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The prevalence of obesity in the Japanese population has been increasing dramatically in step with the Westernization of lifestyles and food ways. Our study demonstrated significant associations between obesity and a number of gastrointestinal disorders in a large sample population in Japan. We demonstrated that reflux esophagitis and hiatal hernia were strongly related to obesity (BMI > 25) in the Japanese. In particular, obesity with young male was a high risk for these diseases. On the other hand, it has been reported that obesity is also associated with Barrett’s esophagus and colorectal adenoma; however, obesity was not a risk factor for these diseases in our study. The difference of ethnicity of our subjects may partly explain why we found no data to implicate obesity as a risk factor for Barrett’s esophagus. Arterial sclerosis associated with advanced age and hyperglycemia was accompanied by an increased risk of colorectal adenoma.

Aim: Owing to carelessness of endoscopists, invasive procedures, such as biopsy, are sometimes carried out inadvertently in patients receiving antithrombotic therapy. The aim of the present study was to retrospectively evaluate the actual status of such careless mistakes and the efficacy of new safety measures. Methods: A questionnaire survey was conducted in 34 endoscopists at Toranomon Hospital about experiences of careless mistakes and experiences of anxiety before and after the procedure. ‘Anxiety before procedure’ was defined as the experience of discontinuing a given procedure because endoscopists remembered that the patient was receiving antithrombotic therapy, and ‘anxiety after procedure’ was defined as the experience of feeling anxious about the status of medication after the invasive procedure. A new measure was introduced at Health Management Center in August 2009. In this measure, endoscopists directly interview each patient about the status of medication just before examination, and attach forceps valves of one of two colors depending on the status of medication. A blue forceps valve is attached for patients undergoing antithrombotic therapy, and a conventional black forceps valve is attached for patients not undergoing antithrombotic therapy. Six months after introduction, a questionnaire survey was conducted in 10 endoscopists in this center. Results: Approximately half of endoscopists (18/34) experienced such careless mistakes. ‘Anxiety’ had been experienced by approximately 80%. After introduction, there was no report of careless mistakes and frequency of ‘anxiety’ evaluated by visual analog scale score decreased significantly. Conclusion: This new safety measure is expected to facilitate safer gastrointestinal endoscopy in patients receiving antithrombotic therapy.

A demonstration UV photooxidation system for the treatment of trichloroethylene (TCE) gas extracted from contaminated soil or ground water has been fabricated to design the operation method. The apparatus involves a complete mixing flow type UV reactor connected in series with a multiple stage one and a gas absorption tower filled with crashed marble. The data that is necessary to design the reactor for promoting the photooxidation reaction effectively under relatively high to low TCE concentration could be obtained. Based on the test result, the concrete method to design the reactor is discussed.Phosgene is one of the acidic products produced by TCE photooxidation. This substance could be eliminated more than 99% by the absorption tower.

UV irradiation method is expected to be one of the remediation technology for the trichloroethylene (TCE) gas extracted from contaminated soil. TCE in gas phase has been known to be decomposed by UV irradiation and acid gas which includes some toxic compounds e.g. dichloroacetyl chloride (DCAC), phosgene, chlorine and hydrogen chloride is produced after irradiation. Therefore they have to be rejected before being released in the air. These components were found to be removed by using absorption tower packed with marbles which were wetted by showering water. DCAC was more easily removed than phosgene and chlorine. Since the pH of the waste water from the tower was almost neutral and calcium cation was dissolved at approximately equivalent amount with chloride and dichloroacetate anions, the acid gas components would be removed by hydrolysis and neutralization reactions.

A study has been made of obtaining the gas phase photooxidative decomposition rate of trichloroethylene (TCE) which was extracted from contaminated soil by evacuation. A cylindrical reactor which was equipped with a low pressure mercury lamp at the center axis (reactor I) was divided into several spaces with barriers. Conversion of TCE increased with increasing the number of divided spaces in the reactor under low gas flow rate, however, the conversion of TCE decreased with increasing the number of the spaces under high gas flow rate. Moreover, the conversion increased with increasing the initial concentration of TCE under the condition of the same gas flow rate. The photooxidative decomposition rate of TCE was obtained by using graphical method under the assumption of that the complete mixing flow was formed and the average photo intensity in each spaces in the reactor was same. The maximum decomposition rate was obtained at the conversion of c.a. 0.8 and the rate was proportional to the 1.2th power of the concentration of TCE. The photooxidative decomposition rate of TCE in a reactor with larger diameter (reactor II) was in passable agreement with the value expected from the data obtained in the reactor I.

Owing to carelessness of endoscopists, invasive procedures, such as biopsy, are sometimes carried out inadvertently in patients receiving antithrombotic therapy. The aim of the present study was to retrospectively evaluate the actual status of such careless mistakes and the efficacy of new safety measures.A questionnaire survey was conducted in 34 endoscopists at Toranomon Hospital about experiences of careless mistakes and experiences of anxiety before and after the procedure. 'Anxiety before procedure' was defined as the experience of discontinuing a given procedure because endoscopists remembered that the patient was receiving antithrombotic therapy, and 'anxiety after procedure' was defined as the experience of feeling anxious about the status of medication after the invasive procedure. A new measure was introduced at Health Management Center in August 2009. In this measure, endoscopists directly interview each patient about the status of medication just before examination, and attach forceps valves of one of two colors depending on the status of medication. A blue forceps valve is attached for patients undergoing antithrombotic therapy, and a conventional black forceps valve is attached for patients not undergoing antithrombotic therapy. Six months after introduction, a questionnaire survey was conducted in 10 endoscopists in this center.Approximately half of endoscopists (18/34) experienced such careless mistakes. 'Anxiety' had been experienced by approximately 80%. After introduction, there was no report of careless mistakes and frequency of 'anxiety' evaluated by visual analog scale score decreased significantly.This new safety measure is expected to facilitate safer gastrointestinal endoscopy in patients receiving antithrombotic therapy.

A 62-year-old female who complained of discomfort in her upper abdominal region and a poor appetite had an endoscopically documented polypoid lesion with a shallow irregular central depression at the lesser curvature of the angulus. A diagnosis of malignant lymphoma was made following a gastric biopsy. A gastric endoscopy performed about 20 days later revealed a marked increase in size with an ulcerated surface the margin of which had an auricle-like shape. These findings were compatible with a diagnosis of malignant lymphoma of the stomach. No medical therapy, such as antineoplastic agents, was given during the follow-up period. A gastric resection was performed 1.5 months after the initial endoscopy. A detailed histopathological examination of the resected gastric specimen revealed a U1-II type ulcer scar but no malignant lymphoma cells. Very few cases of a complete spontaneous regression of a malignant lymphoma of the stomach have been reported either within or outside of Japan though it is well known that lymphomas show rapid morphological changes in some patients who are followed-up without any specific therapy. These rare case reports in the literature are reviewed and discussed together with our present case.

Reports of ectopic sebaceous glands in the esophagus are rare. Six postmortem cases and eight antemortem cases have been reported. In 1990, we studied two patients with ectopic sebaceous glands in the esophagus that were found during endoscopy and confirmed histologically. These lesions macro-scopically resembled gastric xanthomas.

The key issue in the field of therapeutic endoscopy in recent years is the development of a new therapeutic strategy for early gastric cancers using endoscopic submucosal dissection (ESD) technique. ESD was developed to overcome the problem of remnant or recurrent tumors after incomplete resection by conventional endscopic mucosal resection (EMR). Ever since after the emergence of ESD, indication criteria for endoscopic resection of early gastric cancers were extended through expansion of both theoretical and technical conditions. Complete en bloc resection rates were 96.7% and 62.6% in the ESD group and the EMR group, respectively, in our institution. ESD is a highly effective technique enabling us to resect much larger and difficult lesions, which cannot be resected by conventional EMR techniques. However, it involves a much higher complication rate and requires much higher skills. A small lesion less than 20 mm located in a good position can be resected completely, without any difficulties using conventional EMR techniques. Therefore, we must consider the approach to treatment, when conducting an endoscopic resection,it terms of the situation and skills of the endoscopist.

In Japan Barrett's mucosa is defined as columnar lined esophagus (CLE). The prevalence of Barrett's esophagus and Barrett's adenocarcinoma is very low. But in Western countries Barrett's mucosa is defined as CLE with intestinal metaplasia, and many cases of Barrett's esophagus and Barrett's adenocarcinoma are reported. The definite endoscopic diagnosis of Barrett's mucosa cannot be so easy. We investigated the positional relationship between the esophageal hiatus, squamo-columnar junction, and longitudinal vessels in persons who underwent esophagogastroduodenoscopy. Subepithelial longitudinal vessels were found at the lower esophagus in all cases. In no cases were the longitudinal vessels observed under the gastric mucosa beyond the esophageal hiatus. It is peculiar to the esophagus to be able to observe subepithelial longitudinal vessels in the vicinity of the esophago-gastric junction. When longitudinal vessels are found only under the columnar epithelium at the oral side over the esophageal hiatus from the stomach, this indicates Barrett's epithelium. Thus the definite diagnosis of Barrett's epithelium can be made by endoscopy.

We studied the detailed surface structure and changes in the regenerated mucosa during the course of healing of recurrent gastric ulcers treated with lansoprazole or famotidine, using a magnifying electronic endoscope (videoendoscope) and a dye contrast method. The detailed patterns of regenerated mucosa were classified into five types : membranous, spindle-shaped, palisade-shaped, cobblestone-shaped, and almost normal structure. Initially, the membranous regenerated mucosa appears at the ulcer margin and grows into the spindle- and palisade-shaped regenerated mucosa. These latter types of mucosa change gradually into the cobblestone-shaped type, which finally develops into an almost normal structure. Lansoprazole appeared to bring about more rapid growth and changes of the regenerated mucosa than famotidine, although the difference was not statistically significant. We suggest that it is useful, in the assessment of gastric ulcer therapy, to observe the detailed patterns of the regenerated mucosa during the healing process using a magnifying electronic endoscope.