The World Organisation for Digestive Endoscopy (Organisation Mondiale d'Endoscopie Digestive), OMED, is a world federation of independent digestive endoscopy societies or independent endoscopy groups within gastroenterology societies of countries and some areas nationwide. Today, over 80 nations and areas in the world are affiliated as members of OMED . OMED was established as International Society of Endoscopy (ISE) in 1966, and the First Congress was held in Tokyo in the same year. In July of 1976, the name of the organization was changed to a more comprehensive name "The World Organisation for Digestive Endoscopy (Organisation Mondiale d'Endoscopie Digestive) ", OMED . The most important operation of OMED is to hold World Congress . OMED has held World Congress once in 4 years from the 2^nd to the latest 11^th congress . The author served as President of OMED from March 2002 to September 2005 . The policy and direction of OMED are specified in the statutes of the organization, and the activities are carried out by the several committees of OMED. The committees are consisted of standing committees and ad hoc committees that are set up as necessary . Details of the committee activities during the presidency term of the author are described . In 2003 and 2005, OMED Spring Meetings were held jointly with the International Gastric Cancer Association. Under the circumstance where the concept of early cancer was not fully acknowledged by other nations, Lambert of France cooperated with OMED to organize an international study meeting of definition, classification and types of Epitherial tumors in Paris . The results of this study meeting were published in the journal "Gastrointestinal Endoscopy ." After retirement as president, the author has taken part in these activities as the former president. Especially in the Asian countries, the author has cooperated with the Asian Pacific Society for Digestive Endoscopy to take part in the OMED activities . Described in this thesis are the situation of establishment and later growth of OMED, the activities during the author's presidency term and the future direction of activities in OMED .

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The patient was a 50-year-old man who had been diagnosed with Crohn's disease at 30 years of age. He had suffered from an anal fistula since the age of 20. He underwent a stoma in sigmoid colon due to anal stenosis at the age of 48, and a partial resection of the ileum due to perforation and massive bleeding at the age of 49. Then, his anal pain increased and adenocarcinoma was found in a biopsy specimen of the lower rectum stenosis at a nearby hospital. In our hospital, CT and MRI scans showed a 7.5cm tumor in the lower rectum and anus. It was diagnosed as stage IIIa rectal cancer and abdominoperineal resection following chemoradiation was performed. The tumor was seen at the cut end and he died from ileus 2 months after surgery.

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A 68-year-old woman was admitted to our hospital with a one-month history of continuous watery diarrhea. The patient had been taking various medications including lansoprazole for more than six months. On colonoscopy, multiple longitudinal, thin ulcers were noted on the left side of the colon. Multiple biopsy specimens obtained from each segment of the large intestine were found to have thickened subepithelial collagen bands, which measured more than 30μm in thickness. The patients clinical and histological findings were compatible with the diagnosis of collagenous colitis. After discontinuing lansoprazole, the patients symptom improved. One year later, her colonic lesions were found to have healed completely.

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Styptic treatment of diverticulum bleeding with a clip is a manual skill established with safety. However, there is a report of the complication that a clip seems to be a cause. We experienced two cases of colonic erosion formed by a clip that was performed for diverticulum bleeding of the ileum end and an ascending colon. An appropriate clip is important to the patient that antithrombotic therapy was taken, for bleeding of cecum.

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A 75-year-old male visited us after experiencing sudden lower abdominal pain and darkred blood discharge 5 days after colonoscopy. Emergency surgery was performed after a deep ulcer on the mesenterium side of the sigmoid colon and necrosis of the colon wall had been revealed by endoscopy. Rupture of the digestive tract is a known complication of colonoscopy . Although he had stopped taking an anticoagulant for one week, his melena seemed to be caused by the resumption of medication after colonoscopy. We wish to report this case of delayed rupture of the sigmoid colon after colonoscopy with a review of the literature.

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A 30-year-old male was hospitalized with general malaise and jaundice . MRCP showed a small stone in the distal common bile duct with minute stones in the gall bladder . On the next day the bile duct stone was removed employing endoscopic papillary balloon dilation (EPBD) using a 6-mm-diameter balloon with 4 to 6 atmospheres of pressure that was elevated slowly over two minutes. The disappearance of the notch sign in the bile duct was confirmed following the establishment of a 7 fr plastic stent ; stone extraction was performed using basket forceps and a retrieval balloon catheter. After the procedure, the patient developed acute pancreatitis. On day 1, serum and urinary amylases were 3, 120 and 903000 IU/L, respectively. The patient was saccessfully treated with continuous hemodiafiltration, as well as intra -arterial injections of protein inhibitors and antibiotics . EPBD is more conventional them EST, but it carries the potential risk of the patient developing acute pancreatitis . This, when an adaptation of EPBD is employed even by those with technical expertise, efforts should be made to avoid post-procedure acute pancreatitis.

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We tried re-insertion of a percutaneous endoscopic gastrostomy (PEG) tube using endos copic, non-invasive, and catheter-guided method. For the patients in whom tube exchanges through the previous fistula of PEG were impossible due to various reasons . This method could be performed successfully in 21 of 25 patients. Before considering replacement of PEG in patients with reinsertion difficulties, less invasive method as described here can be recommended.

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Background : Unresectable malignant digestive strictures have been treated by palliative surgery in Japan. Palliative surgery is invasive for poor status patients . Therefore, minimally invasive therapies such as endoscopic treatments have been hoped and necessary . Methods : From December, 2005, we treated 15 patients who had unresectable malignant digestive strictures by SEMS (Self-expandable metallic stent) . Its delivery system is TTS (Through the scope) type. Results : Safely and easily we could enforced SEMS placement using endoscopic forceps channel in 14 patients among 15 patients. After SEMS placement, symptoms by digestive stricture were improved and serious complications did not occurred . Conclusion : This TTS type SEMS was unauthorized in Japan, but seemed to be useful palliative therapy.

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Endoscopic submucosal dissection (ESD) allows en-bloc resection for a large lesion . It has a maximal advantage for obtaining an accurate histological diagnosis, although the procedure takes longer and requires grate technical skill, and cardiorespiratory risk is high if too much sedative is administered during ESD procedure. We let you do maneuver itself of ESD with distress more without can preserve quiescent of the patient in insufficient sedation . ESD should to be performed under general anesthesia in the operating room when the procedure is esti mated to take more than two hours. General anesthesia with intra tracheal intubation makes ESD easy and safe to perform. The development of various devices and high-frequency units is supporting this new endoscopic treatment. Some types of devices for cutting (eg . the IT knife) have appeared on the market ; it is essential to understand their electrosurgical charac teristics before using these devices. Accessory devices for hemorrhage and other items are effective for resolving difficult situations and complications. In the same way, to used highfrequency units for ESD safety, we need to understand their mechanism and characteristics, though there is no established theory for ESD.

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Trans-anal decompression including Self-expandable Metallic Stent (SEMS) treatment and trans-anal ileus tube insertion have recently seen employed for various disease related to colorectal obstructions. Use of SEMS was delayed compared with that for other organs. Recently, however, there have been many reports on the use of SEMS in colorectal disease, mainly from the West. SEMS is generally used as a palliative treatment for malignantstrictures of the colon and rectum and bridging to a surgery for obstructing colorectal cancers. Trans-anal decompression treatment can eliminate the need for unnecessary palliative and temporary colostomies for patients with colorectal obstructions. SEMS will become the standard treatment for colorectal strictures when exclusive colorectal EMS and delivery kits are developed.

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