Various risk factors are evaluated on development of post-ERCP-pancreatitis. For the prevention of post-ERCP-pancreatitis, first, to identify of high risk factor of the post-ERCPpancreatitis is essential, and second to practice of possible clinical measures for avoiding it must be performed. Since the vicious circle between activation of trypsin and increase of the internal pressure of pancreatic duct is related greatly for the aggravation of post-ERCPpancreatitis, the administration of the protease inhibitor of enough quantities required for trypsin inhibition in pharmacology in early stage and decrease of the pancreatic duct internal pressure, such as pancreatic duct stenting, are expected for the prevention of aggravation of post-ERCP-pancreatitis. Although a prognosis improvement is expectable by the administration of protease in hibitor of enough quantities, for example continuous regional arterial infusion of protease inhibitor from early stage of pancreatitis, to post-ERCP-pancreatitis patients predicting aggravation of prognosis, there is a problem of the adaptation criteria which must be solved in early enforcement. In the future, the adaptation criteria of the early continuous regional arterial infusion of protease inhibitor enforcement to post-ERCP pancreatitis patient may be solved by introduction of Perfusion CT.

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We report usefulness of endoscopic ultrasonography (EUS) for the diagnoses of chronic pancreatitis (CP). We evaluated EUS features of hyperechoic foci, hyperechoic strand, lobular out gland margin, lobularity, cyst, stone, ductal dilatation, side branch dilatation, duct irregularity, hyperechoic duct margins, atrophy, localized swelling in cases with CP (30 definite and 6 probable) diagnosed by computed tomography (CT) or endoscopic retrograde cholangiopan creatography (ERCP). Hyperechoic foci, hyperechoic strand, lobularity, hyperechoic duct margins in definite or probable CP were recognized in more than 80 % cases. Lobular out gland margin was observed in 14 (47 %) of 30 cases with definite CP, although none with probable CP(P = 0.06). In conclusions, hyperechoic foci, hyperechoic strand, lobularity, hyperechoic ductmargins are useful for screening of CP, and lobular out gland margin would be reliable finding in definite CP.

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A 75-year-old male visited our hospital for medical chek-up . He had been on Rifampicin and Levofloxacin for treatment of atypical mycobacterial disease for the past 4 years . The first endoscopic examination disclosed the mucosa of the esophagus to be black from the upper to lower thoracic esophagus. Endoscopic biopsy specimen pathologically showed that the mucosal epithelium harbored abundant melanin granules and melanophages in the lamina propria . The second endoscopic examination after 6 months off Rifampicin and Levoflaxin revealed the entire disappearance of the black mucosa of the esophagus. A rare case of esophageal melanosis developing during treatment of Rifampicin and Levofloxacin was reported.

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A 57-year-old female was admitted to our hospital due to SMT on endoscopic ultrasono graphy (EUS) a pyloric mass was seen on the side of the greater curvature. It located adjacent to the fourth layer (muscle layer) of the gastric wall. A heterogeneous low echoic pattern was circumscribed by a high echoic thin wall. The preoperative diagnosis was a gastric duplication cyst. A laparoscopic-assisted partial gastrectomy was done. The histological findings were consistent with a gastric duplication cyst. In this case, EUS was very useful for making the preoperative diagnosis.

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A 40-year-old woman presented with oral aphtha and lower abdominal pain. Colonoscopy revealed a huge deep ulcer in the terminal ileum. Because of ineffective predonisolone (PSL) therapy, she was treated with intravenous palmit-dexamethasone incorporated in lipid emulsion every 2 weeks. Five weeks later, colonoscopy revealed a healing of the ulcer, and the oral PSL was reduced without any relapse.

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A 72-year-old man presented with right abdominal pain before his admission to our hospital. A computed tomography (CT) scan of the abdomen showed edematous thickening of wall in the right colon and multiple threadlike calcifications in the colonic wall and mesocolon. Colonoscopic examination demonstrated nodular mucosa with small irregular ulcers surrounded by dark purple mucosa from the cecum to the sigmoid colon. The most severe lesions were located in the transverse colon. Under the diagnosis of phlebosclerotic colitis, the symptom disappeared and laboratory data were normalized by a conservative treatment.

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A 76-year-old Japanese man was referred to our hospital for ileus . Both an abdominal CTscan and abdominal X-ray showed linear calcification along the intestinal wall from the ileum to the sigmoid colon. Colonoscopy revealed edematous blue-purple colored mucosa in the colon and the ileum. Histological examinations of the biopsied specimen showed hyaline-likedegeneration around the small vessels and fibrous thickening at the submucosal layer . From these findings the patient was diagnosed as having phlebosclerotic colitis, which might be responsible for ileus. We reviewed forty previously reported cases of this disease including the present one.

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An ulcerative colitis patient developed postoperative massive intestinal bleeding due to afoy's cirsoid aneurysm of the jejunum along with, frequent, staple line ulcer in the ileal J pouch. 6 years earlier the 23-year-old male patient had had a total colectomy, mucosal proctectomy, and ileal J pouch anal anastomosis. Subsequently, the patient had frequent melena caused by recurrent staple line ulcers located in the ileal j pouch. Though he did not fulfill the diagnostic criteria of pouchitis, the patient was also medically treated for pouchitis. The patient developed massive intestinal bleeding due to a Dieulafoy's cirsoid aneurysm located in the jejunum ; he was effectively treated by an intestinal endoscopic hemostatic maneuver, during which an exposed vessel was clipped. Cases effectively treated endoscopic hemostasis for frequent, recurring staple line ulcers (pouchitis) and Dieulafoy's cirsoid aneurysm of the jejunum are considered to be very rare.

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Endoscopic balloon dilatation (EBD) therapy is the effective therapy for gastrointestinal stricturing disease. The development of double balloon endoscopy (DBE) enabled to perform EBD therapy for small intestinal stricture as well as the esophageal and the colonic stricture. Comparing to surgical operation, EBD is less invasive and time saving therapy . However, the small intestinal EBD is occasionally difficult for the intestinal bending and adhesion . Moreover small accessory channel diameter of the enteroscope, the manipulation of the balloon dilator is bad. In this article, the indication of small intestinal EBD therapy and practical dilatation methods is mentioned.

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We describe our magnification endoscopy technique, focusing on how to obtain a magnified endoscopic image of the gastric mucosal microvascular architecture, as small as the subepith elial capillary. The key procedures are (1) setting the mode and levels of the structural enhancement function correctly, (2) mounting a black soft hood attachment to the tip of the scope to enable magnifying observation, (3) observing the surrounding mucosa before approaching the lesion, (4) carefully bringing the tip of the black soft hood in contact with the mucosal surface by manipulating the scope and by deflating the air in the stomach, and (5) combining this technique with a water immersion technique for greater resolution. This magnification endoscopy technique is an essential technique if the endoscopist is to consistently obtain a maximally magnified endoscopic image where even capillary, which is the smallest unit of vessels in the human body, can be dissected.

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Background : Respiratory suppression is observed during endoscopy under sedation. If respira tory suppression can be predicted before endoscopy, incidental complications can conceivably be prevented. In the present study, we focused on the relation between respiratory suppression from sedation and lung function. Methods : A total of 211 patients underwent respiratory function tests before the surgical operation and gave written informed consent individually to participate in this study. We investigated the relation between respiratory suppression from sedation and lung function. During the endoscopic procedure, when blood oxygen saturation (Sp02) fell to below 90%, the patient was evaluated as 'respiratory suppression present'. Results : Sedation lowered Sp0₂ by an average of 6.0%, and was significantly lower than the prior to sedation blood oxygen saturation (PreSpO2). Compared to patients with Sp0₂ maintained up to 90%, patients with Sp0₂ fallen below 90% were significantly older, shorter in stature, lighter in bodyweight, and more commonly female. Furthermore, respiratory suppression from sedation was influenced by vital capacity (VC) and PreSpO₂. Multivariate analysis was performed, and the receiver operating characteristic (ROC) curve constructed for the respiratory suppression prediction model based on age, height, VC and PreSpO₂ yielded area under the curve (AUC) of 0.79. As VCpredjct can be calculated from age and height, the three variables of age, height and VC in the above model were substituted with VCpredict resulting in a two-factor model based on VCpredict and PreSpO₂. The ROC curve of the two-factor model had AUC of 0.77, which was slightly decreased but by no means inferior. Conclusion : Predicting respiratory suppression from VCpredict and PreSpO₂ is clinically rele vant with the additional benefit of simplicity.

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