be classified into four types. Cases with cholangiogram showing diffuse stenoses in the intrahepatic bile ducts are misdiagnosed as primary sclerosing cholangitis and localized stenosis may be misdiagnosed as cholangiocarcinoma. Detailed examination of cholangiographic findings in autoimmune sclerosing cholangitis elucidated some different points from those of primary sclerosing cholangitis. We concluded that cholangiography is useful in differentiating autoim-mune sclerosing cholangitis from primary sclerosing cholangitis.

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A 72-year-old man was admitted to our hospital with dysphagia. Esophageal endoscopy, esophagogarapy and chest CT revealed long esophageal stenosis, 12cm in length, and a right lower lung tumor. Our tentative diagnosis was advanced esophageal cancer and advanced lung cancer. To remedy the patient's dysphagia a transendoscopic balloon dilatation was done and a self expandable metallic stent was inserted. Postoperative, a pleural effusion increased rapidly and caused respiratory failure. The patient died 6 days after stenting. The esophageal lesion was found to have been the result of lung cancer invasion on autopsy. It is well known that lung cancer can cause esophageal stenosis. However, it is rare that a stent insertion is done in such patients given their poor prognosis. This case suggests that the differential diagnosis should include lung cancer when treating a patient with an esophageal stenosis.

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Gastrocutaneous fistula (GCF) after gastrostomy tube removal is rare in adult while a known complication primarily reported in the pediatric literature. An 36-year-old man underwent a radical treatment of congenital esophageal atresia in infants. When 35 years have passed, he had GCF unexpectedly. We tried endoscopic clipping and achieved to reduce discharge. Then fibrin glue was applied directly over the fistulous tract. We succeeded in fistulas closure completely in short hospital stay. This procedure could be effective treatment without complications, and avoid some unnecessary surgical interventions in GCF treatment.

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A 75-year-old woman was admitted to our hospital with a complaint of abdominal pain in the right lower quadrant. An emergent operation was performed under diagnosis of acute appendicitis. Pathological diagnosis was acute gangrenous appendicitis. Abdominal computed tomogram showed calcification in the wall and mesenterium of the right side of colon. She had colonoscopy examination, barium enema after the operation leading the diagnosis of mesenteric phlebosclerosis. We reported a rare case of mesenteric phlebosclerosis.

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The patient was a 28-year-old male. He visited to our hospital with a chief complaint of epigastric discomfort, abdominal fullness, vomiting and weight loss. Upper gastrointestinal contrast study demonstrated duodenal dilatation with a pear shaped barium-filled structure and thin radio-lucent halo as the barium went past the web. Endoscopy revealed the duodenal dilatation with abrupt end at the site of web. Two small orifices were also found. With ERCP, the proximal orifice was found to be the ampulla of Vater. Distal orifice was found to be a small aperture leading to distal duodenum by contrast study. We made a diagnosis of congeni-tal duodenal web. Endoscopic excision was performed successfully with a snare for polypectomy and an IT knife. The complication was bleeding which was managed with electric coagulation, ethanol injection, and clip without blood transfusion. The postoperative course was satisfactory and he was discharged on the 20th postoperative day. With endoscopic and technical advances, endoscopic resection of the web will be expected to become an useful method in the future.

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A 62-year-old female was referred to our section because of anal bleeding. Endoscopic examination revealed a huge polyp and diverticula with bleeding in ascending colon. We diagnosed that anal bleeding was due to diverticulum of ascending colon. The size of polyp was about 4cm. The anal side of the polyp was divided to some slender tip, and the surface was smooth and light red. On the other hand, the oral side of the polyp was "IKURA-like appearence" mucosa with transpearency. Anal side of the polyp was polypectomized to obtain the diagnosis. The pathological finding was not neoplastic polyp, but retension polyp. This polyp was diagnosed unclassified by Morson's histological criteria.

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A 67-year-old woman presented with lower abdominal pain. Abdominal ultrasound examination detected liver tumors. Then she was referred to our hospital for further examina-tions. A histological diagnosis of carcinoid tumor was made by a needle biopsy of the liver tumor. The primaly carcinoid tumor was not revealed by upper GI or colonoscopy. Small bowel follow-through examination showed a tumor in the ileum. The patient underwent double -balloon enteroscopy by transanal and transoral routes, but the enteroscopy could not reach the tumor because of adhesion or tumor invasion. A partial resection of the ileum and a liver were performed. Postoperative histopathological examination demonstrated the ileal carcinoid tumor accompanied by hepatic metastases. Because small-bowel carcinoid tumor mostly develops multicentric, preoperative double-balloon enteroscopy is useful for investigating other lesion in the small bowel as in our case. Moreover, a marking with double-balloon enteroscopy was effective to determine the extent of the small bowel resection.

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Background and aim:The advantages of the conventional bipolar snare are less opportunity of perforation and heat damage to specimens. But, the disadvantage of the conventionalbipolar snare is easy to bleed at the part of the ceramic insulator. On the sheath type bipolarsnare(B-wave), the wire side has only negative electrodes without ceramic insulator and thesheath side has positive electrode. For this reason, it was reported that B-wave had lessopportunity for bleeding compared with the conventional type. High frequency surgery unit(Erbotom ICC200, ERBE)has an automatic controller for current altered by the impedance ofspecimens by monitoring the cutting condition. Thus, we attempted to analyze the combinationtrial with B-WAVE and Erbotom ICC200 to reduce hemorrhage on polypectomy or EMR ofcolon polyps with the basic examination. Materials and methods:Sixty four patients with 100 polyps lesions were enrolled. Thesepatients were separated in two groups using ERBE and an ordinary blending current unit(Blend). EMR of colon polyps was practically done. Hemorrhage after EMR or polypectomywas analyzed. Result:We recognized 5 cases of hemorrhage in Blend group. Whereas only one case ofoozing in ERBE group. Conclusion:The combination with B-WAVE and ERBE is able to reduce a risk of hemor-rhage on polypectomy and EMR and it will provide more safe and effective resection of colonpolyps by using the bipolar snare.

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Recent advances of industrial technology have enabled us trans-nasal esohago-gastro-duodenoscopy(EGD)easily. Although the techniques of trans-nasal EGD are not difficult, akind of slight barrier exists in starting of trans-nasal EGD. The most important factors ofbarrier are examiner's negative feelings for nasal endoscopy and a lack of knowledge forpreparation. In preparation, we believe that the usage of a little amount of vasoconstrictor asnaphazoline sulphate and high concentration lidocaine, no use of lidocaine jelly or injectivemedicines, and bougienage with Nelaton tube if needed are important. With these appropriatepreparations almost all patients are acceptable for trans-nasal EGD with deep satisfaction.The endoscopes possible for trans-nasal insertion have the almost same abilities in diagnosis ofupper gastro-intestinal tract diseases as the standard tans-oral EGD scopes. More advances inendoscopic function, e.g. observation with magnification and/or enhancement of micro-vascularstructures, with or without more decreasing in size may be expected.

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