上部消化管検査における超広角電子内視鏡（XGIF-QW230）の有用性について検討した。今回使用した機器は，オリンパス社製GIF-Q230をもとに先端部のレンズの視野角を140度から170度に拡大したXGIF-QW230である。XGIF-QW230は，in vitroおよびin vivoの検討でGIF-Q230に比べ広い視野面積を確保できた。視野周辺部で像の歪みが生じたが，生体内では周辺部の歪みはほとんど観察の支障にならなかった。さらに，上十二指腸角や吻合部肛門側の観察がより容易であった。本機種は改良によりルーチン検査に十分使用可能であると考えられた。

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　硬化剤の血管外注入による内視鏡的食道静脈瘤硬化療法（EIS）は，壁の荒廃つまり線維組織への置換を目的としており，残存小血管への効果は二次的である。われわれは粘膜下組織の2mm程度の小血管を直接的作用により血栓化する方法が地固め治療として合理的と考え，レーザー照射法を検討した。しかし従来のレーザー照射では血管の完全血栓化は困難なため，半導体レーザー光の発振波長（805nm）に吸収極大をもつインドシアニングリーン（ICG）を静注しレーザーの効果を増強させる方法を考案した。成犬食道を用いた実験では，0.5mg/kgのICGを30秒で静注後に同量を15分で点滴投与しながら，出力25W，1回照射時間0.2秒の繰り返しパルス照射を行った。急性期には粘膜下層の線維成分の広範な融解壊死像が見られたが，固有筋層にはほぼ傷害がなかった。小血管の血栓化は明らかでなかったが，1週間後には粘膜下層は線維組織で完全に置換されていた。また静脈瘤患者4名に，EISや静脈瘤結紮術（EVL）で太い静脈瘤血管を処置後に上記の方法でレーザー照射した。1～2回の照射で残存小血管は消失し，5ヵ月後でも再発を認めていない。治療中の疼痛や出血穿孔等の合併症もなかった。本法では急性期の血栓化は証明しえなかったが，EISやEVLで大血管処置後の残存小血管に対する安全で効果的な治療法となる可能性が示唆された。今後はICG投与量増加等によりさらに効果的になると考える。

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　孤立性胃静脈瘤に対する治療法の選択には，門脈血行の把握が不可欠である。門脈血行の検索には，これまで主にarterioportography（AP）などが施行されてきたが，近年，より侵襲の少ないthree dimensional computed tomography（3D-CT）も施行されるようになってきた。そこで，今回，孤立性胃静脈瘤における胃腎静脈シャントを中心に，APと3D-CTの有用性について検討した。対象は孤立性胃静脈瘤併存肝硬変例7例で，孤立性胃静脈瘤単独例が3例で，食道静脈瘤併存胃静脈瘤症例は4例であった。その結果，孤立性胃静脈瘤単独例3例全例でAPおよび3D-CTにより，胃静脈瘤とともに胃腎静脈シャントが造影された。3D-CTでは3例全例で，これらのAPの所見に加えて，APでは判断しにくい下横隔静脈が明瞭に造影された。食道静脈瘤併存胃静脈瘤症例4例についてはAPでは4例全例で胃静脈瘤が造影されたが，胃腎静脈シャントの描出は2例であった。3D-CTでは全例，胃静脈瘤および胃腎静脈シャントが造影された。さらに，3D-CTでは食道静脈瘤併存胃静脈瘤症例4例全例で下横隔静脈も造影された。また，3D-CTでは7例全例でAPに比較して，胃腎静脈シャントの腎静脈との分岐部の角度，太さが明瞭に造影されていた。以上から，APは肝臓に関する有用性の高い診断法であるが，3D-CTでは胃腎静脈シャントの腎静脈との合流部を評価することに優れ，胃腎静脈シャントと下横隔静脈との位置関係をみるのに有用であると思われた。

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　著者らは，これまで体外式超音波検査を用いたwater sealed method（WS法）によって大腸の運動機能評価を試みてきた。その結果，WS法で観察可能であったのは盲腸から下行結腸までであるが，右結腸では蠕動収縮と腸内容の移動は一致していたが，横行結腸から下行結腸では必ずしも一致せず，蠕動収縮を伴わない腸内容の移動が観察された。よって右結腸は'能動的移送機能’を有しているものと考えられ，大腸運動機能を評価する上できわめて重要であり，今回右結腸の蠕動収縮の実態を解明するためにWS法と大腸鏡を用いて検討した。WS法での検討では，右結腸の積極的な蠕動収縮は盲腸から肝弯曲部に向かって生じ，半月ヒダの形成およびhaustraの緊張と盲腸の弛緩・拡張がこの蠕動収縮において重要な因子であることが判明した。一方，内視鏡検査による検討では，右結腸の蠕動収縮は半月ヒダによって分けられた細かい腸管のsegmentが，盲腸から肝弯曲部に向かって連続的に圧縮されていくことが観察された。すなわち，右結腸の蠕動収縮は蛇腹のように収縮するのであって，小腸のように'拡張した腸管の口側と肛側が収縮した状態の連続的な移動’のような収縮は全く観察されなかった。以上より右結腸の蠕動収縮では，①半月ヒダの形成が十分に生じる。②腸管壁が緊張しsegment内圧が保たれる。③盲腸から肝弯曲部に向かって連続的なsegmentの圧縮が生じる。の3因子が重要であると考えられた。

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　症例は56歳，男性。進行食道癌に対し1997年7月食道亜全摘，胃管再建術を施行された。その後，上縦隔および両鎖骨上窩に放射線を48Gy照射した。1998年4月多量の下血を主訴に来院した。内視鏡検査にて再建胃管の放射線照射部位に一致して，全周性のびらんと漏出性の出血を認めた。高周波凝固により一時的に止血されたが，その後再出血を繰り返したため，アルゴンプラズマ凝固法（Argon Plasma Coagulation : 以下APC）による焼灼を施行した。その後，患者が腹膜播種性癌再発で死亡するまでの2ヵ月間に再出血は起こらず，全周性の焼灼にもかかわらず治癒過程での瘢痕狭窄も来さなかった。APCは広い面積を短時間に浅く焼灼することが可能であり，本例のような広範囲にわたる漏出性消化管出血の内視鏡的止血法として非常に有用であると考えられた。

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　症例は71歳，男性。1992年から血小板減少を主訴に，他院で経過観察されていた。1998年1月に心窩部痛の精査にて内視鏡検査施行され，多発性胃潰瘍を認めH₂-ブロッカーの投与を開始。経過中，好酸球増多も指摘され，精査を目的として当院血液内科紹介入院。入院中，黒色便を認めたため当科にて内視鏡検査施行。多発性胃潰瘍からの出血を認め内視鏡的止血術を行いPPI投与したが，その後も同病変からの出血を繰り返した。本症例の便中に横川吸虫の虫卵を認め，当初これが好酸球増多の原因と考えたが，駆虫後も改善せず，精査の結果，特発性好酸球増加症候群（以下HES）と診断された。また，潰瘍辺縁からの生検組織にも好酸球浸潤を認めたため，HESに伴う潰瘍と考えステロイド治療を開始し，その後潰瘍は改善した。HESに伴う潰瘍の報告はまれであるが，今回われわれは内視鏡所見を中心に観察し得たので報告する。

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　患者は61歳，男性。生来健康であったが，平成10年11月，黄疸を指摘され当院へ紹介入院。黄疸・肝機能障害を認めたが，肝炎ウイルス抗体はすべて陰性，抗HIV抗体も陰性であった。入院時胸焼けを伴うため，上部消化管内視鏡検査を施行し，十二指腸球部から下行脚に多発性の活動性潰瘍を認めた。生検組織培養，¹³C-尿素呼気試験にて，Helicobacter pylori（H．pylori）は陰性であった。2ヵ月間抗潰瘍剤を投与するも縮小せず，生検組織中の核内封入体は認めなかったが，サイトメガロウイルス（CMV）-IgM高値，肝生検組織のPCRにてCMV-DNAを認めたため，CMV感染に起因する十二指腸潰瘍と診断した。抗CMV剤投与により，自他覚所見の速やかな改善と潰瘍の治癒化を認めた。本症例はH．pylori陰性，抗潰瘍剤に抵抗性の十二指腸潰瘍の場合，その原因としてCMV感染も考慮する必要があることを示唆するものである。

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　症例は58歳，男性。他院にて膵頭部腫瘍を疑われ，経鼻胆管ドレナージ（ENBD）を留置し，当科転院となる。前医での十二指腸乳頭部内視鏡所見は軽度の腫大のみであったが，19日後の内視鏡で発赤，腫大が著明となり大きく変化していた。諸精査にて十二指腸乳頭部癌と診断し，膵頭十二指腸切除術を施行した。摘出標本の割面像では腫瘍の主座は乳頭膨大部にあり，病理組織学的所見では共通管または乳頭部膵胆管発生の乳頭部癌と考えられた。乳頭部癌は膵頭部領域癌のなかでは比較的予後が期待される腫瘍であるが，これまでの報告によると，十二指腸粘膜から発生したものは浸潤傾向が少なく予後良好であるが，共通管，膵胆管発生のものは浸潤傾向が強く，予後不良と考えられている。本症例は後者のタイプのもので，このために短期間の内に内視鏡像が変化したものと考えられた。

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　症例は41歳，男性。29歳時発熱，関節痛，皮膚硬結，舌の潰瘍にて発症し，皮膚生検にて結節性多発性動脈炎（PN）と診断された。ステロイド内服治療開始2ヵ月後に，虫垂炎の診断で開腹した際に回腸末端炎を指摘された。術後，一時的にステロイドを増量したが，漸減後全身症状，腹部症状ともになく経過していた。平成10年1月腹痛，血便出現，大腸内視鏡で終末回腸に1/2周性の潰瘍があり，生検では慢性炎症性細胞浸潤と壊死物質のみで，PNによる潰瘍と診断，ステロイドのパルス療法とエンドキサンを点滴静注した。症状は軽快し退院したが，ステロイド減量中にふたたび血便と腹痛が出現し，内視鏡にて前回と同部位に潰瘍が再燃，ステロイドを増量し潰瘍は改善した。PNの回腸病変の報告は散見されるが，多くは手術や剖検により診断されており，内視鏡的に経過を追えた例はきわめて少なく，単純性潰瘍等の疾患との鑑別も重要なことから考察を加えて報告した。

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　症例は22歳，男性。平成10年11月，嚥下痛を主訴に来院。HIV陽性で免疫異常が認められたため入院となった。入院後出現した下痢の原因検索のため施行した大腸内視鏡検査で，回盲弁上に辺縁明瞭で発赤を伴う類円形潰瘍がみられた。同部位より得られた生検組織にサイトメガロウイルス（CMV）を認め，CMV腸炎と診断した。ガンシクロビル投与にて症状は軽減し，第84病日目に施行した内視鏡検査では回盲弁上にみられた潰瘍は瘢痕化していた。

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A 54-year-old man was admitted for endoscopic mucosal resection. The lesion was located on pylorus ring. Normal saline was injected from duodenum. We did this method by retroflexed endoscopy in duodenal bulb. Due to this method, the lesion was observed easily from stomach and we could perform endoscopic mucosal resection. There is no stenosis of the pylorus ring. This method is available for the lesion on the pylorus ring.

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We reported two patients who had sigmoid colon cancer that was performed endoscopic piecemeal mucosal resection (EPMR) under the retroverted observation. The first case was a 73-year-old man, who had sigmoid colon cancer (villous tumor, 40mm in diameter) . Under retroverted observation, Submucosal injection and partial resection was performed and in ordinary observation, complete resection was performed. Histopathological study revealed well differentiated tubular adenocarcinoma (mucosal cancer) . The second case was 79-year-old man, who had sigmoid colon cancer (nodule-aggregating lesion, 40mm in diameter) . Under retroverted observation, submucosal injection was performed and under ordinary observation, additional injection was performed. The lesion was well lifted after submucosal injection and complete resection was performed. Histopathological study revealed well differentiated tubular adenocarcinoma (mocosal cancer) . The submucosal injection under retroverted colonoscopic observation was useful for the resection of lesions over 30mm in diameter.

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Objects & Methods : We examined 17 patients suffering from peptic ulcers. We confirmed H. p. infection by culturing, microscopy and urease testing. 1) We graduated the degree of the inflammatory change and atrophic change of the gastric mucosa from the endoscopic findings. 2) We examined gastric mucosal flakes under microscopy, scoring the atrophic changes and inflammatory change, from biopsies at Sano's 4 points.
Results : 1) The degree of the inflammatory change of the gastric mucosa decreased after the treatment of H. p. infection from the endoscopic findings and the pathological view points. 2) The degree of the atrophic change of the gastric mucosa didn't change after the treatment from the endoscopic findings. 3) But the degree decreased from the pathological view points at the anal side of the stomach.
Discussion and Conclusion : We could evaluate the gastric mucosal inflammatory change from the endoscopic findings and the pathological view points. But we could evaluate the gastric mucosal atrophic change only from the pathological view points.

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It is thought that it is not easy to stop bleeding from severe portal hypertensive gastropathy (PHG) due to liver cirrhosis by conservative treatment et al. It has been already reported that PHG is pathologically the dilated vessels in gastric mucosa. Therefore, it is thought that partial splenic embolization (PSE) is one of useful treatment for bleeding from PHG because the pressure of the portal vein was decreased after PSE. This study is to determine the usefulness of PSE to stop the bleeding from PHG. From November 1997 to May 1999, five patients have hematoemesis and/or melena due to bleeding from severe PHG by panendoscope. Primary diseases in all patients were liver cirrhosis with Child C. It was to embolize 30%-50% of spleen by PSE. Four patients had severe hypersplenism and residual one did mild one by angiography et al. As a result, in four cases with severe hypersplenism, the bleeding was just stopped after PSE. In residual one with mild splenomegaly, bleeding was just stopped after PSE. However, two days after PSE, the patient was died due to hepatic coma. Therefore, it is thought that PSE is useful to stop the bleeding from PHG in the cases with severe splenomegaly.

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We examined 15 cases of primary duodenal cancer except ampullary cancer. Four cases of cancer in the bulb included 3 early cancers, and 11 cases of cancer in the 2nd portion included 2 early cancers. Histopathological examination showed 3 poorly, 1 moderately, and 11 well differentiated adenocarcinomas. Three cases of early elevated cancer in the bulb were performed endoscopic mucosal resection (EMR) , but 1 case was added surgical operation because of invasion into the submucosal layer. All patients of early cancer, except one patient died of another disease, are still alive. But 7 patients of advanced cancer died within two years after surgical operation. The early cancer of poorly differentiated adenocarcinoma formed IIa type with normal mucosa on the outside area.

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A 52-year-old man was admitted to our hospital because of exacerbation of the symptoms, such as limp and tremor. HTLV-1 associated myelopathy (HAM) , which it was six years since he was diagnosed. Then he started to take Predonisolone (PSL) 30-60 mg/day. After treatment by PSL, symptoms of HAM were gradually improving. But from 50th hospital day, epigastralgia, nausea and vomitting were appeared, following by bloody stool. An X-ray film of the abdomen showed the small bowel gas with the fluid level. Endoscopic examination revealed diffuse redness, erosion and swelling in the duodenal second portion and bulb, and circumferential redness and swelling of esophageal mucosa from pharyngoesophageal junction to esophagogastric mucosal junction (EG junction) , and with two or three linar erosion near EG junction. The biopsy specimen from the duodenum showed larvae of Strongyloides stercoralis, but not the esophagus. This case was thought that severe Strongyloidiasis with esophageal lesion was developed while giving steroid therapy for HAM.

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We observed the procedure of occurrence and healing of submucosal dissection of the esophagus with a giant gastric ulcer on the cardia with endoscopic and Roentogenogram examination. We reported 4cases adding other 3 cases which were treated in our department with some discussion based on literature.
A 64-year-old female visited our hospital complaining vomiting three times after meal, oppressive feeling at chest, and dysphagia, on Dec. 11.
Endoscopic examination at admission revealed hemorrhage and submucosal dissection of the esophagus from E-G junction up to middle portion. Acute gastric ulcer located on the cardia.
Submucosal dissection was seemed beginning to edge of the gastric ulcer.
We diagnosed submucosal dissection of the esophagus and started conservative treatment. Endoscopic examination at the 7th day of the treatment showed that submucosal dissection was in healing and that the gastric ulcer was into healing stage.
Submucosal dissection of the esophagus can be categorized into idiopathic and external case. In idiopathic cases, the increase of the pressure in esophagus by vomiting is considered as one of its causes.
The present case gave us the question to examine if submucosal dissection of the esophagus followed the gastric ulcer or if they occurred at the same time.

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This paper describes a case of granular cell tumor (GCT) of the esophagus, of which was endoscopically diagnosed and resected.
A 43-year-old with multiple GCTs In lower esophagus had been followed up for 7 years and was admitted to our hospital with earnest patient wish for tumor removal. Endoscopy revealed five GCTs with diameter of 7, 10, 20, 42, and 12mm respectively. Endoscopic biopsy showed S-100 positive tumor cell with characteristic eosinophilic granules, of which nuclei were small and moderately hyperchromatic. EUS represented that the tumors had no invasion to proper muscle layer, thus we adopted endoscopic treatment for GCT removal.
In literature views esophageal GCT is a relatively rare disease and so far a total of 170 patient were reported in Japan. The size of the tumor is mostly less than 30mm and only 2% of the tumors behave as malignant tumor. Our case had seven years follow-up period and seemed to have had the biggest tumor among the cases treated endoscopically.
Further observation would be required to avoid unfavorable regrowth and/or tumor relapse.

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Gastric carcinoma in the preceding stage of typical type4 gastric carcinoma was rare to encounter. In this case the main lesion was IIc-like advanced gastric carcinoma on the greater curvature of the antrum. Subtotal distal gastrectomy and D2 lymphnode dissection was done. Macroscopically the distance between the oral margin of the tumor and the surgical margin of the stomach was about 6.5cm and the surgical margin was thought to be free of carcinoma cells. But histologically carcinoma cells infiltrated scattered in the submucosal layer to the oral surgical margin. Lymphatic invasion of the carcinoma cells was not seen in the submucosal layer and fibrous change was very little. The exact detection of the oral spread of the carcinoma preoperatively had been impossible. This case was belonged type4 gastric carcinoma because the submucosal spread was very wide compared with the mucosal spread. And this case was thought to be in the preceding stage of typical type4 gastric carcinoma.

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We have reported that PhotoDynamicTherapy (PDT) on inoperable gastric cancer and unable case for endoscopic mucosal resection (EMR) . On this report, we handle such case for using PDT and Nd-YAG Laser.
A 69-year-old woman, had Type IIc gastric cancer with poorly differentiated adenocarcinoma cells. She had also trouble with severe respiratory dysfunction that impossible to recieved routine upper gastric endoscopy examination. Endoscopic ultrasonography examination implied invasion of submucosal layer. We decided to make gastric fistula, so that she could endure long term endoscopic procedure.
We made fistula in middle body of anterior wall by using endoscopy. Fifty hours after intravenous injection of PHE (Porfimer sodium) , we performed Excimer Dye Laser (EDL-1) . One week after PDT, histological biopsy specimen showed residual cancer cells. We performed Nd-YAG Laser as additional therapy on that lesion. After 4 months of laser therapy, histological biopsy specimen was not revealed carcinoma cells. It was considered that inoperable case, or unsuitable case for EMR, endoscopic laser therapy will show the efficacy for local cure.

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We treated a case of giant gastric polyp using a new resection technique-one port intragastric endoscopic surgery. A 84-year-old male was admitted to our department suffering from anemia. Gastric fiberscopy and an upper GI series revealed a giant adenomatous polyp in the distal region of the stomach. The lesion was 40 mm in diameter, with a stalk of 20 mm. We determined that it would be difficult to remove by conservative endoscopic procedures because of the thick stalk. The surgery was performed under general anesthesia, in the supine position. A panendoscope with 2 channels was inserted through the mouth. First, the anterior gastric wall was fixed to the abdominal wall using Funada fixing equipment. A 12-mm trocar was then inserted into the stomach to the left upper quadrant of the abdomen, after observation. The tumor was pulled by snare wire through the endoscope and resected with a 45 mm linear stapler that was inserted through the trocar. No bleeding or leakage were observed. The puncture wound in the stomach was closed with endoscopic clips. The abdominal wound was closed by hand, and the procedure was completed without difficulty. The postoperative course was uneventful, and the patient was discharged from hospital on the 7th postoperative day, after gastric fiberscopy observation.

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A 63-year-old female with rheumatoid arthritis complaining of anemia was admitted to our hospital. Peripheral blood examination on admission showed pancytopenia and macrocytic normochromic anemia. Blood chemistry examination demonstrated that high level of gastrin, autoanitibody to parietal cells and intrinsic factor, and low level of Vitamin B₁₂. Pernicious anemia was observed on the bone marrow aspiration material. Endoscopic examination showed only an atrophic gastritis, however metachromasia was not demonstrated by means of Congo-red test. And 24 hour pH monitoring of gastric secretion also revealed continuous prominent low level of its acidity. These findings indicated that this case was a rare type A gastritis with Rheumatoid Arthritis.

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We experienced a case of perforation of the remnant stomach due to naso-gastric tube was treated by PEG.
A 73-year-old male, being operated for gastric cancer, had high fever on the 7th post operative day. The contaminated fluid was drainaged from the abdominal cavity. Free perforation of anterior wall of the remnant stomach was observed by Gastrofiberscopy on the 34th post operative day. We preferred to treat it conservatively but condition of the patient was deteriorated gradually.
A balloon catheter was inserted through cutaneous and perforated lesion of gastric wall using the method of PEG on the 36th post operative day. The patient began to recover remarkably. The balloon catheter was removed on 20th day after PEG and the fistule was completely closed in 19 days. The patient was discharged at 84th post operative day.
We reported our experience of the perforation of the remnant stomach treated by PEG successfully.

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A 66-year-old woman was admitted to our hospital because of dyspnea. She was undergone the tumorectomy in her left mandibular malignant melanoma five years ago. Her laboratory data indicated anemia and inflammation. Her dyspnea was considered due to bronchitis and was improved by administration of antibiotics. The endoscopic examination showed a blackish elevated lesion with central depression in the anterior wall of bulbus and pathological findings indicated the invasion of malignant melanoma cells. Multiple metastasis in bilateral adrenal grands, liver, small intestine, and brain were finally discovered, and the combination therapy using IFN-β and DAV (DAV-Feron) was performed. The endoscopic examination after three regimens showed decrease of duodenal lesion and clearance of pigmentation. And CT-scan revealed disappearance of liver metastasis and reduction of bilateral adrenal metastasis. We report have a case of multiple melanoma metastasis successfully treated with chemotherapy.

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This paper represents a 40-year-old UC case, of which lesion was un-favorably reactivated after proctopexy. She was diagnosed as UC (total colitis type) in 1984 and had been medicated with by prednisolone (PSL) and salazosalfapyridine (SASP) . Ever since medication was quitted in 1988, she had been in remission stage successfully. There had been neither clinical symptoms nor colonoscopical finding which would suggest relapsing. In July 1998, she was performed proctopexy for proctoptosis under spinal anesthesia. Although only negligible erosions were seem in rectal mucosa during the surgery, severe low abdominal pain and bloody diarrhea (4-5 times/day) happened to appear two days after the surgery (Day2) . Diclofenac sodium suppository had been used as antipyresis and analgesic for four days (Day 6-9) . Sigmoidscopy was performed at 10 days after proctopexy. It was observed that diffuse mucosal edema and erosions in the rectum and sigmoid colon, diagnosed as severe UC. Furthermore, longitudinal mucosal redness and round-like ulcers in the sigmoid colon were also observed. Immediately PSL (50mg/day) and antibiotics were administered by bolus drip infusion for one hour under fasting and hyperalimentation control and the symptoms had disappeared mostly within a week. This onset might result from surgical procedures and/or NSAID suppository.

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　従来，大腸リンパ管腫は希有な疾患とされてきたが，最近では内視鏡検査の普及に伴って一般の医療現場でも発見される機会が増えてきた。自験例は40歳の女性で，注腸造影検査にて，横行結腸に隆起性病変を認めた。大腸内視鏡検査上，cushion sign陽性の粘膜下腫瘍を認め，内視鏡的にスネアを用いて完全切除が可能であった。切除腫瘤は20×18mm大で，病理組織学的に嚢胞性リンパ管腫と診断された。本症例を含めた本邦報告234例について検討したところ，発症年齢は1～83歳（平均 : 55.1±14.1歳）で比較的高齢者に発見される傾向があり，男女比は131 : 85と男性の発症が多い。病変部位は大腸のどこからも発生するが，横行結腸と上行結腸に比較的多い傾向がみられる。本症に悪性化の報告はないが，急激増大例や腸重積，イレウス，大量出血などの報告もあり，放置すべきではなく，内視鏡的治療のよい適応と考える。

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A 25-year-old twin male patients have had polyposis coli over 100 polyps in the total colon. His elder brother died with multiple metastases from descending colon cancer. Therefore, he received a laparoscopic assisted total colectomy with ileoanostomy. Histopathological examination showed that all polyps except one were tubular adenomas. However, one of them showed intramucosal cancer with adenoma. They have no family history of polyposis coli or colorectal cancer. Reports about the polyposis coli in twins are very rare in Japan.

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A 44-year-old woman was admitted to our hospital because of bright bleeding per anus. After colonoscopy, it was suggested that the cause of bleeding was due to autoamputation of semipedunculated polyp in the transverse colon. Initially, endoscopic clipping was performed to prevent re-bleeding. Laparoscopic partial resection was performed because the pathological diagnosis of the biopsy specimen taken from the lesion suggested highly carcinoma. The residual lesion was well differentiated adenocarcinoma limited in the mucosal layer.

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A 61-year-old man had three pedunculated sigmoid colon polyps resected endoscopically. Since all of the polyps were markedly reddish and moderately large, about 2 cm in diameter, detachable hemostatic snares were used to prevent postpolypectomy bleeding. His condition was stable until 6 days after the polypectomy, when a massive bloody stool defecated suddenly. An emergency colonoscopic examination showed hemorrhagic ulcers at the sites ligated by the detachable hemostatic snares. The hemorrhage ceased spontaneously without special treatment. This is thought to be the first case report showing the possibility of hemorrhaging from the ulcer at the site of ligation taking place after the natural detachment of the hemostatic snare.

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A 45-year-old man with pancreatic tumor, which incidentally found by abdominal ultrasonography on health checkup, was admitted to our hospital. The tumor measuring about 1.0cm in diameter was found in tail of pancreas by computed tomography, and its ring-enhancement was observed in contrasted CT. Endoscopic ultrasound showed an iso-low echoic mass in the taii of pancreas. Surgical operation was performed subsequently. Pathological examination revealed that the inside of cyst wall was lined with squamous epithelium, and lymphoid tissue, siderophore, and cicatrices were seen in surrounding area. Thus it was diagnosed as a lympoepithelial cyst of the pancreas. Lymphoepitherial cyst of the pancreas is rare lesion, which has reported about 30 cases to date since it was first recognized in 1985. We reported a case of lymphoepitherial cyst of the pancreas and discussed it and 29 cases in the literature.

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A 21-year-old female patient was admitted to Kyorin University Hospital with general fatigue. She had a slight elevation of serum transaminase levels and total gamma globulins, and was positive of antinuclear antibodies. Her clinical characteristics had 16 points of AIH scoring system reported by International autoimmune hepatitis group. Laparoscopic findings showed a gentle undulation and multiple reddish markings at the liver surface. There were interface hepatitis with portal expansion, fibrosis, and lymphocytic infiltration by histological examination. She was treated with corticosteroid (30mg/day prednisolone was given initially, then tapered down the dosage) , and serum transaminase levels were normalized. This case had mild liver dysfunction, but laparoscopic findings were severe. It was concluded that laparoscopic examination was useful to have correct data of diagnosis in this case.

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