Some colonoscopy training models appear on the market. These models are very natural and useful but very expensive.
We developed a simple and inexpensive handmade model for colonoscopy training. This model is made of familiar materials such as a cardboard plate, a paper spindle of paper sheets role and a office clip. The paper pipe is fixed at the center of the base plate. And a target “chessman” which is made of an office clip and a drawn figure is set on the plate. A colonoscope is inserted to the pipe. Then a trainee catches the “chessman” in the sight of colonoscope and try to rotate the chessman 360 degrees in the sight without losing the sight of it.
To do well this procedure, a good coordination between the rotation of colonoscope and up-down/ right-left angle knob manipulation is required. For example, the target located at θdegrees to the shaft of the colonoscope. During a 180 degree rotation, the up-down angle shifts θ°→ 0°→－θ°and the right-left angle shifts 0°→θ°→ 0°continuously.
Though it is difficult for beginners to manipulate the two angle knobs by only the left hand, advanced colonoscopists perform them with facility and unconsciously.
The coordination between the rotation of colonoscope and up-down/right-left angle knob manipulation contributes not only to control the target such as a polyp to good location in the sight of colonoscope but also to achieve the smooth insertion of colonoscope.
Our model is suitable especially to practice the coordination between the rotation of colonoscope and angle knob manipulation.
We would appreciate it if our model could be helpful in instruction of colonoscopy.

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Background New diagnostic techniques have dramatically increased the detection of superficial pharyngeal cancer. However, some patients cannot be examined using transoral esophagogastroduodenoscopy (EGD) at otorhinolaryngeal sites due to their gag reflex. On the other hand, Transnasal EGD can be performed comfortably because of its attenuation of the gag reflex. This procedure has thus been progressing, and a new endoscope(model Eg-530NW, FUJI FILM, Tokyo, Japan) was introduced at the beginning of July of 2009. The endoscope is a transnasal endoscope that provides high quality endoscopic image of a field view 140°.
Objectives:To evaluate the diagnostic value of transnasal EGD using a FICE system in detecting another primary head and neck cancers in patients with esophageal cancer (EC) or head and neck cancer(HNC) during the screening of the oral cavity and the Valsalva maneuver.
Subjects and Methods:Three hundred seventeen EC or HNC patients (EC 274, HNC 112, EC combined with HNC 69) underwent transnasal EGD screening with both a white light and an FICE system between October 2009 and October 2011. The Valsalva maneuver and screening of the oral cavity was also performed. The pyriform fossae balloons, and the endoscope is inserted in front of the upper esophageal sphincter, and the postcricoid region and posterior of the hypopharynx are continuously observed. The FICE system enables easily observation of the presense of scattered brown dots to diagnose superficial cancers.
Results A total of 34 superficial cancers were found in 26 patients (8.2%) by transnasal EGD. In particular, 21 primary hypopharyngeal cancers were detected in this study. In addition, four cases of mesopharyngeal cancer, four cases of the floor of the mouth, and three cases of soft palate, buccal mucosa and larynx in one case were found. Fifteen of those cases were determined to have intraepithelial neoplasia.
Conclusion Therefore, transnasal endoscopy may become the standard examination modality for the screening of the oral cavity, pharynx and larynx.

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Background : Endoscopic triamcinolone injection (ETI) post-esophageal endoscopic submucosal dissection (ESD) have been reported to be effective for prevention of stricture. But the appropriate method of injection, how many sessions should be performed, the proper concentration of triamcinolone suspension, the proper dosage of one injection, is remained unclear.
Aim : Only one session of ETI performed immediately after ESD was reported to be effective for prevention of post-ESD esophageal narrowing^4，5) , but had a few complications. To establish the safer and more effective and efficient method of ETI, we estimated the feasibility of our institute′s ETI method described below.
Method : 7 patients of superficial esophageal squamous cell carcinoma treated with semi-circumferential (more than three fourths of the lumen) ESD in Showa General Hospital from May 2011 to August 2012 were evaluated. A number of sessions of ETI were restricted to two sessions, immediately after ESD and one week after. The triamcinolone suspension was adjusted to 13-20mg/ml concentration. Each 0.1-0.3ml of this suspension was injected into submucosa of the periphery and the base of post-ESD ulcer at 1cm-1.5cm intervals. 6 weeks after the process, esophagogastroduodenoscopy was performed and examined the incidence of esophageal stricture and the necessity of endoscopic balloon dilatation (EBD) .
Results : Esophageal stricture was not found on endoscopy at 6 weeks after the second session of triamcinolone injection in all patients, and no patients complained of dysphagia and required EBD. There were no complications associated with this method, no perforations nor systemic side effects.
Conclusions : This study suggests that two sessions of triamcinolone injection method is safe and effective for prevention of esophageal stricture after semi-circumferential ESD. But it is indispensable to acquire the skill and the few arts of endoscopic manipulations for safe and effective ETI. This method is suggested to be an effective strategy, but further study in a larger subject is required.

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Background : Percutaneous endoscopic gasrostomy (PEG) has been classified as a high bleeding risk procedure (ASGE and JSGE guidelies) . Patients who undergo PEG are often on antiplatelet therapy. Data on the safety of peri-procedual use of these drugs is limited.
Objective : To assess the risk of bleeding in paitents who receive antiplatelet therapy.
Method : PEGs were placed in 288 patients in our hospital from April 2008 to December 2011. 41 patients received antiplatelet therapy.
Results : In 41 patients who received antiplatelet therapy, 38 patients received mono antiplatelet therapy while 3 patients received dual antiplatelet therapy. 2 patients (4.9%) had evidence of bleeding after PEG and both received dual antiplatelet therapy (one was aspirin and clopidogrel, the other was cilostazol and clopidogrel) . There was no case of bleeding with mono antiplatelet therapy (0%) .
Conclusion : Use of single antiplatelet agent before or after PEG may not increase the risk of bleeding. Dual antiplatelet therapy should reduce to single agent.

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We studied 32 patients with gastric lesions whose biopsy specimens showed moderately to poorly differentiated adenocarcinoma and who were treated by ESD from April 2007 to March 2010 at the Cancer Institute Hospital. All patients were observed by NBI magnified endoscopy and en bloc resection was performed. We defined NBI findings of characteristic blood vessels of undifferentiated-type early gastric cancer as “irregular vessels”. We compared the presence of irregular vessels with the histology of ESD specimens. In total, 20 of the 32 patients had irregular vessels, and all 20 cases were of the undifferentiated mixed-type. 6 of the 12 cases that were not observed to have irregular vessels were purely differentiated adenocarcinoma. 12 out of 13 mixed-type cases in which the undifferentiated type was dominant were observed to have irregular vessels (92.3%) . 8 out of 13 mixed-type cases in which the differentiated type was dominant were observed to have irregular vessels (61.5%) . Despite the presence of undifferentiated mixed-type gastric cancer, 6 patients were not observed to have irregular vessels. The reason for this is the narrow area of undifferentiated adenocarcinoma and localization of the undifferentiated adenocarcinoma at a deeper part of mucosa.

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Background and objective : Among private hospitals in Tokyo, there is currently little report about statistics of cancer which detected by diagnostic endoscopic procedures. We performed digestive endoscopy through 30 years. We focus on the character of early gastric cancer cases detected in this series of study including the endoscopic findings and pathological examinations.
Methods : From February 1982 to January 2012, 22821 cases of EGD (esophagogastroduodenoscopy) were performed for symptomatic patients. Among them, 186 cases of early gastric cancer in 175 patients were identified. They diagnosed cancer by pathological study followed by endoscopic biopsy, EMR, ESD and surgical operative procedures.
Results : The early gastric cancer group includes 175 (44.5%) patients of 393 total gastric cancer patients. In the early gastric cancer group, Male, Aged 65-74 years group were mostly detected. Focus on the cancer locations, M (middle body of stomach) lesion 101 cases (54.3%) , L (lower body) lesion 67 cases (36.0%) , and U (upper body) lesion 15 cases (8.1%) were detected. We found higher incidence in M lesion. Especially 0-Ⅱc with JGCA classification, tubular adenocarcinoma, pT1a (M) detected on lesser curve site were the most popular feature of them. Meanwhile, undifferentiated carcinoma among excavated type and differentiated carcinoma in protruding type was significantly higher incident than another type. Additionally in whole early gastric cancer in this study, excavated type, pT1b2 was identified 30 cases (27.0%) .
Conclusions : Sitting on the bedside under the charging medical environment, we reviewed early gastric cancer identified in this private hospital diagnosed by pathologically followed by endoscopic study. From this statistical data, we think that diagnosability of early gastric cancer is affected not only progression of endoscopic device but improvement of circumstance around the hospital including bed number of the hospital and proficiency of endoscopist.

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Background and Aim : Acute hemorrhagic rectal ulcer (AHRU) is the disease characterized by sudden onset of painless and massive rectal bleeding in elderly bedridden patients with severe comorbid illness. AHRU has increasingly been reported in Japan. The aim of this study is to elucidate the clinical characteristics in these patients.
Method : From April 2004 to June 2010, 28 patients were diagnosed with AHRU in our hospital. We investigated the clinical features, endoscopic findings, hemostatic treatment and course of patients with AHRU retrospectively.
Result : Most of these patients were elderly (median age 78.5) . The number of bedridden patients with Performance Status 3 and 4 is relatively high (82%) . Comorbid illness existed in all patients such as Diabetes mellitus (9 patients) , cardiovascular disease (9 patients) , chronic liver disease (8 patients) , cerebrovascular disease (7 patients) , chronic renal disease (7 patients) , orthopedic disease (7 patients) and malignancy (6 patients) . Endoscopic examination revealed irregularly shaped ulcer in 19 patients, round or nearly round small ulcer (s) in 7 patients, Dieulafoy-like ulcer in 2 patients. Exposed vessels were observed in 11 patients to whom endoscopic hemostatic treatment was performed. As a endoscopic treatment, Clipping was performed most frequently (9 patients) . Other treatments were endoscopic band ligation (2 patients) , local injection of hypertonic saline-epinephrine (HSE) solution with clipping (2 patients) . Successful hemostasis was achieved in 10 patients (91%) . 7 patients died by the aggravation of comorbid disease after bleeding related to AHRU.
Conclusions : However endoscopic hemostatic therapy is effective for active bleeding with AHRU, the underlying comorbidities of the patients influence the prognosis after bleeding.

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