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After endoscopic treatment for esophageal cancer, a 65-year-old male underwent surveillance esophagogastroduodenoscopy. A 12-mm discolored flat lesion was noted on the greater curvature of the middle gastric body. Magnifying endoscopy with blue laser imaging demonstrated an irregular papillary surface. Biopsy revealed atypical cells with mucus and irregularly distributed nuclei. The lesion was diagnosed as a gastric-type neoplasm with low atypia. Thereafter, endoscopic submucosal dissection (ESD) was conducted and specimen was sent for biopsy. The ESD specimen suggested a signet-ring cell carcinoma with MUC5AC-positive phenotype and adenocarcinoma of the fundic gland type, with MUC6 positivity and pepsinogen I positivity in the shallow and deeper layers, respectively. Moreover, the cervical region of fundic glands demonstrated a transformation zone of the signet-ring cell carcinoma into an adenocarcinoma of the fundic gland type. Herein, we report this rare case along with a literature review.

A 16-year-old woman identified with colonic distention using chest X-rays visited our hospital. Although abdominal computed tomography (CT), colonoscopy, and barium enema study indicated suspected duplication of the sigmoid colon, the exact portion of communication between the normal colon and the duplicated colon could not be determined. The patient was released, but followed up due to the lack of symptoms. After 7 months, she was urgently re-hospitalized due to the complaint of abdominal pain. Her abdominal CT revealed the wall thickness and distention of the duplication as well as voluminous stool containing barium. After the improvement of her symptoms and on the basis of the inflammatory findings, laparoscopic surgery was performed on the patient. Finally, the lesion was diagnosed as tubular- and continuous-type colonic duplication. Duplication of the colon is a relatively rare occurrence in adulthood. Herein, we report a case of duplication of the sigmoid colon diagnosed prior to surgery in an adult.

Recently, the Japanese Society of Gastroenterology (JSGE) developed an evidence-based clinical guideline for functional dyspepsia (FD). Multiple factors (including disturbance of gastric motility and hypersensitivity) may be associated with the pathophysiology of FD. Among these, acid plays a crucial role in the pathogenesis of FD. The presence of gastric acid affects gastric motility and sensitivity. Additionally, duodenal acidification induces proximal gastric relaxation and hypersensitivity to gastric distension. Systematic review showed that proton pump inhibitors (PPIs) and histamine type -2 receptor antagonists (H2RAs) are effective for the treatment of FD as the first line therapy, and both provide same level efficacy.

A woman in her 70s with fever and abdominal distension was referred to our hospital for investigation. She had just finished a course of pegylated interferon and ribavirin combination therapy for chronic hepatitis C. Abdominal computed tomography revealed peritoneal thickening and ascites. QuantiFERON(®)-TB Gold was positive, ascitic adenosine deaminase was high, and fluorine-18-fluorodeoxyglucose positron emission tomography (FDG-PET) showed diffuse accumulation in the peritoneum. Although these findings suggested tuberculous peritonitis, we did not detect Mycobacterium tuberculosis in any bacterial cultures, ascites, or other specimens. However, laparoscopic peritoneal biopsy demonstrated a large number of miliary white nodules in the parietal and visceral peritonea. Pathological examination of these nodules revealed epidermoid granuloma with giant Langhans' cells and caseous necrosis. Finally, the diagnosed of tuberculous peritonitis was established. It is important to consider tuberculosis in patients presenting with new symptoms while receiving interferon therapy.

We report a case of pancreatic pseudocyst associated with pancreatic cancer that was successfully treated with endoscopic pseudocyst drainage, which allowed continuation of chemotherapy. A 74-year-old woman complaining of jaundice was diagnosed with locally advanced cancer in the head of the pancreas, and she underwent chemotherapy with gemcitabine. One month later, she was admitted to our hospital for severe epigastralgia, and she diagnosed with a pancreatic pseudocyst that was 14 cm in diameter. Endoscopic ultrasonography-guided pseudocyst drainage was successfully performed. The amylase concentration of pseudocyst fluid was 13,320 U/L, and bacterial culture was negative. The epigastralgia soon resolved, but 1 week later, the size of the pseudocyst was 12 cm in diameter. Endoscopic retrograde pancreatography revealed communication of the pancreatic duct with the pseudocyst. A pancreatic stent was placed. The patient again underwent chemotherapy for 3 months, without major complications. The pseudocyst was no longer visible 3 months after stent placement. The patient died of pancreatic cancer with peritonitis carcinomatosa, 6 months after the initial diagnosis.

We report a case of ultrasound-guided infraorbital nerve block with a hockey stick typed probe in plane approach. Individual difference of infraorbital anatomy makes it difficult to puncture the infraorbital for a man, and the risks include bleeding, double vision and paranasal sinus puncture. The advantage of ultrasound-guided nerve block has been reported. Compared with conventional land mark method approach, ultrasound technique is thought to be easy to perform, more quickly and safely without any complications. From our results, we have demonstrated that ultrasound-guided infraorbital nerve block assisted by hockey stick typed probe could become one of the safe methods for this purpose.

To date, there are many studies on the association between Helicobacter pylori (H. pylori) infection and gastroesophageal reflux disease. Here we reviewed the relationship between H. pylori status and the development of reflux esophagitis (RE) or Barrett's esophagus (BE). According to many case-controlled studies, H. pylori infection may play a protective role in the development of RE. However, the frequency of RE development does not increase following successful H. pylori treatment based on the previous studies including meta-analysis and systematic review. Even though RE newly develops after H. pylori eradication, endoscopic findings reveal mild such as grade A or B according to the Los Angeles Classification System. With regard to BE, there is an inverse significant relationship. Since there are few studies indicating that BE increases after treatment of H. pylori, the eradication should be recommended for patients with H. pylori infection irrespective of the presence of RE or BE even in terms of the prevention of gastric cancer.

The prognosis for pancreatic cancer with distant metastasis is not good. The case reported here concerns a pancreatic body cancer with multiple liver metastases for which multidisciplinary therapy of S-1+gemcitabine(GEM)therapy, surgery, and radiofrequency ablation proved to be effective, resulting in complete remission. The patient was a 77-year-old female. She was asymptomatic and diagnosed with pancreatic body cancer with multiple liver metastasis at the end of December 2008 by ultrasonography. After careful examination, GEM 1, 200mg/body was administered on days 1 and 15, and S-1 was administered orally at 80mg/day for two weeks, followed by two weeks of rest. By the end of the 15th course, the size of the tumor had reduced from 26. 5mm to 14. 4mm, and all but one of the liver lesions disappeared; the remaining one lesion was measured as 14. 5mm by ultrasonography. We performed pancreas body and tail resection and radiofrequency therapy for the remaining single liver metastasis. After operation, GEM was administered once a month for 4 months. S-1 was not administered, but a new lesion was revealed at the S8 area by ultrasonography. We restarted S-1+GEM therapy and in 5 months the new lesion disappeared from image examinations. She is alive and in complete remission 16 months after the operation.

We report five-metallic stent placement cases for malignant duodenal stenosis. Two of them received a placement of Ultraflex by over-the-wire (OTW) procedure, and the other three received a placement of WallFlex by through-the-scope (TTS) procedure. We assessed the baseline characteristic of the patient, procedural time and food intake after the stent placement for both OTW and TIS groups. OTW GROUP CASE 1: A 93-year-old woman with cancer of the ampulla of Vater, 60 min. in procedure time and low-residue diet after stent replacement. OTW GROUP CASE 2: A 76-year-old man with pancreatic cancer, 90 min. in procedure time and low-residue diet after stent replacement. TTS GROUP CASE 1: A 56-year-old man with recurrent postoperative bile duct cancer and gallbladder cancer, 16 min. in procedure time and full diet after stent replacement. TTS group case 2: A 79-year-old woman with pancreatic cancer, 40 min. in procedure time and liquids only after stent placement. TTS GROUP CASE 3: A 64-year-old woman with pancreatic cancer, 17 min. in procedure time and liquids only after stent placement. In comparison with OTW, TTS placement was much easier and it took a shorter procedural time. However, we consider that a selection of suitable stents and an assessment of the location for good food intake after stent placement are more important.

Therapeutics targeting disease-sensitive genes are required for the therapy of multifactorial diseases. There is no clinical report on therapeutics for allergic disease-sensitive genes. We are focusing on the histamine H₁ receptor (H1R) as a sensitive gene. H1R mediates allergy histamine signals. H1R is a rate-limiting molecule of the H1R signal because the signal is increased with elevated receptor expression level. We discovered that the stimulation of H1R induced H1R gene expression through PKCδ activation, resulting in receptor upregulation. The mechanism of H1R gene expression was revealed to play a key role in the receptor expression level in studies using cultured HeLa cells and allergic rhinitis model rats. Preseasonal prophylactic treatment with antihistamines is recommended for the therapy of pollinosis. However, the mechanism of the therapy remains to be elucidated. We demonstrated that repeated pretreatment treatment with antihistamines in the allergic rhinitis model rats resulted not only in improvement of symptoms but also in suppressed elevation of H1R mRNA levels in the nasal mucosa. A clinical trial was then initiated. When symptoms and H1R mRNA levels in the nasal mucosa of pollinosis patients with or without preseasonal prophylactic treatment with antihistamines were examined, both symptoms and high levels of H1R mRNA were significantly improved in treated compared with untreated patients. These results strongly suggest that H1R is an allergic disease-sensitive gene.

Objective: The prognosis for pancreatic cancer with distant metastases is not good. The case reported here is of pancreatic body cancer with multiple liver metastasis in which S-1+gemcitabine (GEM) therapy proved to be effective., Case: A 77-year old female. She was asymptomatic and diagnosed as a pancreatic body cancer with multiple liver metastases at the end of December 2008 by periodical ultrasonography. After careful examination, GEM 1,200mg/body was administered on days 1 and 15, and S-1 was administered orally at 80mg/day for two weeks, followed by two weeks rest. Currently, at the end of the 10th course, tumor size has been reduced from 26.5mm to 18.9 mm, and two of the five liver metastatic lesions have disappeared, while the remaining three liver lesions have been revealed as scars by CT examination. Tumor marker levels have been remarkably decreased. Ten months from the initial diagnosis, there has been no side effect and chemotherapy is being continued., Conclusion: In pancreatic cancer with distant metastases, S-1+GEM therapy may be able to provide a long-term prognosis.

Functional dyspepsia (FD) is a condition with multifactorial pathogenesis, which includes dysmotility, increase of acid secretion, visceral hypersensitivity, psychological factors, H. pylori infection, genetic alteration, and/or inflammation. FD is common condition also in Japan, and the patients are usually managed as chronic gastritis for the sake of health insurance regulation in primary care setting. Presence of dyspeptic symptoms should be clearly discriminated from histologically defined chronic gastritis. Acid inhibition drugs and use of prokinetics are regarded as two major candidate drugs, yet only limited efficacy of these medicines has been reported by placebo-controlled trials. Although usefulness of other drug options, such as H. pylori eradication, psychotropic drugs, and/or herbal medicine has been reported, more evidence and validation studies for their efficacy are necessary.

The simplified international diagnostic criteria for autoimmune hepatitis (AIH), re-revised by the International AIH Group in 2008, were investigated in 114 patients with AIH from 15 centers in Japan. While applying of the criteria, we had to pay attention to anti-nuclear antibody measurement methods, and liver histology scoring. Definite and probable AIH were diagnosed in 83 and 22 patients, respectively. The criteria were found to be useful for the diagnosis of AIH in Japan. However, 9 patients who did not meet the diagnostic criteria showed normal immunoglobulin G levels or were negative for autoantibodies. As the criteria were unreliable for diagnosing such atypical cases in the present series, we speculated that we should not rely solely on these, criteria and take a more holistic approach to diagnosis in such cases.

Recent studies have shown that RAAS plays a pivotal role in the progression of chronic liver diseases, i.e., liver fibrosis and hepatocellular carcinoma (HCC). Many studies have demonstrated that the clinically used angiotensin-converting enzyme inhibitor (ACE I), and AT1-R blockers (ARB) significantly attenuated the liver fibrosis development and HCC. The combined treatment of ACE-I with other clinically used agents, such as interferon, imatinib mesylate, and vitamin K shows more potent inhibitory effects on the development of liver fibrosis and HCC. Since RAAS inhibitors are widely used in the clinical practice without serious side effects, they may represent a potential new therapeutic strategy against the progression of chronic liver diseases.

A 54-year-old man had been admitted to Nara city hospital because of hematemesis and dyspnea caused by physical exertion, and was given a diagnosis of esophago-cardial varices and portal venous thrombosis. He was transferred to our hospital for further examinations and treatments. Ultrasonography (US) and computed tomography (CT) revealed the progression of portal venous thrombosis. Danaparoid sodium was administered to treat the portal vein thrombus. 5 days later, the patient was found to have hematemesis resulting from a cardial varices rupture. After endoscopic variceal ligation (EVL) and endoscopic injection sclerotherapy (EIS) was performed, danaparoid sodium was administered for 2 weeks. After the treatment, portal vein thrombus had almost disappeared. Due to an increased risk of bleeding, cases of esophago-cardial varices with portal venous thrombosis must be treated with care. This is the first report of upper gastrointestinal bleeding due to danaparoid sodium. Danaparoid sodium must be carefully administered when patients have portal venous thrombosis with delicate varices.

When a 32-year-old man was 18 a traffic accident caused splenic rupture, for which he underwent splenectomy, complicated postoperatively by hepatitis. As part of routine follow-up with his family doctor for chronic hepatitis C, a hepatic tumor was detected on plain abdominal computed tomography (CT), and he was admitted to our hospital for further investigation and treatment. Based on the results of abdominal dynamic CT, abdominal magnetic resonance imaging(MRI), abdominal angiography, CT during hepatic arteriography (CTHA) and CT during arterial portography (CTAP), we performed a laparotomy for suspected hepatocellular carcinoma. The operative findings were a 40 mm dark purple-brown nodule on the surface of the S7 segment of the liver, as well as multiple nodules, less than 20 mm in size but otherwise of similar appearance, scattered over the abdominal viscera and peritoneum, in particular the greater omentum. A hepatectomy was not performed, as we considered this to be a case of intrahepatic splenosis, so the abdomen was closed after a liver biopsy was taken. Histopathological examination of this specimen confirmed the diagnosis. As there have been only 19 previous reported cases of intrahepatic splenosis, we hereby present this valuable case with a review of the literature.

Histamine H(1) receptors are down-regulated as one step in receptor desensitization. Five phosphorylation sites of the H(1) receptor seem to play a key role in receptor down-regulation. In contrast, an increase in the H(1) receptor expression level following its mRNA elevation was found in the nasal mucosa in hypersensitivity model rats. Up-regulation of the H(1) receptor was induced by the direct stimulation of the H(1) receptor. H(1) receptor up-regulation was suppressed by pretreatment with antiallergic agents.

A 23-year-old woman had lower abdominal pain, diarrhea and bloody stool was admitted and given a diagnosis of influenza B. Her home doctor had started treatment by neuraminidase inhibitor (oseltamivir) the previous day. Colonoscopic examination revealed an area of hemorrhage and erosion in the left transverse colon. After halting oseltamivir treatment these symptoms disappeared and her colonoscopic findings improved. A drug-induced lymphocyte stimulation test was positive for oseltamivir. This case is the first reported case of acute hemorrhagic colitis induced by oseltamivir.

When tissues are injured and bleeding occurs, blood clotting is immediately activated and fibrin clots are formed by thrombin. Afterwards, antithrombin III promptly inactivates thrombin, which restricts the clotting to the bleeding site. In inflamed sites, tissue factor is expressed on cells in the lesion by stimulation from cytokines, and produces thrombin. In this case, thrombin may survive longer because of inefficient inactivation by antithrombin III due to dilution and less perturbation in the interstitial fluid, and therefore, has a greater chance to activate thrombin receptors (protease-activated receptors: PARs) on the cells, which induces various cellular events including proliferation, migration, and shape change. Recent studies have suggested a pathophysiological association of the PAR pathway with crescentic glomerulonephritis. However, the role of thrombin in human diseases has not been fully studied, probably because of a lack of simple and reliable methods for measuring thrombin in clinical samples. To solve this problem, we developed an ELISA system for human alpha-thrombin and applied it to the measurement of thrombin in the urine of patients with glomerulonephritis. Thrombin in urine was detected in glomerulonephritic patients but not in healthy volunteers or disseminated intravascular coagulation patients, which suggests that thrombin in urine may reflect thrombin generation by clotting activation in the glomerular lesion.

A 65-year-old woman was referred to our hospital because of cough and sputum. Chest CT scan revealed a coin lesion (about 1.5 cm diameter) with slight speculation at the right upper lobe. We suspected a lung cancer and performed video assisted thoracic surgery (VATS). Under the thoracoscopy, the tumor was completely extirpated with safety margin by the partial resection of the right upper lobe. Pathological findings definitely revealed inflammatory pseudotumor, fibrohistiocytic variant type. VATS is a good indication for the diagnosis and treatment of inflammatory pseudotumor. This case was reported together with some reviews of the literature.

We report a 74-year-old woman with malignant fibrous histiocytoma (MFH), treated successfully by radiation and followed with chest wall resection and reconstruction. The patient suffered from right back pain and her chest X-ray showed a clear round shadow in the middle field of the right lung. Chest computed tomography (CT) showed a 5 x 5 cm tumor in diameter, involving the right 8 rib with destructive changes. After radiation therapy of total 30 Gy to the tumor to obtain the safety surgical margin, we widely resected 10 x 9 cm chest wall with 3 ribs in area under thoracoscopy and performed reconstruction using GORE-TEX Soft Tissue Patch. The pathological and immuno-histochemical diagnosis showed pleomorphic type of MFH. Final result of the tumor negative in surgical margin manifested that our technique of chest wall resection and reconstruction using thoracoscope after the irradiation to the tumor was very safe and useful.

A 61-year-old female was admitted with abnormal shadow on chest X-ray. Chest computed tomography (CT) showed a clearly localized flat tumor at the peripheral region of the left lung. We suspected localized fibrous tumor of the pleura (LFTP) and performed video-assisted thoracic surgery (VATS). Under the thoracoscopy, the tumor was connected to the visceral pleura with a short pedicle and completely resected with safety margin. Pathological findings, including immunohistochemical examination, definitely revealed benign LFTP. VATS is a good indication for the diagnosis and treatment of LFTP. This case was reported together with some reviews of the literature.

The functional study on NF-kB bindings sites in transcription-regulatory region of rat inducible type nitric oxide synthase (iNOS) has been carried out by reporter assay to learn the signaling mechanisms of actions of interleukin-1 (IL-1). By progressive excision of 5'-ends of the insert and introduction of mutagenesis of each NF-kB binding site, it has been shown that 3 kB sites are essential for IL-1-induced signaling pathway in a mutually dependent manner.

The use of CT has increased rapidly in the past two decades, in part because of the development of helical CT and multidetector row CT. The benefits obtained by CT are not, however, without risks. This paper emphasizes the importance of keeping radiation doses during CT procedures as low as reasonably possible, especially for pediatric and small adult patients. In order to evaluate the risk of exposure, precise dosimetry is important. This paper introduces a new film dosimetry system that can be used easily in any institution and with any CT apparatus.

In this study, we elucidated the efficacy of our prophylactic method for wound infection in pull-percutaneous endoscopic gastrostomy (PEG). The total 29 patients received the pull-PEG. The first 8 patients received the oral sterilization with povidone iodine and antibiotics at the time of pull-PEG (Group-I). The frequency of wound infection in this group was 50.0% (4/8). It was revealed that all infections were induced by methicillin resistant staphylococcus aureus (MRSA). 3 patients were MRSA positive in the throat. In Group-II, we eradicated MRSA in the throat before the pull-PEG by combination mupirocin calcium hydrate with the Group-I treatment. In contrast in Group-I, the frequency of wound infection was significantly reduced in Group-II (4.8%: 1/21). The results showed that our eradication method was very useful for prevention of the wound infection in pull-PEG treatment.

We investigated six cases of inoperable remnant and recurrent gastric cancer treated with radiotherapy with regard to quality of life (QOL). The radiation dose was from 22 to 70 Gy, with a mean dose of 46 +/- 18 Gy. Four cases could be evaluated. Two were PR and two were NC. No patients could ingest food before radiotherapy, but two became able to eat whole gruel, one half gruel and three water. The mean survival time was 5.5 months and prognosis was not improved. Subjective symptoms such as food passage disturbance were decreased by radiotherapy and QOL was improved. Radiotherapy for patients with inoperable gastric cancer seemed to be effective in improving QOL.

As a part of studies to clarify the efficacy mechanism of carmofur (HCFU), a 5-FU analog, the degree of cross-resistance to HCFU of cell lines of cultured human colon cancer DLD-1 and a stomach cancer NUGC-3, both of which had acquired resistance to 5-FU, was studied in vitro and in vivo. In vitro, both resistant cell lines showed no or little cross-resistance to HCFU under a short-term drug exposure, and very low cross-resistance to HCFU, as compared to resistance to 5-FU, under a long-term drug exposure. In therapeutic experiments using nude mice bearing parent or subcutaneously transplanted 5-FU-resistant DLD-1 cells, HCFU exerted almost the same growth-inhibitory effects on both tumors. These results suggest that HCFU itself may have its own anti-tumor mechanism, different from that of 5-FU.

Protein kinase C (PKC) family, is now classified into three groups; conventional (cPKC), novel (nPKC) and atypical (aPKC), and to date, 10 members of isozymes have been identified. We have suggested that PKC is essential to interleukin-1 (IL-1)-triggered expression of inducible NO synthase (iNOS), and that by pharmacological analysis, cPKC is not involved in iNOS induction in rat vascular smooth muscle cells (VSMC). In the present study, we identified some PKC isozymes and investigated the effect of PKC alpha knockdown by antisense oligodeoxynucleotide (AS-ODN) strategy on iNOS expression and nuclear translocation of NF-kappa B in RASMC. Western blot analysis revealed the presence of cPKC (alpha), nPKCs (delta and epsilon) and aPKCs (tau and lambda). Short-time (10-20 min) treatment with phorbol 12-myristate 13-acetate (PMA) induced translocation of PKC alpha from cytosolic to particulate fraction. PKC alpha was completely downregulated by treatment with 100 nM PMA for 24 hours. Treatment with AS-ODN against PKC alpha mRNA depleted PKC alpha specifically, and had no detectable effect on the other PKCs. The production of iNOS mRNA, but not nuclear translocation of NF-kappa B, stimulated by IL-1 beta was decreased by PKC alpha knockdown. These results suggest that there are 5 PKC isozymes in RASMC, and that PKC alpha is involved in iNOS expression triggered by IL-1 beta, supporting our previous pharmacological conclusion.

Five amino acid residues of the human histamine H1 receptor that participate in histamine binding were identified using mutant H1 receptors by site-directed mutagenesis and 3D computer modeling of the receptor. The computer modeling provided two conformations of the receptor, non-active and active forms, and it was hypothesized that the binding of histamine to the receptor leads to the active state through the rewinding of the alpha-helix of TM-V. The binding sites of histamine were divided into two groups, one determined the ligand affinity and the other directly participated in the conformational change of the receptor, and the H1 antagonists bound only to the former. The mode of binding of histamine to the H1 receptor was different from those of catecholamine to the beta-receptor and of histamine to the H2 receptor.

Purpose: To elucidate MRCP diagnostic usefulness compared to ERCP., Patients, Methods: 29 MRCP performed patients diagnosed by ERCP were studied., Results: MRCP showed 92%, 67% sensitivity and 73%, 100% specificity in choledocholithiasis (CBD) and cholecystolithiasis (GB), respectively. MRCP revealed 4.0 false positive and 1.5 false negative in CBD and GB, respectively. MRCP could detect 22 stones out of 33 in CBD and 13 out of 42 in GB. As for the maximal diameter, MRCP depicted 31% for less than 5 mm and 100% for over 6 mm in CBD. In GB, 7% for less than 5 mm, 83% for 6-10 mm and 100% for over 11 mm., Conclusion: Although the depection of tiny stone is limited, MRCP is a useful diagnostic tool for cholelithiasis, especially choledocholithiasis.

We retrospectively reviewed magnetic resonance cholangiopancreatography (MRCP) of 25 patients with acute cholecystitis based on clinical, sonographic and surgical findings. Intramural high signal intensity on MRCP was demonstrated in 22 of the 25 patients (88%), and pericholedochal high signal intensity was observed in 6 of the 25 patients (24%). Pericholecystic or perihepatic fluid was demonstrated in 6 of the 25 patients (24%). Gallbladder stones were identified in all 21 patients (100%) by sonography, in 19 of the 21 (90%) by MRCP and in 11 of 18 patients by CT (CT was not performed in other 3 patients). Common bile duct calculi were detected in all 6 patients (100%) by MRCP, in 2 of the 6 (33%) by sonography, and in 5 of the 6 (50%) by CT with confirmation of surgical finding or endoscopic retrograde cholangiography (ERC). MRCP had a high accuracy in diagnosing acute cholecystitis with the finding of intramural high signal intensity. MRCP is an excellent method to evaluate acute biliary disease and may replace CT and ERC in the preoperative evaluation of acute cholecystitis.