Ulcerative colitis and Crohn's disease are idiopathic, chronic disorders and are called “inflammatory bowel disease (IBD)” in the narrow sense. Diagnoses are made based on diagnostic criteria. Imaging modalities play important roles in the diagnosis of IBDs ; however, a dilemma exists in that images of other disorders are similar. Along with the remarkable advances in therapeutic measures, the need for an exact diagnosis is increasing. Especially, misdiagnosis of infectious disorders such as Camplylobacter enterocolitis, amoebic colitis, intestinal tuberculosis, and Yersinia enterocolitis must be avoided. In addition, discrimination between ulcerative colitis and Crohn's disease should be made with caution. In this article, endoscopic differential diagnoses between IBD and other disorders are described.

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To prevent post-operative hemorrhaging in patients who have undergone an endoscopic mucosal resection (EMR), it has not been definitively concluded that using a clip is the most effective method. We considered the benefits of hemostatic clips in this study.
During the period from January 2010 to February 2012 we conducted a randomized controlled trial at our hospital among patients who had undergone an EMR. In this trial we examined the hemostatic effect of using a plication clip. Four patients (1.0%) in the clipped group (n=211) and 9 patients (2.1%) in the non-clipped group (n=216) had post-operative bleeding, with no statistical differences between groups. Patients who had diabetes, a Ip polyp or who were using anticoagulant drugs were significantly more likely to experience related post-operative hemorrhaging in this study than those without those factors. Care should be taken with such patients.
In conclusion, because a plication clip had little effect in preventing post-EMR bleeding its use is unnecessary, if only to reduce labor and other costs.

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A 60-year-old man was referred to our hospital for examination of an esophageal submucosal tumor-like protrusion detected by endoscopy that caused discomfort upon swallowing. Endoscopic ultrasonography revealed that the lesion was derived from the submucosal layer. During careful endoscopic follow-up, morphological changes were observed at each of the 5 endoscopic examinations that were performed within 6 months. Repeated endoscopic observation at regular intervals, including a pathological evaluation as well as imaging examinations, led to the final diagnosis of esophageal tuberculosis without any other lesions. Combination therapy for 6 months using pyrazinamide, isoniazid, ethambutol and rifampicin was administered, resulting in the complete disappearance of the lesion. Although esophageal tuberculosis is a relatively rare disease, it should be taken into account as one of the differential diagnoses in cases of esophageal submucosal tumor-like lesions manifesting morphological changes within a short period.

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This paper presents a case of gastric cancer with intramural metastasis to the esophagus for which endoscopic submucosal dissection (ESD) was effective. A 61-year-old man underwent a total gastrectomy for advanced gastric cancer in August 2009. Histologically, the gastric cancer was confirmed to be a moderately differentiated adenocarcinoma and the proximal margin of the resected specimen was free of cancer cells. The TNM stage of the gastric cancer was pT3 (tumor invades the subserosa) pN0M0. One year after the operation, the patient underwent a routine examination by upper gastrointestinal endoscopy. Because the endoscopic examination revealed a tumor in the lower esophagus that macroscopically resembled a 0-IIa type primary esophageal cancer, he underwent endoscopic mucosal resection (EMR) in October 2010. The tumor resected by EMR was histologically confirmed to be a moderately differentiated adenocarcinoma and displayed the same characteristics as the previously resected gastric cancer. Histological examination showed that the vertical margin of the EMR specimen was positive for cancer cells. Then, the patient underwent endoscopic submucosal dissection (ESD) in December 2010. Histologically, the ESD specimen was shown to be a moderately differentiated adenocarcinoma and it was confirmed that very little tumor tissue had been present in the submucosa at the time of ESD. The horizontal and vertical margin of the ESD specimen was free of cancer cells. At present the patient is alive without recurrence 31 months after the ESD.

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A 69-year-old man with H. pylori negative- and API2-MALT1-negative gastric MALT lymphoma was successfully treated by radiation therapy. The lymphoma presented as two distinctive submucosal tumors, with one each located on the cardia and gastric body. These tumors were endoscopically followed-up yearly for 9 years before treatment, making this case report of value in understanding the clinical course of this rare type of gastric MALT lymphoma.

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The patient, a 72-year-old woman, was in the hospital for operation of a right ureter carcinoma. On endoscopic examination to ascertain the cause of anemia, an early gastric cancer (IIa+IIc) 30 mm in diameter surrounded by diffuse antral vascular ectasia (DAVE) located on the greater curvature of the antrum was evident. The gastric cancer was resected by endoscopic submucosal dissection (ESD). Histological examination of the removed gastric tissue revealed gastric mucosal cancer (tub1) accompanying diffuse submucosal heterotopic gastric glands. We concluded that this case is of interest because of the rarity of an early gastric cancer surrounded by DAVE that was treated by ESD.

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A 68-year-old female with a past history of diabetes mellitus, hypertension, and hyperlipidemia was hospitalized due to subarachnoid hemorrhage for which coil embolization was performed. After the procedure, she had left lower abdominal pain and discharge of blood. We performed colonoscopy and made a diagnosis of arteriovenous malformation (AVM) with a diameter of about 15 mm in the rectum due to the finding of centripetally collecting vessels with pulsation. A region enhanced in the early phase was found in the wall of the rectum by abdominal CT, and the collecting vessels to which blood flowed through the superior rectal artery were found by 3DCT. Because the patient had rectal bleeding intermittently we performed transcatheter arterial embolization (TAE). Abdominal angiography revealed a distended artery, nidus, and early venous return. The patient was treated successfully with TAE using coils and n-butyl 2-cyanoacrylate. Vessels disappeared and a small ulcer was found by colonoscopy 7 days after TAE. No discharge of blood was observed subsequently.

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Background : Infected pancreatic necrosis (walled-off necrosis : WON) is the major risk factor for sepsis or multiple organ failure after severe acute pancreatitis. For treatment, direct endoscopic necrosectomy (DEN) has been performed as an alternative to percutaneus CT-guided drainage in our hospital.
Objective : The clinical usefulness of two treatment procedures was evaluated in 6 cases of WON. Between July 2009 and June 2011, 3 patients were treated by EUS-guided drainage and 3 patients were treated by CT-guided percutaneous drainage.
Results : Of the 6 cases of WON, 3 were managed by DEN after EUS-guided drainage. Although 1 of the 3 patients required CT-guided drainage because of an abscess extending to the posterior pararenal space, the treatment was successful in all 3 patients without any complications. The other 3 cases of WON were managed by CT-guided percutaneus drainage because their clinical conditions were unstable and they required intensive care. That treatment was successful in all 3 patients after a long hospitalization.
Conclusions : Although EUS-guided drainage is an effective initial therapy and DEN is also an efficacious technique with an acceptable safety profile, we would not primarily recommend endotherapy for unstable cases or cases with a large abscess extending far from the transluminal access point ; i.e., those in the posterior pararenal space and the pelvis. In such cases, CT-guided percutaneus drainage should be considered for initial or additional therapy.

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Recent advances in endoscopic procedures, such as narrow band imaging systems and magnifying endoscopy, have enabled the precise observation of the hypopharynx and cervical esophagus. We developed endoscopic laryngo-pharyngeal surgery (ELPS) as minimally invasive surgery for superficial carcinoma of the larynx and pharynx. First, we insert the laryngoscope with endoscopic guide and place it at on the upper part of the vocal cord. We lift the larynx by the laryngoscope and fix the laryngoscope. The curved laryngoscope gives us a good visual field and working space between the hypopharynx and the cervical esophagus. After lifting the larynx using the laryngoscope, the endoscopist inserts the endoscope and the operator inserts the forceps and electric device transorally. After iodine staining, we mark the normal mucosa just 1-2 mm away from the cancer margin and inject Epinephrine-added physiological saline solution to the subepithelial layer. After the circumferential cutting, we resect the lesion with the forceps and electric device. ELPS for superficial carcinoma of the hypopharynx and cervical esophagus is a feasible and effective treatment.

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Endoscopic biliary stenting (EBS) is a well-established palliative treatment and the first choice for the management of unresectable malignant hilar biliary obstructions. Plastic tube stents (PSs) and self-expandable metallic stents (SEMSs) are the most commonly used in EBS. The efficacy of SEMSs has been extensively described for the treatment of distal biliary obstructions ; however, their efficacy has not been sufficiently evaluated for the treatment of unresectable malignant hilar biliary obstructions. Therefore, the more effective stent type and mode of stenting (unilateral versus bilateral) for unresectable malignant hilar biliary obstructions remain controversial.
EBS plays an important role in maintaining the patient's condition and in determining the subsequent prognosis and quality of life, and therefore, it is essential that biliary stents do not result in occlusions or complications during the period of clinical use. In this regard, SEMSs are more suitable for unresectable malignant hilar biliary obstructions.
In general practice, we first perform endoscopic naso-biliary drainage (ENBD) followed by additional ENBD tube placement in cases where unilateral drainage is not sufficient. A single stent is used for unilateral drainage and 2 stents are used for bilateral drainage after improving jaundice and cholangitis.
SEMSs also help reduce the number of re-intervention sessions required and the overall treatment cost compared to PSs. Furthermore, SEMSs with low axial force are important for long-term patency and decreasing the incidence of SEMS-associated complications, as these SEMSs confer good conformability, enabling a close fit with the bile duct. Finally, SEMSs with a large cell width make the initial partial stent-in-stent placement and re-intervention easier, safer, and more effective for unresectable malignant hilar biliary obstructions.

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