Endoscopic ultrasonography (EUS) is useful for the diagnosis and treatment of pancreatobiliary diseases. EUS plays important roles particularly in the detection of small lesions, differential diagnosis, and tumor staging. A new endoscopic ultrasound processor has recently been developed. It improves fundamental imaging and enables three new functions, namely, tissue harmonic, elastography, and contrast harmonic endoscopic ultrasonography (CH-EUS). The tissue harmonic function provides high-quality images of cystic and solid lesions in the pancreas. Elastography is useful in differentiating between benign and malignant lesions. CH-EUS is beneficial for the differential diagnosis of pancreatic tumors. However, many aspects regarding the usefulness of these three functions in the diagnosis of pancreatobiliary diseases remain unknown. Additional studies are warranted to clarify the new functions in the EUS apparatus in more detail.

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A 57-year-old man presented to our hospital with abdominal distention and bilateral leg edema. Upper GI series, endoscopy and abdominal CT scan showed the features of type 4 advanced gastric cancer ; however, no malignant cells were observed in biopsy specimen sampled from the thickened wall. Laboratory examination showed significantly decreased serum total protein and albumin levels ; therefore, 99m Tc—HSA scintigraphy was performed to investigate the enteric protein loss. It demonstrated the accumulation of radioactivity in the colon, suggesting the presence of protein-losing enteropathy. Colonoscopy showed no abnormal findings from the rectum to the terminal ileum ; however, all intestinal biopsy specimens revealed severe eosinophilic infiltration into the mucosal layer. Taken together, the final diagnosis of eosinophilic gastroenteritis was made.

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A 63-year-old man with multiple myeloma was referred to our hospital with the complaint of melena. Upper gastrointestinal endoscopy showed a huge submucosal tumor with redness and erosion and he was diagnosed with gastric invasion of multiple myeloma by examination of biopsy specimens. The patient required a large volume of blood transfusion, and the tumor was treated with radiation therapy 40 Gy. After the therapy, the tumor drastically decreased in size on follow-up endoscopy and the melena disappeared. Gastric invasion of multiple myeloma is very rare. Our case is the first case in Japan in which radiation therapy was ascertained to be effective for gastric invasion of multiple myeloma.

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A 90-year-old man was admitted to our hospital because of fever and abdominal pain. On computed tomography imaging, his gallbladder was swollen ; therefore, he was diagnosed with acute cholecystitis. Due to dementia and to avoid self-removal of the tube, endoscopic ultrasonography (EUS)-guided gallbladder drainage was attempted. First, the gallbladder was punctured using a 19G FNA needle from the duodenal bulb. A 0.025 inch guidewire was inserted into the gallbladder, and after dilation of the fistula, a fully covered metallic stent was placed from the gallbladder to the duodenum. To prevent stent migration, a pigtail plastic stent was placed within the metallic stent. Adverse events were not seen. Herein, we reported a case of acute cholecystitis in which EUS-guided gallbladder drainage was clinically effective.

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Dysphasia is one of the most important disorders that need to be treated in today's aging society. Evaluation for patients with gastrostomy or to be with gastrostomy ; thus, there are increased opportunities for gastrointestinal (GI) endoscopists to perform this procedure. Of the two main examination methods of VE and videofluoroscopic examination of swallowing (VF), VE is easier for GI endoscopists to carry out, and conventional VE in which a laryngoscope is used allows for efficient evaluation. Increasing the number of treating physicians, through the dispersion of this technique among GI endoscopists, will greatly enhance the treatment of dysphasia, leading to a greater benefit for patients. Hence, the immediate establishment of a care system including training for the procedure and sufficient patient support is necessary.

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Treatment methods for esophageal cancer are divided into endoscopic resection, chemoradiotherapy and surgical resection. These treatments are associated with benign esophageal strictures which have a negative impact on the quality of life of patients, mainly because of dysphagia which may lead to malnutrition, weight loss and aspiration. Endoscopic dilation with bougies or endoscopic balloon dilatation is the first-line therapy for such strictures. Some patients have severe dysphagia because of strictures that are refractory to repeated bougies or balloon dilatation. A new electrocautery method called radial incision and cutting (RIC) has been proposed as the second-line treatment for refractory benign esophageal strictures. The RIC method is characterized by cutting away the fibrotic tissue to maintain a wider lumen following radial incisions with an insulated-tip knife.
Endoscopists must be aware of not only the incidence and risk factors for benign esophageal strictures, but also how to effectively treat such strictures. In this article, we describe benign strictures after esophageal cancer treatment and methods for managing them successfully.

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Esophageal achalasia is a benign esophageal motility disorder resulting from an impaired relaxation of the lower esophageal sphincter. The principles of treatment involve disruption of the sphincter at the esophagogastric junction. Treatment techniques include balloon dilatation, botulinum toxin injection, and surgical myotomy. In 2008, per-oral endoscopic myotomy (POEM) was introduced by Inoue et al. as an endoscopic myotomy with no skin incision. The procedure has been well accepted and widely applied owing to its minimal invasiveness and high cure rates. Moreover, there have been discussions on wider indications for POEM and new technical developments have been reported. The present article reviews the historical background and present status of POEM, as well as future prospects for its application in the treatment of esophageal achalasia.

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