Helicobacter pylori (H. pylori) infection and gastric lesions in patients with rheumatoid arthritis (RA) administrated non-steroidal anti-inflammatory drugs (NSAIDs) for a long term were studied.
1) Gastric ulcer patients occupied over 30% in H. pylori positive and negative patients with RA. A frequency of gastritis was higher in RA group than control group. Gastritis was more frequent in H. pylori negative patients than positive patients.
2) We got a result that H. pylori dose not mutually effect on gastric lesions in RA patients administrated NSAIDs.
3) A positive rate of H. pylori infection was lower in RA group than control group (each 59.6%, 72.5%) . It was same in cases of gastric lesions like gastric ulcer and gastritis. On the other hand, the frequency of gastric lesions were higher in RA group than control group.
4) There were no difference between RA group and control group in inflammation, activity and atrophy score of gastric mucosa in both H. pylori positive and negative cases.

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We evaluated usefulness of ERUS for detecting residual stone after endoscopic treatment in this study. From October 1994 to April 1998, subject are 40 cases which could not be detected by ERC after endoscopic treatment (EPBD 31, EST 9) of bile duct stone. Average age of subjects is 66.0 and sex ratio is 23 : 17.
ERUS could detect residual stone in 22.5% (9 case of 40) . Characteristics of these 9 cases with residual stone is as follows ; average number of bile duct stone is 2.2, average size is 16.1mm, and rate of employing EML is 66.7% (6/9) . Rate of residual stone with and without EML is 31.5% and 14.3%, respectively. The size of ultrasonic probe (USP) is smaller, 2.4mm in diameter, than that of per oral choledochoscope (POCS) . USP can be traversed through the channel of diagnostic duodenoscope, therefore it is not necessary to exchange a duodenoscope after endoscopic treatment, whereas POCS needs exchanging it. Further more manuplation of USP is easy, compared to POCS. However, the differention between air and stone, and detection of bile duct stone in pneumobilia is only problematic in ERUS.
We concluded that ERUS is useful for evaluating residual stone after endoscopic treatment of bile duct stone, especially in case which is treated by EML.

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A 28-year-old man was admitted to our hospital due to dysphagia during meals. He was diagnosed as having achalasia in 1996. The dysphagia improved following administration of nifedipine (10mg) . The effect of nifedipine administration diminished in May 1997, and dysphagia recurred.
Upper gastrointestinal endoscopy revealed normal findings. Esophagography showed mild dilatation of the middle and lower esophagus and mucus pooling. On conventional esophageal manometric examination, basal lower esophageal sphincter (LES) pressure was 55mmHg. LES relaxation on swallowing was 80%, and residual LES pressure after swallowing was 12mmHg. Basal esophageal body pressure was higher than the intragastric pressure. All esophageal contractions on swallowing 5 ml of water were simultaneous. The amplitude of simultaneous contraction was 60～100mmHg. In general, a patient with simultaneous contraction is considered to have diffuse esophageal spasm (DES) . However, proposed criteria for the manometric diagnosis of DES include the presence of simultaneous esophageal contractions and the preservation of some peristalsis. Base on these results, we diagnosed this patient with DES-like nonspecific esophageal motility disturbance (NEMD) .
To treat NEMD, we performed endoscopic pneumatic dilatation (140-170mmHg, 3 min, 3 times) . A subsequent decrease in basal LES pressure (55 → 25mmHg) and residual LES pressure after swallowing (12 → 2mmHg) were observed. After endoscopic dilatation, dysphagia during meals disappeared entirely.

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A73-year-old female was admitted to our hospital to prevent esophageal varix due to liver cirrhosis. Just after third session of endoscopic injection sclerotherapy (EIS) , she had dysphasia and chest pain. Next day after therapy, endoscopic findings showed intramural hematoma and plain chest X-ray showed no enlargement of the upper middle portion. Four days, she had dyspnea and loss of consciousness and was recovered after inserting the tube to the trachea.
That time, plain chest X-ray showed enlargement of the upper middle portion. After that, Hb was not decreased. Six days after intubation, she had hematoemesis. It was to stop the bleeding from the hematoma by insertion of SB tube. After stopping the bleeding from hematoma, SB tube and the tube to trachea were extubated. Ten months after EIS, there was no recurrence of the varix. It has been reported that hematoma after EIS was not miserable.
In this case, hematoma was very large to press the trachea. It was thought that the pressure of the hematoma was very high. Therefore, one of the causes of the hematoma was thought to be bleeding from the artery near the varix due to prick the artery during EIS.

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A 34-year-old woman with AIDS admitted to our hospital because of hematemesis. We performed an endoscopic examination. On this examination, the giant esophageal ulcer was a typical punched out type. And histological examination revealed cytomegalic inclusions which was positive by immunohistostaining. This result showed esophageal ulcer was caused by CMV. The ulcer healed with therapy of gancicrovir (5mg/kg/day) and G-CSF (250mg/2days) after 40 days. And no cytomegalic inclusions were observed in biopsy specimen.
This paper reports a case of typical esophageal ulcer due to CMV associated with AIDs. And gancicrovir was effective for this case. The gastrointestinal complication is important to decide her span of life. It is neccesary to know specific endoscopical findings and we must perform quickly diagnosis and therapy.

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A 58-year-old man with an advanced cancer in the lower esophagus was emergently admitted to our hospital because of severe pain in the abdomen and the back. He was diagnosed as acute panperitonitis due to perforation of the lower esophageal cancer and immediately underwent surgical treatment with wash and drainage of the abdominal cavity.
Covered SEMS was endoscopicaly inserted in the 27th post operative day, and oral feeding became possible thereafter. He had a good quality of life after being discharged in the 71st post operative day. It is suggested that endoscopical inserting of covered SEMS after the surgical treatment for panperitonitis is effective for the patient with perforated lower esophageal cancer into the abdominal cavity.

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We present a case of 16-year-old woman admitted our hospital complaining abdominal pain, nausea and fever. She suffered from melena and purpuric rash on the third and seventh hospital days. Endoscopic examination of upper GI tract revealed multiple redness and erosion in the middle body and antrum of the stomach and duodenal bulb. Colonoscopic findings are similar to the upper GI findings or severer. The biopsy specimens of skin showed perivascular cellular infiltrations and focal accumuration of IgA was noted by IgA immunohistochemistry.
We diagnosed Schönlein-Henoch purpura from physical findings and examinations. She treated by steroid and preparation of facter XIII and recoverd gradually.

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A 52-year-old Japanese male was pointed out a Yamada IV type polypoid lesion at the first portion of duodenum with endoscopic examination for a health check, incidentally. And histologic examination revealed it was hyperplastic polyp. Subsequent endoscopic examinations were followed up periodically for 2 years, and still biopsies showed hyperplastic figure.
Adenomatous component in the lesion was found by the endoscopic biopsy on September 1997, so the lesion was resected by endoscopic snare polypectomy 5 months later without any complication. Resected specimen was 30×25×15mm in size, and it was composed of hyperplastic mucosa with adenomatous foci, histologically.
To date, only 23 cases of duodenal hyper plastic polyp with adenomatous foci have been reported, and cases resected by endoscopic snare polypectomy was rarely seen. Endoscopic snare polypectomy for duodenal polyp is considered as great significant method in diagnosis and therapeutic aspects because of obtaining of whole lesion. And it might be also expected low incidence of complication including after bleeding using this method. We reported a resected duodenal hyperplastic polyp with adenomatous foci case by endoscopic snare polypectomy.

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A 70-year-old male patient referred to our department on October 14, 1997, had received a geriatric health screening including upper gastrointestinal (UGI) series of radiography, which poited out his gastroduodenal abnormality, and UGI endoscopy carried out at a nearby clinic thereafter had given a suspicious dignosis of gastric lymphoma.
Our UGI series of radiography and endoscopy revealed swelling folds in the stomach and multiple polypoid lesions in the duodenal bulb. Biopsy specimens were taken from both gastric and duodenal lesions. Barium enema demonstrated a submucosal tumor-like elevation of 50mm in diameter in the caecum, and numerous polypoid lesions in the entire colon and rectum. In these lesions the surfaced was smooth and the elevated component was gently sloped.
Biopsy was also carried out from these colorectal lesions. Histopathologically, B-cell type of lymphoma cells were detected from all the specimens of the stomach, duodenum, and colorectum. The above examinations results assure the diagnosis of non Hodgkin's lymphoma appearing as MLP in this case presented.

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Intussusception in the adult is a rare entity in the literature. This report presents a case of intussusception due to inverted stump of the appendix produced by previous appendectomy.
The patient is 38-year-old man, who was admitted to our hospital with RLQ pain. Appendectomy had been performed eight months ago. The mass, fist in size, was palpable at the right lower abdomen. Small intestinal gas was noted on the plain X-ray films of the abdomen. Intussusception of the ascending colon was confirmed by abdominal CT with a characteristic sign, so called “target like appearance”. Reduction of the intussuscepted ascending colon was successfully performed under electronic endoscopic control.
A polypoid elevated lesion was endscopically noted at the head of intussuscepted colon. It was the inverted appendeceal stump prodused by previous appendectomy. The polypoid lesion was released with removal of suture materialnoted around the inverted appendeceal stump. Abdominal CT and electronic colonoscopy are very useful for diagnosis and treatment of intussusception.

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A 48-year-old man visited our hospital for medical checkup. X-ray and endoscopic examinations revealed multiple polypoid lesions in his esophagus, stomach, duodenum and colorectum. He had facial papules and papillomatous oral lesions, and was diagnosed as Cowden's disease.
Cowden's disease is characterized by multiple hyperplastic or hamartomatous lesions originating from three embryonic germ layers in the whole body. This disease is frequently complicated with malignant tumors and should be considered in the differential diagnosis of gastrointestinal polyposis syndromes.

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A 48-year-old woman was admitted to our hospital because of painful swallowing. Upper gastrointestinal endoscopic examination showed a undermining deep ulcer with an elevated margin in the middle esophagus. However the biopsy specimens taken from the lesion showed histologically no epitheloid cell granulomas. We treated the lesion as a esophageal ulcer with unknown etiology. The ulcer were improved by fast and intravenous drip only for 4 days.
About 3 months later, the patient was admitted to our hospital again for same symptom. Endoscopic examination revealed a same esophageal ulcer as the last time one. Since the 8th hospital day, bloody stool was seen. So we performed colonoscopy at 8 November 1997. Colonoscopy showed ulcers with bleeding. We diagnosed both esophageal lesion and colon ulcers are due to Crohn's disease. The patient was treated by total parenteral nutrition and prednisolone, resulting in an improvement of both lesions.
There have been only one report of Crohn's disease which preceded esophageal ulcer in Japan. Our case is the second case. This case was therefore reported and compared with other literature about Crohn's disease with esophageal lesion.

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A 74-year-old man with the complaint of watery diarrhea and dizziness was admitted to our hospital. Blood chemical studies on admission showed hypopotassemia (K 3.2mEq/l) , and the rectal discharge contained high level of potassium (43.1mEq/l) was seen. Contrast enema and endoscopic examination revealed a large villous tumor in the recto-sigmoid. The operative finding showed intussusception due to villous tumor of the sigmoid colon.
We should take careful preoperative management for the patient with villous tumor in the light of possible complications ; electrolyte depletion syndrome and intussusception.

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We report a patient with hyperplastic polyp developing after endoscopic polypectomy for early colonic cancer.
A 62-year-old man was admitted to our hospital due to endoscopic polypectomy for early colonic cancer (type Ip) with big stalk, sized about 15mm in diameter at the sigmoid colon. The removed lesion revealed histologically as papillotubular adenocarcinoma with invasion to the submucosal layer (sm₂) . Follow-up endoscopy after 17 days showed a reddish lobular polyp (type Ip) at the resected site. Sigmoidectomy was performed and resected lesion revealed histologically as hyperplastic polyp.
A case of colonic hyperplastic polyp developing after endoscopic polypectomy for early colonic cancer has never been reported in Japan. The mechanism was still unknown, but was thought that excessive regeneration of epithelium was promoted by defect of epithelium after endoscopic polypectomy, suture of resected edge by clips and mechanical stimulation by peristalsis and stool.

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A very rare case of the left sided gallbladder with congenital cystic dilatation of the common bile duct and anomalous arrangement of pancreatobiliary duct is reported.
A 24-year-old woman was admitted to our hospital for epigastralgia and vomiting in February 1998. Blood examination revealed liver damage. Preoperative images such as CT, ultrasonography, and ERCP, showed cystic dilatation of the common bile duct, and anomalous arrangement of pancreatobiliary duct, with the left sided gallbladder.
The operative findings demonstrated that gallbladder located at the lateral segment of the left lobe of the liver, and the cystic duct connected with left side of the common bile duct. Cholecystectomy, resection of the cystic dilatation and reconstruction with hepatico-jejunostomy were performed. Histological examination showed inflammatory change and no evidence of malignancy.
Until 1998, only 3 cases of the left sided gallbladder with congenital cystic dilatation of the common bile duct and anomalous arrangement of pancreatobiliary duct have been reported in the Japanese literature.

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A 39-year-old male with a complain of general fatigue and jaundice was admitted to our hospital. Computed tomography, ultrasonography, magnetic resonance imaging and endoscopic ultrasonography showed an expanding thickness in the whole pancreas with swellings of several lymph nodes around the pancreas. We were not able to rule out pancreatic cancer or malignant lymphoma by these imagings.
To obtain a histological diagnosis, we performed biopsy of the pancreas under laparoscopic exploration. At the time of operation, we approached into the peritoneal cavity with an open laparoscopy method. Pneumoperitoneum was introduced and maintained at 8 mmHg during the operation. Then we prepared the spleen and the tail of the pancreas to raise from the retroperitoneum. We performed needle biopsy twice and wedge resection of the pancreas under direct vision. Histological diagnosis of the frozen section in the operation revealed no evidence of malignancy. The final diagnosis was chronic pancreatitis with fibrosis.
We have reported a case in which biopsy of the pancreas under laparoscopic exploration is useful to obtain the final diagnosis.

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We performed upper gastrointestinal endoscopy of 371 cases to examine whether pethidine, used in addition to diazepam, improved patient tolerance to upper GI endoscopy compared with the use of diazepam alone. Out of the 274 cases, received diazepam alone, 138 patients (50.4%) answered that they were sleeping during upper GI endoscopy and felt pleasant. But 8 patients gagged severe although they felt pleasant.
On the other hand, out of 97 cases who received pethidine in combination with low dose diazapam, 56 cases (57.7%) answered that they were awake during upper GI endoscopy but felt no discomfort. And almost all patients showed no gagging during the procedure of upper GI endoscopy. Three cases showed slight respiratory depression but recovered soon by call their attention to deep breathing.
We conclude that pethidine in combination with low dose diazepam is more exellent sedation than diazepam alone, if only we use them carefully.

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The authors reported our experience of the new video endoscope (XGIF-1T230Y) in clinical use. Olympus Company newly developed this model for endoscopic treatment of upper gastrointestinal tract, which is characterized by a larger biopsy channel (3.7mm in caliber) . The larger channel was extremely useful for endoscopic balloon dilatation to post-operative esophageal stricture, because the balloon was smoothly put in and out through the channel without any damage.
Furthermore, endoscopic hemostasis was easier using this model, since coagulated blood was sucked effectively through the channel and the clots on a bleeding site was removed by a flush of water through newly equiped wash-out channel. It was concluded that this endoscope is very useful any for kinds of endoscopic treatment.
We, further, hope that new divices would be developed fitting a larger channel to perform treatment more easily, safely and certainly.

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The transparent cap and hood at the tip of the endoscope is a very useful device for biopsy, local injection, polypectomy, clipping, and laser irradiation treatment. But these device has demerit of narrowed visual field.
However, this device is sometimes hazardous on emergency endoscopy, or on turning the tip of the endoscope to observe the body and the cardia of the stomach. If the cap or hood at the tip of the endoscope equipped the capacity to slide in and out when necessary, this limitation would be overcome. We developed a cap which equipped this capacity. We modified the part of the O-ring of the sliding device MD-48809 (Sumitomo BL Co) which is already equipped to install on the tip of the endoscope. It slides freely when necessary. When pulled back, it provides wide visual field. When pushed forward, it facillitates placing clips on bleeding vessels. Using this device, we successfully stopped active bleeding of the remnant gastric stomal ulcer in a 57-year-old male.

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Clinical usefulness of gold probe, a bipolar electrohemostastic catheter, which was recently available in Japan, was examined. The gold-spiral electrode on the probe tip provides bipolar electrohemostasis.
Among the patient in whom emergent upper gastrointestinal endoscopy was performed from February to May in 1998 in our hospital, the endoscopic hemostastic therapies using gold probe were performed in 10 patients. The bleeding site were gastric ulcer in 7 patients, gastric cancer in one, Mallory-Weiss syndrome in one, and gastric submucosal tumor in one. Seven out of the 10 patients, the endoscopic hemostastic therapies were performed solely with gold probe ; hemostasis was successful in 6 of them, however, rebleeding was observed in one. Three out of the 10 patients, hemostastic therapies with gold probe were unsatisfactory, and the additional therapies with ethanol injection or clipping were undertaken.
Selection of the patients indicated for electrohemostastic therapies with gold probe and improvement of the technique of the electrocoagulation should be necessary to achieve more effective hemostastic effect.

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We reported three techniques in withdrawing specimen (“suction trap method”,“Roth retrieval net method”, and“transparent cap method”) following endoscopic resection for colorectal diseases.
In the suction trap method, a gauze was put in the connection part of suction tube. This method made it possible to withdraw the specimen smaller than 7～8mm in diameter by suction only. The Roth retrieval net method was useful for patients who had multiple lesions larger than 7～8mm in the right side colon and large tumor that endoscopic piecemeal mucosal resection should be performed. All specimens were able to be withdrawn at one time by this method. The transparent cap method was useful for patients who had a lesion greater than 20mm, and it could provide complete withdrawing of the whole specimen without injuring the specimen.

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For recent four years 46 patients were treated by TEM (transanal endoscopic microsurgery) for early rectal cancers and cancer-like lesions in our hospital. Most of the tumors which we resected were situated in the upper and the lower of the rectum (Ra and Rb) because of the technical difficulty of TEM in the rectosigmoid and sigmoid colon.
The risk for the perforation of rectal wall increases and the behind-the-fold type lesions were usual in the upper rectum. Therefore, the injecting the saline solution into the submucosa is effective for the mucosectomy by TEM and the other techniques for TEM are also useful such as cross-hand technique. By mastering these techniques, it is possible to select a less invasive method for surgical treatment of early rectal cancers and cancer-like lesions.

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From 1989 to 1998 we experienced 29 patients who were removed foreign bodies of the upper gastrointestinal tract by endoscopy at Jikei Aoto Hospital.
Most of foreign materials are coin and button shaped battery for children, but press through pack (PTP) and fish bone for adult. All endoscopic removals were performed without complications. All foreign bodies have not to be removed by endoscopy. We consider removal of foreign bodies as follows.
Esophageal foreign bodies have to be removed immediately because they cause the esophageal ulcer and perforation. Almost gastric foreign bodies are discharged naturally. But sharp or long foreign bodies are intended for endoscopic removal. Button shaped batteries which remains in stomach over 24～48 hours should extract because it causes chemical and electric damage. It is concluded that hearing of clinical history and exact endoscopy are necessary.

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Endoscopic variceal ligation（EVL）is one factor influencing the development of portal hypertensive gastropathy（PHG）. Though the pathogenesis of this condition has not been described, it is important to investigate the relationship between variceal inflow and PHG.
This study was conducted to determine how a modified method, eradicative EVL（eEVL）, which utlizes approximately 40 rings, affects portal hemodynamics and PHG. Thirty-seven cirrhotic patients were examined serologically, endoscopically and portographically before and 2 weeks after eEVL.
The development of PHG was observed in 15 of 37 patients（40.5％）after eEVL. These 15 patients had slightly higher Child-Pugh scores and a significantly（p＜0.05）larger number of variceal inflow vessels（left, posterior and/or short gastric veins）by percutaneous transhepatic portography before eEVL. A significant（p＜0.001）decrease in these vessels was revealed post-eEVL.
The development of PHG seems to be due to congestion of these vessels caused by the eradicative therapy for esophageal varices.

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We experienced 19 cases of antibiotic-associated colitis (AAHC) in our hospital. Nineteen patients (twelve were men and seven were women, median age were 44) suffered from AAHC in period from December 1988 to May 1998. Symptoms were abdominal pain and bloody stool in all patients.
The reasons for antibiotic administration were common cold in 13 cases, Helicobacter pylori eradication therapy in 2 cases and anal fistula, fever, abdominal pain and solar dermatitis each in 1 cases. Antibiotics were sultamicillin tosilate in 14 cases, amoxicillin in 2 cases and cefotiam, cefdinir and ofloxacin each in 1 cases. AAHC occurred in 3 to 14 days (median 6.6days) .
The affected areas were cecum 42%, ascending colon 71%, transeverse colon 93%, descending colon 57%, sigmoid colon 36%, rectum 21%. Colonoscopy revealed diffuse redness, edema, erosion and bleeding in mucosa. Clostridium difficile was cultured in 3 of 14 cases from stool. In all cases symptoms and endoscopic findings improved after stop of the antibiotics, fasting and transfusion in several days.
In conclusion, AAHC is iatrogenic disorder and antibiotics must be used carefully.

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The patient was a 64-year-old male suffering from alcoholic liver cirrhosis and esophageal varices. The follow-up endoscopy revealed the aggravation of esophageal varices and superficial esophageal carcinoma. Subsequent endoscopic ultrasonography disclosed the perforating vein of varices on the anal margin of esophageal carcinoma. Accordingly endoscopic variceal ligation (EVL) was conducted as the treatment for the varices. Then the decrement of the varices was confirmed by endoscopic ultrasonography. Afterward endoscopic mucosal resection (EMR) was employed as the treatment for esophageal carcinoma. EMR was safely performed without inducing bleeding and complications.
Several cases of esophageal varices complicated with esophageal carcinoma have been reported. In this case, however, esophageal carcinoma existed on the perforating vein of esophageal varices and the immediate risk of EMR seemed to be high. The adoption of endoscopic ultrasonography before and after the endoscopic therapy was useful and secured safer treatment.

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A 67-year-old female was admitted to our hospital because of abdominal discomfort, weight loss and tarry stool. Endoscopic examination revealed active bleeding by put the air into the stomach. Upper GI X-ray examination shows the rigidity of gastric wall from the upper to middle body. Abdominal CT scan revealed the thickeness of gastric wall.
Selective gastroduodenal arteriography shows a marked hypervascularity at the middle body and fundic area. The patient underwent total gastrectomy. Macroscopic finding shows extensive hemorrhagic gastric mucosal lesions. Histological findings shows mucosal erosive lesions, thickness of the submucosal layer and the markedly vascular hyperplasia.
In this case, there are no charactristic identity with gastric antral vascular ectasia (GAVE) , diffuse antral vascular ectasia (DAVE) , Osler disease and A-V malformation.

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A 69-year-old male, he had received regular treatment for diabets since 1991. He showed sever anemia in March 1996, and admited to our hospital to define the corse of anemia and to treat. Laboratory data on admition showed sevire anemia (Hb 6.7g/dl) and positive occult blood in feces. Endoscopic examination reveiled diffuse red spots because of blood vessels expansion and blood coagulation in the gastric antrum. These findings suggested gastric antral vascular ectasia. Endoscopic biopsy was performed to confirm the diagnosis. The specimen taken from the antral mucosa demonstrated dilated vessels in the gastric mucosa. The diagnosis of GAVE was confirmed. Since gastrointernal bleeding continued and anemia progressed with consavative terapy (H₂ recepter blocker) endoscopic electrocoagulation treatment was performed. This treatment was repeated 6 times. After the terapy there was remarkable improvement in anemia.

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A case of gastric antral vascular ectasia (GAVE) which successfully treated by heat probe coagulation is reported. The patient is a 66-year-old female and she has been followed due to liver cirrhousis with hepatitis C virus. She complained anemia and admitted to our hospital.
According to the gastroscopic findings and pathological findings of the endoscopic mucosal resection specimen, diagnosis of the GAVE was made. The lesion was treated by heat probe coagulation therapy for times. The lesion was improved and she has had no reccurence.
The most of case with GAVE have many kinds of complication such as liver cirrhousis. We conclude that the endoscopic treatment included heat probe coagulation therapy as a minimally invasive treatment is useful and effective for the GAVE.

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A 75-year-old man in whom hypertension was diagnosed in 1987 developed a mild anemia for the first time in December 1996. He complained of passage of tarry stool since March 1997. Endoscopic examination was said to reveal chronic hemorrhagic gastritis and he treated with oral iron and famotidine 40mg twice a day. But, recurrent tarry stool did not improved. Because of anemia and hypoproteinemia, he was admitted to our hospital in August 1997. Endoscopic examination revealed longitudinal red stripes and diffuse erythematous spots indicating dilated vessels in the gastric antrum. Endoscopic mucosal resection specimen demonstrated dilated vessels in the proper gastric mucosal layer, leading to a diagnosis of gastric antral vascular ectasia (GAVE) .
Because he refused surgical and endoscopic treatment at first, he received medical treatment again. But he had no improvement. In November 1997, laser treatment was started by his agreement. Photo coagulation was carried out using Nd-YAG laser. The power setting for photo coagulation averaged 39W and the pulses were delivered at a duration of 0.5 seconds. After three sessions, the dilated vessels in the antrum were almost obliterated and his anemia and hypoproteinemia improved subsequently. There were no complications as a result of laser treatment. Laser photo coagulation is safe and effective treatment for GAVE and should be considered as first line therapy.

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A 50-year-old male with diabetes melitus and chronic pancreatitis complained of left hypochondralgia. He continued to have high fever and CRP value on laboratory studies. Gastroendoscopy showed a small protusion on the mucosal surface of the gastric corpus. Abdominal US revealed cystic mass lesion with internal debris in the upper abdomen. Abdominal CT scan revealed unilobular cystic mass located just adjacent to the posterior wall of the stomach. ERCP disclosed that the cystic lumen of this tumor was communicating with pancreatic duct.
At surgery, a large cystic mass was noted to locate between stomach and pancreas and closely attached to the stomach wall. Cut surface of the stomach wall demonstrated a narrow fistula that penetrating the whole thickness of the stomach wall. Histologically, the cystic mass proved to be a chronic active abscess involving subserosal layer of the stomach.
Our patient had suffered from repeated pancreatitis, diabetes mellitus and habitual alchol intake, and an abdominal mass had developed subsequently, all of these evidences were retospectively suggestive of pancreatic pseudocyst with secondary abscess. In this case, fistulization into the stomach failed to serve as an adequate drainage because of such a complicated pattern of fistulization as likely to be termed“pancreatic duct-infected pseudocyst-stomach”fistulae.

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This paper reports a 67-year-old man who was diagnosed as having gastric ulcer (stage A₁) in January 1995. The ulcer recurred repeatedly despite treatments using PPI and other drugs. H pylori infection was detected by anti-Hp Ig-G antibody (2＋) , RUT (＋) , microscopy (＋) , and the ¹³CUBT (46.2‰) , so eradication therapy was performed in May 1996. The therapy consisted of a PPI (30mg/day of lansoprazole) , AMPC (1,500mg for 2 weeks) , and CAM (400mg for 2 weeks) . Although the ulcer healed to stage S₁ by 4 weeks after completion of therapy, eradication was concluted to have failed because the ¹³CUBT was result 8.7‰ after 4 weeks and 17.5‰ after 8weeks.
Subsequently, an H₂-blocker was administered and the ulcer healed to stage S₂ in October 1997 (17 months after eradication therapy) . The ¹³CUBT value was 1.9‰, and RUT, microscopy, and serum anti-Ig-G antibody were all negative. In this patient, H pylori was considered to have been spontaneously cleared because he did not take medications that could eliminate the organism after the eradication therapy, except for 1,500mg of AMPC for 5 days to treat an acute upper respiratory tract infection.

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A case of duodenal ulcer and esophagitis at the different time after eradication of Helicobacter pylori (H. pylori) was experienced.
A 56-year-old male consulted our department at 40 years old because of epigastric pain. Endoscopic diagnosis was gastric ulcer at that time. H. pylori was detected by histological examination of endoscopic biopsy specimens in 1994. H. pylori eradication therapy was performed then. We recognized success of eradication and develop of duodenal ulcer 2 months later. Six months later, duodenal ulcer was healed by medication, but we found newly esophagitis. Eradication therapy of H. pylori decrease the recurrence rates of peptic ulcer, but has a possibility of onset of newly esophago-gastroduodenal lesions.

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Recently, the association between Helicobacter pylori (H.pylori) infection and primary lymphoproliferative disorders of the stomach has been reported. There are several case studies showing the healing of low-grade gastric lymphoma of mucosa-associated lymphoid tissue (MALT) after the eradication of H. pylori. However, the treatment of MALT lymphoma is still a point of controversy. We applied the treatment for peptic ulcer using H₂-blocker or proton pump inhibitor (PPI) to 3 patients with non-neoplastic lymphoid hyperplasia (so-called reactive lymphoid hyperplasia ; RLH) or low-grade MALT lymphoma.
Follow-up endoscopic examination in case 1 (RLH) still showed the same ulcerative lesion, but histological specimen showed the only inflammatory infiltration composed of plasma cells and lymphocytes. Case 2 (RLH) did not show a change for the worse not only endoscopically but also histologically. The disease in case 3 (RLH) progressed during the treatment with H₂-blocker and the diagnosis of low-grade MALT lymphoma was confirmed by histological examination. After PPI was applied to the patient, endoscopic view was improved remarkably and gastric histological specimen showed the mild inflammatory reaction with almost normal mucosal architecture.
In conclusion, the treatment for peptic ulcer might be useful in treating patients with RLH or low-grade MALT lymphoma.

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A 24-year-old male, visited our clinic with a chief complaint of eipigastralgia.
The panendoscopic examination revealed a small acute ulcer at the gastric angle and histological study showed signet ring cell carcinoma in one specimen of the three biopsies. At the second endoscopic examination, the ulcer was almost healed as a scar. Radical resection was done 44 days after first cosultation.
Two small carcinoma foci were found around the scar of the ulcer. Pathological examinations showed signet ring cell carcinoma lacated within the mucosa just beneath the ulcer scar without invasion (carcinoma in situ) , m, ly (－) , v (－) .

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A 64-year-old Japanese man visited Yokohama Seamen's Insurance Hospital in October 1994, for careful examination of his stomach, because the gastrogram at medical check up one month before had indicated the slight transformation of the antrum. An early gastric carcinoma type IIc＋IIa, 15 mm in diameter, at the greater curvature of the antrum was diagnosed by gastrogram and endoscopy. On November 21, 1994, laparoscopic wedge resection of the stomach using a lesion-lifting method was performed. Macroscopically the lesion was resected at least 10 mm from the margin. Histopathological examination showed moderately differentiated adenocarcinoma within the mucosal layer. He was discharged on December 9, 1994, to follow in an outpatient basis.
His residual stomach was examined every 4 months by endoscopy. No abnormal findings had been found until December 1996. However, on April 1997, endoscopy and gastrogram indicated type IIc early gastric cancer, 20 mm in diameter, at the posterior wall of the middle of the residual stomach. On May 20, 1997, distal gastrectomy was performed. Macroscopically, the distance between secondary carcinoma and the scar of the surgery in 1994 was 20 mm. Histopathological examination showed well differentiated adenocarcinoma within the mucosal layer. He was discharged uneventfully on July 6, 1997.

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A 54-year-old female visited our hospital to receive further examination and treatment for metastatic bone tumor. The upper GI X-ray series, the endoscopy with biopsy and the endoscopic ultrasonography revealed the IIc type of early gastric cancer with submcosal invasion at the greater curvature of the lower gastric body, which was diagnosed signet-ring cell carcinoma histologically. The bone scintigram with ^99mTc-HMDP showed the multiple bone metastases. Abdominal CT scan showed the existence of multiple lymph node metastasis in the para-aortic area. The serum CA19-9 was much higher than normal range.
The CA19-9 protein was positive in the cancer cells in both primary gastric cancer and the left supra-cravicular lymph node by the immunohistochemical stain with anti-CA19-9 monoclonal antibody. Thus, we speculated that the tumor cells should produce CA19-9 protein.

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A 56-year-old female was hospitalized with multiple gastric polyps pointed out at the complete physical examination in August 1989. By the gastroscope, multiple polyps were observed from lower body to fornix of the stomach. They were completely diagnosed hyperplastic polyps by the biopsy specimens. After that, every year, gastroscopy and the biopsy was performed.
In March 1996, we find a view of structural atypical change of the mucosal glands form the specimens taken from the biggest polyp. February 1997, the polyp was suspected to be partially changed adenocarcinoma, we proceeded endoscopic mucosal resection. The clubbing from polyp was measured 52×15mm. Histological examination showed 52×15mm, well differentiated adenocarcinoma.
We observed a case of well differentiated adenocarcinoma change from gastric hyperplastic polyp during 7 years.

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A 59-year-old man was admitted to our hospital for further evaluation of the tumor of the stomach. Endoscopic and X-ray examination revealed the tumor showing submucosal-like with a small ulceration and irregular margin on the top. Initially, the pathological diagnosis of the biopsy specimen taken from the ulcer lesion was the suspicion of lymphoma. However, the second biopsy successfully disclosed the tumor as the poorly differentiated adenocarcinoma, and gastrectomy was performed.
Histological examination showed the tumor, measuring 20×16mm, was located in the submucosal layer almost covered by normal mucosa. Cells of poorly differentiated adenocarcinoma were scattered, and surrounded by abandoned lymphoid stroma. The diagnosis of epithelial origin tumor was established by Keratin stain of the tissue. Retrospectively, this case was considered to exhibit relatively typical sign of gastric carcinoma showing the feature of a submucosal tumor.

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A 64-year-old male who was found to have synchronous triple cancers following distal gastrectomy for a gastric cancer 8-years before. Endoscopic examination revealed a 0-IIb cancer in the esophagus and a IIa cancer on the suture line of the remnunt stomach. Colonoscopic examination revealed a IIa＋IIc cancer in the recto-sigmoid (Rs) . Endoscopic mucosal resection was performed for the cancers of esophagus and remnant stomach. Rs cancer was treated by laparoscopic assisted recto-sigmoidectomy with D₃ dissection.
Pathohistological findings shows squamous cell carcinoma (m₁, ly₀, v₀) in the esophageal cancer, well differentiated tubular adenocarcinoma (m, ly₀, v₀) in the gastric cancer and well differentiated tubular adenocarcinoma (sm₃, n₀, ly₀, v₀) in the rectal cancer. Synchronous early triple cancers of the esophagus, stomach and colon were very rare cases reported in Japan, and our case was the only one report to treat all cancers with endoscopic treatment.

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A rare case of gastric cancer coexisted with a primary malignant lymphoma of the stomach is reported.
An 83-year-old woman was referred to the hospital because of a gastric cancer in the antrum at another hospital. She visited complaining of abdominal pain. After admission, endoscopic examination revealed a Borrmann-2 like lesion in the lesser curvature of the antrum. She underwent distal gastrectomy. In the resected specimen, the Borrmann-2 like lesion with a early gastric carcinoma type III like lesion in the antrum was found. Histopathologically, the Borrmann-2 like lesion was poorly differentiated adenocarcinoma with the invasion depth of sm, and the type III like lesion which was posterior wall of the carcinoma showed proliferation of atypical lymphocytes. On immunohistochemical stains, the atypical lymphocytes were positive for L-26 which was antibody for B-cells.
We should not only focus on the main lesion, but also observe another lesion in the endoscopic examination.

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A rare case, a 59-years-old male, complicated dreamy state after endoscopic polypectomy of the polyp of duodenal bulb was experienced.
Though the consciousness level of the patient depressed, he had a memory of doctor's conversation in the course of and after endoscopic polypectomy. It is different from global amnesia. This case is the first experience in our department. We couldn't find the same report of dreamy state caused by gastroduodenal endoscopy in references. It's necessary for us to aware that endoscopy rarely cause depression of consciousness level.

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The patient in this case was an 81-year-old man with a history of gastrectomy performed at his age of 69. While receiving ambulatory therapy for alcoholic cirrhosis of the liver, obsolete myocardial infarction, chronic heart failure and chronic renal failure he was hospitalized due to melena. On emergency endoscopy there were noted multiple shallow gastric ulcers on the oral side of the gastrojejunostomy, although no esophageal nor gastric varices were detected. Treatment was begun with local injection of ethoxysclerol.
However, as the passage of bloody stools persisted still on the following day, an in-depth exploratory endoscopic examination resulted in identification of nodular varices located on the opposite side of the Vater's papilla at the blind end of the afferent duodenal loop as the source of bleeding. Because of fibrin plugs noticed at the vertexes of the varices an attempt was made to administer Histoacryl by local injection, which proved successful in arresting bleeding.
The present case was considered worth reporting in that local injection of Histoacryl proved to be effective in stopping bleeding from duodenal varices that developed at the closed stump of the afferent duodenojejunal loop created by the Billroth-II technic.

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Post-bulvar duodenal ulcer is a relatively rare disease, of which incidence is less than 5% among the whole gastrointestinal ulcers. We reported four cases of post-bulvar acute ulcers, followed after cardiovascular surgery.
In all case ulcers were observed as multiple, longitudinal, symmetric and band-shape, unlike peptic ulcers. Every patient had no characteristic basal disease and got recovered after oral administration of proton pump inhibitor (PPI) . Insufficient blood supply from pancreatico-duodenal artery, the initial feeder of this legion, might cause ischemic disorders by cardiovascular surgical procedures.

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A 79-year-old female entered our hospital because of tarry stool. Gastrointestinalscopy revealed multiple hemorrhagic ulcers in the fornix of the stomach. Her laboratory data showed thrombocytopenia and immunological disorders. Making a careful examination, we considered that she had systemic lupus erythematodes with antiphospholipid syndrome.
In spite of prescription of proton pump inhibitor the gastric ulcers were not improved. Furthermore, hematochezia occured to her. Colonoscopy revealed longitudinal ulcers of the left sided colon and biopsy specimen from the ulcer floor showed fibrinoid necrosis histologically. Therefore, we diagnosed the colonic ulcers as ischemic colitis due to lupus vasculitis. It was speculated that the gastric ulcers were also caused by lupus vasculitis. Afterward, gastrointestinl bleeding was continued and the general condition grew worse. We prescribed steroid to suppress vasculitis. As a result, bleeding was stopped and the general condition was getting better.
It was recognized that the gastric and colonic ulcers were healed by the repeated endoscopic examination. It is considered very rare that lupus vasculitis occures multiple hemorrhagic ulcers of the upper and lower digestive tract such as this case.

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A 77-year-old men was admitted to our hospital because of hematemesis. Laboratory examination revealed anemia and renal disfunction. Blood loss from angioectasia of the jejunum was diagnosed by endoscopically characteristic dilated vessels. Those lesions were treated endoscopic electrocoagulation and clipping, blood transfusion and conjugated estrogen therapy.
Treatment was successful and anemia was inproved. Endoscopical electrocoagulation, clipping and systemic conjugated estrogen therapy is effective treatment for bleeding from angioectasia of the jejunum.

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We report herein a rare case of bleeding jejunal ulcer successfully treated with colonoscopic clipping.
A 57-year-old man underwent Hartmann's operation for perforation of cancer of the rectosigmoid. He developed disseminated intravascular coagulopathy and septis by mechycilin resistant staphylococcus aureus postoperatively. Twelve days after the operation, he suddenly presented with melena which resulted in hypovolemic shock. Emergency angiography revealed extravasation from the branch of the jejunal artery. Hemostasis of the jejunal lesion was achieved by transarterial embolization using gelatine sponge. Five days after the embolization, he presented with melena again.
A colonoscope was introduced into the jejunum perorally. An arterially bleeding small ulcer located 25 cm distally from the Treitz's ligament was successfully clipped. Although he died of hypercalcemia 43 days after the operation, no bleeding from the ulcer was seen until death.
Our experience suggests that colonoscopic clipping is one of the effective methods of hemostasis for bleeding ulcer of the upper jejunum especially in poor-risk patients.

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We experienced a case of acute appendicitis associated with ileocecal polypoid lesion. The patient was a 74-year-old female and she had had continuous lower abdominal pain for 10 days. After conservative therapy, she was performed colonoscopy. It showed small polypoid lesion at the appendicial orifice. Histopathological findings of biopsy specimen showed infiltration of inflammatory cells in submucosal space and nucleic atypia of some infiltraded lymphcytes and they suggested us that malignant lymphoma could not be denied.
According to these findings, she was undergone ileocecal resection to determine the characterisity of the tumor and so as not to recurrent of appendicitis. Histopathological findings of the resected specimen showed atypical ephithelium at the polypoid lesion without evidence of malignancy and it was considered as a regenerative change. After operation she did well.
In literature, there are some case reports about appencial diseases include malignancies, Crohn's disease and appendicitis, and few cases of them were diagnosed correctly preoperatively because of diagnostic difficulties. There is only a little information about appencial diseases like this case. Pancity of the information prompt us to present a case.

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An 81-year-old woman was admitted to the hospital because of bloody bowel discharge. Colonoscopy revealed dilatation and gently swelling of the blood vessel in the transverse colon in the hepatic flexure region. Colonic angiodysplasia was diagnosed.
Anemia progressed despite repeated blood transfusion, hense partial resection for the transverse colon was performed. Histopathological examination revealed dilated blood vessel mainly in the submucosal layer, a finding consistent with colonic angiodysplasia.
Colonic angiodysplasia in a narrow sense is one of the causes of bloody bowel discharge in elderly patients, and is considered to be a lesion due to degenerative changes for the blood vessels as a result for aging. The present case corresponds to such narrowly defined colonic angiodysplasia. Colonoscopy is useful in diagnosis.
The possibility of colonic angiodysplasia has to be suspected in elderly patients with lower digestive tract bleeding. As for therapy, endoscopic treatment which is relatively simple and less invasive is generally considered the first option. In the present case, however, the lesion was extensive and situated in an area difficult for endoscopic treatment. Surgical treatment was therefore performed.

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