In this paper, I selected pioneers in the Kyushu area who actively applied digestive endoscopy (gastroscope, gastrocamera and early fiberscope) in its early days. I have included all those who are domiciled in Kyushu, who were born or raised in Kyushu, and who have learned or worked at medical schools in Kyushu even if they already left the area.
In the area of the rigid esophagoscope, the presence of Inokichi Kubo of Kyushu Imperial University was outstanding, and the first use of the rigid gastroscope in Japan was reported by Hayari Miyake and Jun Miyagi of Kyushu Imperial University. As to the flexible gastroscope, Nakatani reported his experience before he got the position of professor of Nagasaki Medical School. The real Japanese endoscopic situation thereafter starts in the 1960s with the gastrocamera, and in Kyushu, the report of Yuzuki et al. presented at the fourth Gastrocamera research Meeting in June 1959 and the one of Sato of Kagoshima University at the fourth Kyushu regional branch meeting of the Japanese Society of Gastroenterology in the same date are regarded as the dawning of digestive endoscopy.
The first General Meeting of the Gastrocamera Society was held in 1959, and researchers from the Department of Surgery in Kumamoto University, the Department of Internal Medicine lead by Sato in Kagoshima University Medical School and the Department of Internal Medicine in Kyushu Kosei Nenkin Hospital presented their works there. Furthermore, the study group of Kyushu branch of the Gastrocamera Society were set up before the formation of parent society.
Presenters from the Kyushu area at the second General Meeting of the Gastrocamera Society were mostly doctors who belonged to the universities, and they later became regional leaders. After that, Kyushu regional branch society of the parent gastrocamera society were also formed.
The society was expanded to the Japan Endoscopy Society in 1961, but the participation from general hospitals other than universities was limited only to Kyushu Kosei Nenkin Hospital and Kagoshima City Hospital.
The last graduates of the old-education-system of the universities left the schools in 1954, and many researchers who later took active roles in the field of digestive endoscopy graduated from universities several years before and after that year. This paper describes stories of those real pioneers in detail.

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Duodenal neuroendocrine tumours (NETs) including “carcinoids” comprise 16.5% of all gastrointestinal NETs in Japan and are increasing in prevalence in Western countries where they currently account for only 2 - 3% of gastrointestinal NETs. The 2010 WHO classification defined a carcinoid as NET G1, which is well differentiated and has low proliferative activity. However, small duodenal NETs are usually asymptomatic except for the ampullary carcinoid causing obstructive jaundice. Most tumors express hormonal production immunohistochemically, but clinically are almost hormonally silent and rarely develop into the Zollinger-Ellison syndrome (ZES) presenting as a gastroduodenal ulcer and chronic diarrhoea. The carcinoid grows slowly, and metastasis to regional lymph nodes occurs even with small tumors at a rate that cannot be ignored. A definite strategy for duodenal carcinoids has not yet been established. Tumors which invade the muscular layer or metastasis to the paraduodenal lymph nodes need radical resection such as a pancreaticoduodenectomy. For small, non-metastatic carcinoids of the 1st portion limited to the submucosa, endoscopic resection is one optimal noninvasive procedure, while endoscopic papillectomy for the ampullary carcinoid needs further decision making. The size, location, cell type (G1∼3), functional activity and the stage of the tumour, in addition to the individual state, should be taken into consideration to obtain effective management.

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The endoscopic diagnosis of Clostridium difficile colitis(CDC) with the existence of a pseudomembrane has been well-recognized, but the endoscopic images of CDC have been varied. We should therefore not persist in basing the diagnosis of CDC on the finding of the pseudomembrane. In the present study we report on 9 cases of CDC which showed an aphthoid erosion, but without any pseudomembranous lesion. However the meaning of the existence of an aphthoid erosion in CDC is not clear, and we thus investigated these 9 cases to elicit any such significance. The clinical manifestations of CDC with aphthoid erosions were mild, so that the presence of an aphthoid erosion indicated a mild case of CDC. When in doubt regarding a diagnosis of CDC with an aphthoid erosion without a pseudomembranous lesion, we should perform anaerobic cultures to identify the CDC-related toxin to confirm the diagnosis and decide on the treatment.

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A 19-year-old male, 156 cm tall, weighing 45 kg and with a BMI of 14.3, was diagnosed as having long gap esophageal atresia with a tracheoesophageal fistula (type C) on the day of his birth. On the following day, he underwent surgery comprising fistula ligation plus gastrostomy. Six months later, the patient underwent a definitive delayed primary repair with Livaditis' circular myotomy, but a severe anastomotic stricture of esophagus developed. He underwent endoscopic balloon dilation many times because of the anastomotic stricture, but the effect was limited. The stricture was about 27 cm in the front teeth in endoscopy, and a barium swallow revealed that the length of the stricture was about 2 cm. He was capable of only a small amount of oral ingestion and was fed via the gastrostomy. We judged that a surgical procedure would be difficult due to the decreased respiratory function caused by his tracheomalacia. We therefore treated him with magnetic compression revision anastomosis, in which a pair of 2 cylindrical Samarium-cobalt rare-earth 320 mT (3200 G) magnets, 15×5 mm (diameter×thickness) were used. We inserted endoscopes from the mouth and the gastrocutaneous fistula, and endoscopically placed one magnet orally and the other magnet anally to the stricture, as close together as possible. The magnets bonded together on the third day after the operation, travelled down the digestive tract and were excreted on the 18th day. At a two-year postoperative follow up, the patient was doing well without any sign of restenosis.

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A 70-year-old woman was examined with screening esophagogastroduodenoscopy. Endoscopic findings showed a reddish flat lesion with Ban unclear margin at the gastric angle and multiple white nodules in the 2nd part of the duodenum. Magnified endoscopy of thew gastric lesion with narrow band imaging showed a villous surface pattern and moderate microvascular atypia. The endoscopic diagnosis of the gastric lesion was MALT lymphoma, and that of the duodenal lesion was follicular lymphoma (FL). Biopsy specimens were taken from both lesions and pathological diagnosis was gastroduodenal FL. Double balloon endoscopy revealed multiple white nodules in the jejunum and ileum and thus this patient was diagnosed as having gastrointestinal follicular lymphoma. pirarubicin, cyclophosphamide, vincristine, prednisone and rituximab were chosen for the initial treatment. Gastric involvements of gastrointestinal FL have been reported in only 1.2% of FL cases. Multiple white nodules were observed in the duodenum, but not in the gastric lesion. Follicles in the stomach lesion existed in the deep mucosal layer compared with the duodenal lesion. Our opinion, therefore, was that the gastric lesion did not show the typical multiple white nodule pattern. We report a case of follicular lymphoma with stomach involvement.

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A 70-year-old male had undergone low anterior resection for rectal cancer. Anastomotic leakage after the surgery had induced a severe anastomotic stricture making defecation difficult and which had proved resistant to several treatment attempts with balloon dilation and bougienage. Colonoscopy and a Gastrografin enema examination demonstrated a pinhole stenosis of the anastomosis. As there was no cancer recurrence around the stricture, endoscopic diode laser therapy was then selected.
We used a compact diode laser system (UDL-60 Olympus) via colonoscopy. Although this system has equal clinical advantages to the Nd : YAG laser, it is smaller and more portable. The colonoscope was introduced into the rectum, and was positioned optimally to the rectal stenosis. The tissue surrounding the stenosis was penetrated using the contact endoprobe of the diode laser system, and removed with biopsy forceps. No complications such as bleeding or perforation occurred. After the treatment, the stenosis had improved and good progress was maintained for 1 year and 9 months without any recurrence. We therefore concluded that endoscopic diode laser therapy could be one of the promising treatment options for severe anastomotic rectal strictures.

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We describe herein a rare case of metastatic colon cancer diagnosed 15 years after gastrectomy. The patient was a 62-year-old man with diarrhoea and abdominal pain as his major symptoms, who had undergone a total gastrectomy for gastric signet ring cell carcinoma 15 years previously. Colonoscopic examination showed two-thirds circumferential stenosis caused by a submucosal tumor in the descending colon and circumferential stenosis with irregular and nodular mucosa in the rectum. Histological examination revealed signet ring cell carcinoma. The cancerous lesion was finally diagnosed to be metastatic colon cancer traced back to the gastric cancer by immunohistological investigations. He was diagnosed as having inoperable colon cancer with multiple stenoses and was treated with TS-1.

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We report herein on 3 patients with anal condyloma acuminatum identified following a biopsy of a bulging lesion that was found via retroflex visualization of the rectum. Anal condyloma acuminatum is closely associated with human immunodeficiency virus (HIV) infection and is often difficult to treat. In patients with this condition, magnified observation with narrow band imaging (NBI) revealed capillary blood vessels twisted like a hairpin on the surface of the mucus membrane. Such findings could be useful in differentiating anal condyloma acuminatum from other bulging lesions.

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We report on a case of a 58-year-old man who had undergone a pancreaticoduodenectomy for cholangiocarcinoma 5 years previously. The patient had undergone periodic surveillance examination with no evidence of recurrence detected until recently. He had, however, suffered repeated attacks of acute pancreatitis seven times over the previous five years. We employed endoscopic retrograde cholangio-pancreatography (ERCP) using a double-balloon endoscope, as an anastomotic stricture was suspected based on the diagnostic imaging. With this approach, the anastomotic stricture was visualized and after dilation of the anastomosis using a tapered catheter, a 7 Fr plastic stent was inserted and left in the main pancreatic duct. Two months later, he had acute pancreatitis again, because the pancreatic stent had dropped. We therefore tried balloon dilatation once more and reinserted a pancreatic stent. With a followup period of about 1 year, no recurrence of the acute pancreatitis has been noted. We suggest that double-balloon endoscopy and treatment using balloon dilatation is a useful option for the management of anastomotic stricture formation after pancreaticoduodenectomy.

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Cancers of the oral cavity, oropharynx, hypopharynx and larynx have been diagnosed at an advanced stage in many patients because the clinical symptoms are often obscure. Although the endoscopists guide the endoscope through the oral and laryngopharyngeal regions at the time of an upper digestive endoscopy examination, it has been difficult to detect superficial squamous cell carcinoma. Narrow band imaging (NBI) combined with magnifying endoscopy clearly enhances the microvascular structure of the mucosal surface. NBI is a promising and potentially powerful tool for identifying early stage carcinomas in the oropharyngeal and hypopharyngeal regions during a routine endoscopic examination. Effective examination may make it possible to reduce the number of patients who have to lose their speaking and swallowing function following radical surgery. If more early stage cancers can be detected by this screen, the prognosis of oropharyngeal and hypopharyngeal cancers might be improved in the near future. We offer herein some guidance on how to conduct a thorough examination in the oropharyngeal and hypopharyngeal regions to offer earlier detection of cancers.

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