Heater' probe unit was developed for the hemostasis of peptic ulcer. We applied heater probe therapy to (a) F0 recurrent esophageal varices and (b) vascular ectasia. (a) Eighteen patients with F0 RC (＋) recurrent esophageal varices were treated with heater probe unit. F0 varices disappeared just after the treatment. In five to sixteen months follow-up after treatment, we experienced no case of bleeding from esophageal varices. Additional treatment was performed in three patients with recurrence of RC sign. (b) Ten patients with gastric vascular ectasia were also treated with heater probe unit. This therapy was effective for hemostasis and disapperance of vascular ectasia. Serious complication did not occur in any case. It is concluded that heater probe therapy is safe and effective for these non-ulcer lesion.

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Cases of esophageal varices with strongly suspected participation of arterial blood as revealed by color Doppler endoscopic ultrasonography (CDEUS) are reported. In the left gastric vein, pulsative waves were detected in 4 (7.5%) of 53 cases. In two of these 4 cases, pulsative waves were recognized in the posterior branch of the left gastric vein. Both were treated endoscopically.
Case 1 : 70-year-old female. Child B, liver cirrhosis. The blood flow in the left gastric vein before treatment consisted of continuous waves, the flow velocity being 6.5cm/sec. The varices were F0RC (－) in endoscopic findings 1 month after treatment. CDEUS showed pulsative waves in the blood flow in the left gastric vein and the posterior branch of the left gastric vein, the flow velocity being 7.2 and 21.8cm/sec respectively. The blood flow in the paraesophageal vein consisted of continuous waves, the flow velocity being 18.6cm/sec. The flow velocity increased suddenly in the posterior branch of the left gastric vein and the paraesophageal vein.
Case 2 : 51-year-old male. Child A, primary biliary cirrhosis. Endoscopic treatment had been performed for esophageal varices 2 years before. A recurrence of esophageal varices was detected recently. Before treatment, pulsative waves were detected by CDEUS in the left gastric vein and the posterior branch of the left gastric vein. The flow velocity was 3.6 and 9.2cm/sec respectively. The blood flow in the paraesophageal vein was continuous wave, the flow velocity being 8.9cm/sec.
In both of these two cases, marked pulsative waves were observed in the posterior branch of the left gastric vein. CDEUS suggested strongly suspected direct participation of arterial blood. Arterio-venous anastomosis occurred presumably at the level of the posterior branch of the left gastric vein.

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In our hospital, We experienced 42 esophageal cancer cases from Jan. 1997 to Dec. 1998 (Table 1) . Among 42 cases, we performed argon plasma coagulation (APC) of 10 advanced esophageal cancer cases and a case of conditioning fistulas cased by leakage after esophagectomy of esophageal cancer (Table 2) .
Nine advanced cancer cases implanted selfexpanding metal stent (Boston scientific Japan K. K.) after APC and 8 cases could take regular diet after implantation of metal stent. Two cases of tumor overgrowth out of metal stent, treated by APC again and improved symptoms after APC.
There were no fetal complications, however, 9 cases had fever, 5 chest pain and/or heart burn and 3 vomiting after APC (Table 3) .
Indications of APC for esophageal cancer were as follows, tumor ingrowth and overgrowth of metal stent, reduction of tumor volume, residual lesions or local recurrence after endoscopic mucosal resection (EMR) of early cancer and conditioning of fistula.
In our study, We considered APC was safe and effective treatment and useful of tumor reduction for advanced esophageal cancer before implantation of metal stent.

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In selecting the therapeutic procedure of gastric cancer, surgical treatment with wide lymph node dissection has been mostly applied for radical resection. In recent years, early gastric cancer not requiring lymph node dissection is increasingly treated by endoscopic membrane resection or laparoscopic local resection. However, there is a risk of lymph node metastasis and the regional lymph node dissection is required in early gastric cancer with submucosal infiltration. The cases of early gastric cancer are largely divided into the following three : (1) those which dose not require lymph node dissection, (2) those which can be well treated by D1 or D1＋＃7 lymph node dissection and (3) those which dose not require D2 lymph node dissection. We should be very careful in selecting the therapy.
The authors histopathologically investigated the specimens taken from early gastric cancer cases operated at our institution from 1987 to 1997 and investigated the therapeutic option for early gastric cancer requiring lymph node dissection. The size, histological type, depth, and presence or absence of ulcer and lymph node metastasis were investigated for the lesions from 200 early gastric cancer cases (100 mucosal gastric cancer cases and 100 submucosal invasive gastric cancer cases) . The investigation indicated that minute invasion (sm1) has no lymph node metastasis regardless of presence or absence of ulcer and is an indication of LADG (no more than D1 dissection) . And that moderately invasion (sm²) cancer lesions of less than 4cm for differentiated type and less than 1.5cm for undifferentiated type with absence of ulcer can be an indication of the same operation. And other sm² cancer cases can be the extended indication of LADG (D1＋＃7 dissection) . The submucosal invasive cancer cases severer than these will be an indication of conventional distal gastrectomy (D2 dissection) .

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Pneumatosis cystoides Intestinalis (PCI) were seemed to be rare in the colonic lesion. In this report, 3 cases of PCI were diagnosed endoscopically and endoscopic ultrasonographically (EUS) . EUS were performed using ultrasonic probe with water filling method after colonoscopic observation finished.
These lesions were mainly noted in the ascending colon with multiple submucosal tumor like lesion (size range to 5mm-20mm) . From EUS findings, high echioc band were noted in the marginal zone of mucosa and submucosal layer and aechoic shadow under high echoic band suggesting the exsist of gas. These findings were shown similarly in these cases. Two cases were followed-up endoscopically and they revealed vanishment of such multiple lesions. In one of them, multiple whitish spots were noted at the site of elevated lesion. EUS findings also showed gas bands disappear.
Experimental EUS study which were obtained by injected the air to the submucosal layer revealed quite similar findings as previous cases. But the EUS after air injected into subserosal layer showed extremley different findings.
From these study, it could be concluded that PCI were diagnosed definitely when EUS was used.

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A 49-year-old woman had a 23-year history of progressive dysphagia and weight loss. She visited a clinic complaining that she was unable to swallow a tablet. Endoscopic examination was attempted but endoscope could not pass through the stenosis of the cervical esophagus, so she was referred to our medical center. Her esophagogram showed an esophageal web, and laboratory studies showed iron-deficiency anemia. Iron treatment was administrated and the web was perforated with a balloon dilater under endoscopic guidance. One month later, the patient had no dysphagia, and no further dilatations were required. Dysphagia with iron-deficiency anemia, esonphageal web, glossitis, and koilonychia in middle-aged women constitute Plummer-Vinson syndrome (PVS) . Iron replacement therapy will improve the dysphasia in many cases, and symptomatic webs are easily treated by dilation. PVS is associated with an increased incidence of esophageal cancer, and surveillance endoscopy is recommended.

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A 43-year-old man visited to our hospital because of anal bleeding. Emergent colonoscopy revealed multiple shallow punched ulcers at the ileum and confirmed active bleeding. Clipping procedure was effective method as hemostasis. The pathogenesis of the lesions were suspected to be induced by diclofenac sodium. He had taken 75 mg of diclofenac sodium thrice a day for shoulder pain during a month. The lesions disappeared about 30 days after discontinuation of diclofenac sodium and bowel rest by hyper alimentation therapy. The lesions were differentiated from other disease by the clinical course, laboratory data, endoscopic and histological findings. NSAIDs induced lesions of the small intestine was rare and massive hemorrhage was one of the characteristic aspect. Clipping was one of the effective hemostasis for the NSAIDs induced hemorrhagic lesions.

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A 19-year-old male underwent allogeneic bone marrow transplantation (BMT) for acute lymphocytic leukemia. He had massive diarrhea on the 100th day after transplantation. Colonoscopic examination showed granular, reddish and erosive mucosa of the colon and the ileum. And the biopsy specimen revealed apoptosis of the epithelial cells, cryptabscess and infiltration of lympho-cyte in the storoma pathologically. Though the cytomegalovirus (CMV) anti-genemia examination was slight positive, we diagnosed his diarrhea as acute graft-versus-host disease (GVHD) by pathological finding. We administered steroid for acute GVHD and the volume of diarrhea decreased. But after a while diarrhea became massive again. Repeated colonoscopic examination showed spotty and diffuse reddness of the ileocecum and the biopsy specimen revealed inclusion bodies in nuclear of the mucosal cells pathologically.

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The patient was a 54-year-old man. Owing to a positive result in fecal occult blood test, he visited our department for the detiled examination.
Plain abdominal X-ray film and Abdominal CT scan shows linear calcification along the colonic wall of the cecum, ascending and transverse colon. Barium enema film shows sclelosis of the colonic wall from the cecum to splenic flexure and'thumb-printing’like appearance on part of the transverse colon.
Colonoscopic view shows blue-purple colored mucosa with indistinct vascular pattern in the right-sided colon and irregular ulcers in the transverse colon. Histological picture of the biopsied specimen disclosed ischemic intestinal lesions caused by phlebosclelosis.
Follow up colonoscopic view shows the progression of the lesion to the descending colon and the healed white scars which used to be present as open ulcers in six months before on the transevers colon.
These unusual venous lesions have been rarely reported, and their pathogenesis remain unknown, we discuss the clinical and histological characteristics of this case.

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Upper GI series was performed on a 72-year-old-female patient complaining loss of appetite on January 9. No remarkable findings was observed except for the significant atrophy of gastric mucosa, but the barium pool of the submucosa was detected at the posterior wall of the fornix after vomitting. She was admitted our hospital because of a small quantity of hematemesis and a fever rising to 38℃. Endoscopic findings showed a white linear tear and a swelling like submucosal tumor at the posterior wall of the fornix. A little free air was detedted on her abdominal X-rays at admisssion, but was removed day 3. She recovered by the conservative treatment.
We reported a rare case of Mallory-Weiss syndrome complicating upper GI series and forming submucosal mass of barium with a review of the literatures. It should be careful to performe the upper GI series for elder patients with sever atrophic change and loss of flexibility of stomach.

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A 60-year old man visited our clinic with diarrhea and constipation. Barium enema and colonoscopic examination revealed a white elevated lesion, type IIa＋I with granular surface about 27mm in size at the ascending colon. Endoscopic Mucosal Resection was performed. Macroscopic findings of the resected specimen revealed as a lesion type IIa. Histological findings showed serrated pattern without adenomatous component, diagnosing hyperplastic polyp. We performed ki-67 (Mib-1) stain in order to examine the localization of proliferating cells. The labeling index of Mib-1 in this polyp was 21.6% at the lower zone and 0.7% at the upper zone. The localization of the proliferating cells was quite close to that in ordinary colonic mucosa, indicating that this polyp is to be non-neoplastic though it is actually big in size (type IIa) .

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We have performed a clinical evaluation on the new Olympus endoscopy system for upper digestiv tract, EVIS-CV240 and GIF-Q240. This new system features better insertability and maneuverability, higher resolution and larger monitor size. This system also enables EUS procedures with the use of US miniature probe.
We have selected 10 doctors with 5 years or more experlence in endoscopy, and performed a questionnaire for 67cases pesformed using this system. The questionnaire included comparison of picture quallty in enhance of structure levels 1, 4, and 8 (hereunder ESL) in the esophagus, stomach and duodenum, and comparison to the current CV200 and GIF-XQ230 system.
As for picture quality, the result showed improvement in the new system. In higher enhance of structure levels, clearer observation of the visible vascular pattern, redness of the mucosa, and change in color were possible for all tracts.
Ln comparison to the CV200 and GIF-XQ230 system, overall results showed improvement in the new CV240 and GIF-Q240 system, however, some identified problems in its maneuverability.
Through our evaluation we conclude that the new CV240 and GIF-Q240 system is useful for observation in the upper digestive tract. This may lead not only to a reduction of misdiagnosis, but more importantly, this may lead to a progress in higher level diagnosis with the use of accumulated high quality pictures of minute lesions.

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Rabeprazole (RPZ) concentrations were measured in gastric mucosa from inhibition zones on H. pylori culture medium and calibration curves.
The proton pump inhibitor (PPI) RPZ and H. pylori were used to measure inhibition zone diameters. The methods were prepared according to previously described. RPZ standard dilution solution was used to make drug concentrations of 0.05～100μg/ml. The diameters of inhibition zones were measured with discs method (72 hours, 35℃, in CO2) . The effects of gastric juice on H. pylori were assessed by adding gastric juice obtained during upper gastric endoscopy to the standard dilution solution. Gastric juice was also centrifuged, heat-treated, filtered by dialysis, and dried, and the antibacterial activity evaluated. H. pylori growth was examined using the pre-endoscopy drugs xylocaine spray, xylocaine jelly, gascon drops, and untreated gastric juice.
A linear curve was obtained for drug concentrations of 0.78～100μg/ml, however, marked increases in inhibition zone diameter were seen with gastric juice addition, suggesting the existence of a substance of suppressed H. pylori. The substance seemed to exist for all treatments, with the pre-endoscopic drugs having the greatest inhibitory effect. Untreated gastric juice did not possess the inhibitory effect.
It is hoped that in the future this method can be used directly assay the concentrations of PPIs and other drugs in the gastric mucosa in successful and unsuccesuful H. pylori eradication cases.

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It is well known that there is a chronic active gastritis (CAG) in Helicobacter pylori (H. pylori) infected stomach. A characteristics of CAG between in H. pylori positive gastric ulcer and duodenal ulcer were studied. We found many differences as follows :
1) CAG was stronger in corpus than in antrum in H. pylori positive gastric ulcer. It was remarkable in cases accompany by gastric mucosal atrophy.
2) In H. pylori positive duodenal ulcer, CAG was stronger in antrum than in corpus. There was no relation in atrophic change of gastric mucosa.

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For the past five years (Feb. 1993-Jan. 1998) , 42 handicapped patients with upper gastrointestinal complication underwent endoscopic examination at the institute.
To take a safe measure, at least four staff members were to assist the handicapped patients during the endoscopic examination. The incidence of esophageal hiatus hernia and reflux esophagitis were particularly high (73.7%) in patients associated with severe mentally and physically disorders who are lying in bed and tube feedings.
When performing endoscopic examination on mentally and physically patients, keeping the safety of the patient in mind, consideration while carring out sedation is important.
Therefore it is necessary to have at least four staff members namely the endoscopist, a sedation specialist, a nurse, and care-worker during the examination.

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From January 1993 to August 1998, five cases of lymphangioma of the colon were diagnosed with endoscopic ultrasonography (EUS) . Endoscopically, four cases revealed as the smooth surfaced hemispherical lesion which covered with normal mucosa with transparency. Only one case revealed a slight elevation in the transverse colon.
EUS findings showed monotonous low echoic area in the submucosal layer and 4 cases of hemispherical lesions were accompanied with septum formation. Four cases were diagnosed cytologically (aspiration cytology) and one case of them was diagnosed histologically after endoscopic resection. Remaining one case was diagnosed only by EUS and have been followed up for these 2 years without any remarkable changes, not only endoscopically but in EUS.
In conculusion, EUS findings of lymphangioma was specific and would be the most helpful diagnostic procedure.

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The method of injection hemorrhoidal sclerotherapy via rigid anoscope has not been generally accepted because it is difficult to inject a sufficient amount of sclerosant into the adequate site of the rectal mucosa, and because the effectiveness of this method is unsatisfactory. The first paper of the endoscopic hemorrhoidal sclerotherapy was published in 1991, where the new method was shown to overcome the shortcomings of the former method. Since Jan. of 1995 to Oct. of 1998, we performed endoscopic hemorrhoidal sclerotherapy for 187 patients, of which we were able to follow the 166 cases. The purpose of this study is to analyze the clinical effectiveness of the endoscopic hemorrhoidal sclerotherapy. In 63 cases of anal prolapse, the procedure was effective in 58 cases (92.1%) . In 99 cases of hemorrhoidal bleeding it was effective in 98 cases (99.0%) . All 4 cases of anal pain were effective. Retreatment was needed in 22 cases. And surgical therapy was needed in 6 cases. By using this technique we were able to select the adequate site for injection and were able to inject the sclerosant sufficiently and safely. In conclusion, the endoscopic hemorrhoidal sclerotherapy is an easily-perfomed, safe, and effective modality for the treatment of symptomatic internal hemorrhoids.

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A self-expandable metallic stent (EMS) was implanted in the bile duct in 20 patients with inoperable malignant biliary strictures, and was assessed for utility and problems. Anti-tumor therapy was administered to 9 patients. Of 20 patients, 17 patients (85%) returned home after EMS implantation, of whom 7 patients had to return to hospital because of stent obstruction. The 12-month cumulative rate of post-implantation patency was 48.5% and the 12-month cumulative survival rate was 36.4%. There was no difference in patency rate or survival rate in relation to anti-tumor therapy. Complications of EMS implantation occurred in 11 patients (duodenal ulcer in 4 patients, cholangitis in 5 patients, acute cholecystitis in 2 patients and acute pancreatitis in 2 patients) . Internal fistulation by EMS implantation did much to improve the quality of life of patients with inoperable malignant biliary strictures. It shouled be borne in mind, however, complications may occur depending on the site of EMS implantation or the type of EMS.

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One hundred and twelve polyps (Ip87, Isp23, Is2, mean size1.4cm) were excised using the detachable snare with a two-channell colonoscope. No complication such as bleeding or perforation was found after the polypectomy in 112 lesions. This method enables polypectomy to be easy, secure and certain to conduct.

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The case was a 67-year old male with a past history of gastrectomy due to gastric ulcer. Upper gastrointestinal tract endoscopy for follow up in 1995 showed an erythematous, slightly depressed lesion in the middle thoracic esophagus. Biopsy specimen disclosed dysplasia. Follow up endoscopy in November 1997 showed a round, elevated lesionwith a central erythematous elevation which was not stained by iodine spray. The central elevation had depressed during ultrasonic endoscopic examination after admission, which disclosed poorly-differentiated squamous cell carcinoma with sarcomatous element. No transitional zone was found between squamous cell carcinoma lesion and sarcomatous lesion. Immunohistochemistrical staining disclosed that the sarcomatous component was negative for epithelial membranous antigen and positive for vimentin, which demonstrated the elevated lesion as pseudosarcoma. The patient underwent subtotal thoracic esophagectomy after chemotherapy. Histological examinasion of the resected specimen showed that the remaining tumor invaded the muscularis propria with no metastatic lymph nodes. We have reported a rare case of carcinosarcoma presumably classified as pseudosarcoma.

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A 66-year-old male was seen in Hitachi General Hospital because of dysphagia. Endoscopic examination revealed a 5cm-sized elevated lesion showing grayish and hemorrhagic granular surface at the lower third of the esophagus. Biopsied specimens of the lesion was diagnosed as carcinosarcoma of the esophagus. No distant metastasis was estimated.
Subtotal esophagotomy and proximal gastorectomy were carried out emergently due to hematemesis.
The tumor was histologically diagnosed as malignant melanoma by histpathological and immunohistochemical examination. Histological staging was represented as follows : A₁, N₁, M₀, Pl₀ stageII, ie (－) . Melanoma cells permeated in the lymphatic vessels and small veins (ly₂, v₁) .

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A 63-year-old Japanease male was incidentally pointed out a elevated lesion on the greater curvature of the upper stomach body at a health check. Subsequent endoscopic examinations were followed up periodically for 6 years. The internal echo pattern of elevated lesion, which was resembled to myogenic tumor changed by the Endoscopic ultrasonography (EUS) in February 1998, so he admitted to our hospital for further invastigation and treatment. Endoscopic and upper gastrointestinal double contrast X ray examinations showed the nodular elevated lesion with mucosal bridging fold, which had no ulceration. EUS revealed submucosal tumor, which was the 27mm in diameter and seemed to be originated from 3rd to 4th layers, and showed cystic and solid internal echo pattern. So, we attempted EUS guided fine needle aspiration cytology (FNA) to the elevated lesion, then which was diagnosed gastric abscess. To date, only 16 cases of gastric abscess have been reported in Japan and no cases have been diagnosed by EUS guided FNA cytology. EUS guided FNA cytology will be of help to evaluate gastrointestinal submucosal lesion in the near future. We reported a case of gastric abscess, which resembled to myogenic tumor of the stomach by endoscopic ultrasonography.

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Recently, a new concept of gastrointestinal stromal tumor (GIST) has been advocated to the tumor which is originated in the mesenchymal tissue. We report on two cases of gastric GIST with extraluminal growth.
Case 1 : A 58-year-old male was pointed out a lesion in the upper corpus of the stomach by gastric mass survey in 1997. The lesion was formed with pressure from outside of the gastric wall. The endoscopic examination using an ultrasonic probe showed the hyperechoic mass, 5 cm in diameter, which had the continuity with the fourth layer of the gastric wall. Partial gastrectomy was performed because the malignancy could not be excluded. The lesion was composed of spindleshaped cells and diagnosed as GIST by immunohistochemical study.
Case 2 : A 74-year-old female was pointed out a submucosal tumor, 1.2cm in size, in the upper corpus of the stomach by gastric mass survey in 1998. Endoscopic ultrasonography revealed the homogeneous hypoechoic mass, 5 cm in diameter, which developed to outside of the stomach and had the continuity with the fourth layer of the gastric wall. It was resected and diagnosed as GIST by immunohistochemical study.
We are not aware of any reports of a case of GIST with the extraluminal growth, which was demonstrated by ultrasonic endoscopy.

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A 72-year-old female referred to our hospital because of upper abdominal pain on Septenber 27, 1997. She had been suffered from Rheumatoid arthritis during recent two years, and was treated with NSAIDs, immunosuppresive agents. Endoscopic examination revealed multiple erosions on the lesser curverture aspect of the antrum. Endoscopic ultrasonography revealed small aechoic lesions in the submucosa. After the biopsy of a erosion, a small cyst appeared. In spite of treatment with PPI, her multiple erosions were not cured. On endoscopic examination one month and one year later, the same findings were found on biopsy.
Gastric submucosal cysts are rare disease. Many cases of gastric cyst were diagnosed by operated specimens with gastric cancer. In this case, it seemed that, this gastric cyst was caused by chronic inflammation. Because many inflammatory cells were found in the gastric mucosa and submucosa with thickned muscularis mucosae. We thought that this case was valuable one, because it was dificult to detect gastric submucosal cysts that were diagnosed without operation on literature.

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The relationship between Helicobacter pylori (H. pylori) infection and foveolar hyperplastic polyp has been reported. In our study, 6 cases of foveolar hyperplastic polyp located on antrum or angulus were disappeared and reduced after the eradication of H. pylori.
It is considered that this phenomonen is due to the improvement of H. pylori-induced mucosal inflammation. This result suggests that the H. pylori eradication may be expected as a new treatment of foveolar hyperplastic polyp.

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A gastric elevated lesion of a 47-years-old woman was followed by endoscopy for 4 years from 1994, because histological findings of biopsy specimen showed as hyperplastic polyp. In 1998, 4 years later, biopsies were performed and histological study indicated hyperplastic polyp with severe atypia. The lesion was completely resected by endoscopic polypectomy. Pathohistological findings showed almost 70% of the total area was occupied with adenocarcinoma cells, and the rest was diagnosed as hyperplastic tissue. We reported a case of smooth surface elevated lesion in stomach which was finally diagnosed as carcinoma. These results suggested that biopsies from every part should be performed in order to diagnose gastric smooth surface elevated lesion, and complete resection by endoscopic polypectomy should be done.

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A 89-year-old female was admitted to our hospital recommended endoscopic gastrostomy. Her activity of dairy living was limitted by hemiplegia. It was difficult for her to intake food perorally. Endoscopic gastrostomy was done. But feeding trouble was occured frequently by the elevation of intraabdominal pressure. Then, endoscopic jejunostomy was intended. When jejunal tube guided endoscopically inserted in duodenal bulb, perforation was happened. Peritonitis and secondary pancreatitis were occured. But her accident was recovered by conservative treatment. This case report suggest that when endoscopic procedure was necessary for after-gastrostomized state, careful management was important.

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A 91 year-old female was admitted to our hospital because of hematemesis. Emergency endoscopic examination disclosed an exposed vessel in the large diverticulum of the second part of the duodenum. Clipping of the vessel was performed endoscopically, and no further bleeding took place thereafter. Hemorrhaging from a duodenal diverticulum is a rare condition and only 56 cases have been reported in Japan. Although resection of the diverticulum was the most popular approach for hemostasis formerly, endoscopic procedures such as ethanol injection therapy have recently become more widely used. Clipping was done in 5 cases and failed to stop bleeding in one case. Exposed vessels which are the cause of bleeding from duodenal diverticulum are seen in about a half of the reported cases. Therefore endoscopic clipping procedure, compressing the bleeding vessel directly by metal clip, is thought to be one of the most effective ways of stopping hemorrhaging from duodenal diverticulum.

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A 24-year-old woman came to the hospital for the biennial check-up. She had had iron deficiency anemia since the age of 11 years, and was found to have multiple polyps in the stomach, small bowel and colon (reported at the 44th Endoscopy Congress) . Polyps were pedunculated as well as sessile, and particularly there were more in the jejunum. Laparotomy was carried out and 39 polyps were removed surgically ; anemia improved subsequently. She was followed every 2 years thereafter. In Nov. 1996, she developed mild anemia. Upper GI endoscopy disclosed 2 polyps in the stomach, colonoscopy demonstrated several, and barium study numerous polyps in the small bowel. Polyps in the small bowel were removed under laparotomy. These polyps were hyperplastic histologically. We now report on this patient with recurrent juvenile polyposis with a review of the literature.

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A 26-year-old man with hemophilia A was admitted to the hospital complaining of persistent lower abdominal pain. Ultrasound showed a cystic fluid collection around the rectum. Abdominal CT and MRI revealed a heterogenous mass around the rectum extending to lower sigmoidal colon. Gastrografin enema showed stenosis due to extrinsic mass of the rectum. Colonoscopy showed a disturbance of extension as well as intramural hematoma. Abdominal symptomes were resolved after administration of cryoprecipitate under the diagnosis of intramural rectal hematoma.

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A 66-year-old man visited our hospital complaining of rectal bleeding. Colonoscopic study showed tumor in the transverse colon. Transverse colectomy was performed. Tumor was 1.5×2.5cm in size, diagnosed as endocrine cell carcinoma invading subserosa, with lymphnode metastasis (n3) , but without liver and peritoneal metastasis. Prognosis of such colonic endocrine cell carcinoma has been recognized very poor, recently. It tends to occur in rectum but our reported case, tumor occupied in the transverse colon, relatively rare site.

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A 46 year-old man was pointed out positive test for fecal occult blood wtihout any symptom. Barium enema examination showed rectal polypoid lesion without any mucosal lesion, however, total colonoscopy revealed ulcer lesions localized only in the cecum covered with yellowish coat. Pathological study showed erosive change and PAS-positive round cells phagocyting red blood cells, which suggested trophozytes of Entamoeba histolytica. Serological examination for Entamoeba histolytica was positive and metronidazole 1.5g/day was given for a week. Two months later, there was no ulcer lesion in the cecum. This case suggested the importance of total colonoscopy for anyone with positive fecal occult blood and of thinking amoebic colitis as one of the colonic inflammation in the ileocecal region.

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A 17-year-old girl having no remarkable past history was admitted to our hospital because of abdominal pain, pyrexia and mucosanguinous diarrhea. Blood chemistory findings on admission were all within normal limits exept for incresed CRP level and white blood cell count, indicating an acute inflammatory reaction. A few stool cultures yielded no enteric pathogens. Colonoscopy demonstrated diffuse multiple aphthoid lesions with circumferential redness in the enteric colon and rectum, being compatible with aphthoid colitis proposed by K. Yoshikawa. She was treated by antibiotics and bowel rest, which have been reported to be effective to aphthoid colitis but were not in this case. Her symtoms and the increased inflammatory reactions improved soon after the administration of Sarazosulfapiridine (SASP) , and colonoscopy done 3 weeks later revealed that aphthoid lesions were healed. Since colonic aphthous ulcer can be an early phase paradigm of inflammatory bowel diseased such as Crohn's disease, we need further observation, but no evidence of recurrence has been noticed for 8 months. This case suggests that SASP can be one of therapeutic options to an aggressive case of so-called aphthoid colitis.

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A 58 year-old woman visited our hospital, with slight fever and goiter. She was treated by NSAID as subacute thyroiditis. Clinical symptom disappeared, but erythrocyte sedimentation rate (ESR) remained accelerating. 2 years after the treatment, occult blood test of her feces turned to positive in mass survey for colorectal cancer. Colonoscopy revealed circular stricture with irregular, shallow and ringed ulcers on right sided transeverse colon.
Biopsy specimen showed granulomatous inflamation with caseation necrosis. Chest X ray showed tiny nodules on both upper lobes of the lung.
Anti-tubercular drugs were effective, and ESR normalized.
Mycobacterium tuberculosis was not detected by Ziehl-Neelsen's staining and PCR technique.

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Dilatation with a balloon catheter was successfully performed for a sigmoid stricture which occurred in a patient with ischemic colitis. A 82-year-old male patient presented with diarrhea and lower abdominal pain from the end of January 1998. He was admitted to our hospital in February. Colonofiberscopy showed narrowing of the lumen and ulcer in the sigmoid colon. Barium enema showed a 3.5cm length stenosis and thumb-printing shadow in the sigmoid colon. He was diagnosed as ischemic colitis. As the symptoms disappeared after conservative therapy, he was discharged in March. Because the symptoms recurred from May, he was readmitted in June. Colonofiberscopy showed marked stenosis of the sigmoid colon that could not be passed through by the scope. After the stricture was dilated by balloon dilator, he referred no complains. No crecurrence of the stenosis has occured five month after the procedure. The balloon dilatation technique may be worth trying before surgical treatment in treating ischemic colonic stricture.

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Torsion of the gallbllader is a rare disease which is difficult to diagnose preoperavility, because of its non-specific symptomes Most of patients with this disease are operated on with a diagnosis of acute cholecystitis, peritonitis or appendicitis.
Recently, owing to the development of modern imaging procedures, a few cases in the Japanese literatures were diagnosed preoperavility.
An 82-year-old man complaining of right hypochondriac pain was found to have remarkable abdominal tenderness and defense. Ultrasond examination demonstated a swollen gallbllader with thickened wall and a small amount of ascites. Subsequent computed tomography visualized the constriction at the gallbllader neck. We attempted percutaneous transhepatic cholecystography to obtain further information. The first puncture demonstrated the bird beak sign at the distal part of the constricted portion of the gallbllader. The cystic and common bile duct were visualizedby the second puncture at the proximal part of constriction. Operation was performed one day after the onset, with suspicion of torsion of the gallbllder because of the bird beak sign. At operation, the congestive and swollengallbllader was found to be twisted clockwise by 210° to 240° at the nwck. Pathological features of the resected gallbllader specimen were compatible with diagnosis of gallbllader torsion.
It is anticipated that percutaneous transhepatic cholecystography may yield an increasing number of accurately diagnosed cases of gallbllader torsion before operation. Because of the risks of complications from the puncture procedure, the surgeon should be prepared for prompt operation.

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A 66-year-old man with alcoholic liver cirrhosis was admitted to our hospital for endoscopic injection sclerotherapy (EIS) in December 1997. He was submitted to EIS using 1% aethoxysklerol. After two sessions of EIS, a hyperemic area with marginal irregularity was detected in the posterior wall, 33cm distal from his incisor. It was not stained by iodine, and was diagnosed as squamous cell carcinoma histologically in the biopsied specimen. Because endoscopic ultrasound sonograpy showed that the carcinoma located only in the epithelial layer, we perfoemed endoscopic mucosal resection using EEMR (endoscopic esophageal mucosal resection) -tube.
There have been 20 cases of esophageal carcinoma after EIS reported in Japan. But there was no case of esophageal carcinoma discovered by EIS.

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We report an 78-year-old man reffered toour department for the management of dysphagia. Endoscopy revealed the cardiac gastric carcinoma and a 7cm-long invasion towards the esophagus. The covered self expanding metalic stent (WALLSTENT^R, SCHINEIDER) was inserted.
On the next day, the stent migrated 3cm down. The patient could swallow diet smoothly. 4 days later we started tegafur・uracil 600mg/day therapy and 3 weeks later, cisplatin 75mg drip infusion added. A month later, tumor overgrowth hap-pened to the proximal uncovered part.
The second covered WALLSTENT was inserted at oral side and overlapped 7cm to the first stent. The secondstent was not migrated. 10 days later, the first stent was migrated down and collided to the stomach wall. We could not pull up the first stent by a baloon or forceps. 24 days later, both stents fell down to the stomach and connected with each other.
We put in an overtube through the 2-chnnneled fiberscope, hanged the stent by a forceps, snared it, and put the stent into the overtube. The connection between the two stents aparted when the stent was removed with the overtube.
A week later, the rest stent was removed by the same method. WALLSTENT can removeusing fiberscope. It is rare report that the removal of the WALLSTENT which was fallen into the stomach lumen using fiberscope.

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A 69-year-old woman who has suffered from loss of appetite, constipation and weight loss. She had an experience of dysentery 52 years ago and no history of tuberculosis. Chest X-p showed normal appearance. Barium enema examination showed a narrowing in the rectum and cord like lesions in the hepatic flexure. Total colonoscopy revealed diffuse and multiple ulcer scars and mucosal bridges between normal mucosa in the entire colon. Histological findings were almost normal. It was reported that endoscopic findings dysentery may vary from erythema to marked superficial ulcerations and rarely deep ulcers. In this case, it was suspected that multiple colonic ulcers of dysentery 52 years ago became multiple ulcer scars and mucosal bridges in the entire colon.

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