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Background: The association of multiple submucosal cysts (MSC) of the stomach with gastric carcinoma has attracted clinical and pathological attention. The aim of the present study was to evaluate the diagnostic ability of endoscopic ultrasonography (EUS) for MSC and to investigate the relationship between MSC and gastric carcinoma. Methods: Six hundred and one patients with variable gastric diseases were examined by EUS. We used two ultrasound endoscopes (GF-UM2 or GF-UM3; Olympus, Tokyo, Japan) with either a 7.5 or 12 MHz probe and examined MSC using the water repletion method. Stomachs resected for gastric carcinoma were examined histologically. Results: Endoscopic ultrasonography was able to identify submucosal cysts as echo-free round masses in the submucosal layer when the cysts were larger than 2 mm in diameter. Of 601 patients with variable gastric diseases, 16 (2.7%) were diagnosed with MSC. Twelve of these cases were accompanied with gastric carcinoma and MSC was histologically confirmed in 11 cases after surgical resection. The frequency of MSC detected by EUS was 4.7% (10/215) of early gastric carcinomas, 1.1% (2/185) of advanced gastric carcinomas and 2.1% (4/195) of other gastric diseases without gastric carcinoma. Six cases were a postoperative recurrence of gastric carcinoma. Only 25% (4/16) of MSC gave rise to endoscopic findings of submucosal tumor(s). Most MSC were distributed in the gastric body and the cysts were located beneath or adjacent to the carcinoma in approximately half the MSC cases accompanied by gastric carcinoma. Conclusions: Endoscopic ultrasonography provides information in the clinical diagnosis of MSC with regard to the existence and distribution of the cysts and the locational relationship between MSC and gastric carcinoma.

Dieulafoy ulcer was defined based on endoscopic findings as an ulcer (1) of 10 mm or less in diameter, (2) of grade Ul-ll or less and (3) showing vascular protrusion in its floor. We evaluated the clinical background and endoscopic findings of Dieulafoy ulcer and studied the usefulness and problems of endoscopic hemostasis. Patients with Dieulafoy ulcer accounted for 8.7 % of 321 patients with diseases treated by endoscopic hemostasis excluding sclerotherapy. The patients were predominantly males, and their average age was 61 years. An association with other diseases was noted in 21 patients (75%). Therefore, more than 50 % of the patients were treated with NSAIDs such as aspirin. The most frequent site of this disease was the posterior wall of the upper gastric body. In particular, the ulcer was located in the superior duodenal angle. In six of the 28 patients, the ulcer and the exposed vessel were similar in size. Endoscopic hemostasis was successful in 25 patients (89%). Hemostasis was acheived by emergency surgery in two and by transcatheter arterial embolization (TAE) in one. No patient showed recurrence. Most Dieulafoy ulcers can be conservatively treated by endoscopic hemostasis. However, a few cases can not be managed conservatively and shock develops due to fatal massive bleeding. In such patients, the timing of TAE or surgery must be carefully considered.

A Dieulafoy ulcer is defined as a gastric ulcer with a massive hemorrhage from a shallow circular depression with an eroded artery in the center. The disease entity has been variously described as Dieulafoy ulcer, exulceratio simplex, gastric aneurysm or submucosal vascular malformation. In this study, the relationship between Dieulafoy ulcers and hemorrhagic Ul-II shallow solitary ulceration was investigated according to the macroscopic and histologic findings of the resected stomach. The hemorrhagic Ul-II solitary ulcers resected were located on the upper or middle gastric body. Most of them were small sized (under 10 mm) ovoid ulcers, and had exposed (eroded) arteries on the ulcer floor. Histologically, the Ul-II ulcers showed ulceration in the acute phase without fibrosis. We concluded that a Dieulafoy ulcer and hemorrhagic solitary Ul-II ulcer are the same. In fact, a Dieulafoy ulcer has no special pathogenesis such as congenital abnormal vessels, aneurysm, etc.

We examined the histological characteristics of the foveolar zone of the gastric body mucosa, using dye endoscopy and endoscopic biopsy. In 63 patients, the gastric area type of the gastric body was placed in one of the following categories; fundic gland type 0 (F0), where small and fine areas are arranged closely to one another; F1, where the areas are largest in size, round and high; F2, where the areas are intemediate in size but not so high; F3, where small and flat areas are loosely arranged; pseudo-pyloric gland type 1 (Pb1), where the areas are regular in size and arrangement; and the completely atrophic gland type (Pb2) with areas irregular in size and arrangement. The histological characteristics of the foveolar zone were emmined on printed microphotographs of the biopsy specimens of the gastric body. The density of the gastric pit was defined as the number of pits in a 1 mm width of the mucosal surface and depth of the foveolae was measured as the distance between the top and bottom (or the isthmus) of the foveolae as seen on vertical sections. The gastric pit density and depth of the foveolae were dense and shallow, respectively, in FO and sparse and deep, in Pbl and Pb2 respectively. The degree of these factors showed independency in area types F0, F1 and Pb2 and there were correlations of P

Reactive lymphoreticular hyperplasia of the stomach has been reported rarely. Furthemore, submucosal tumors of the type found in this condition are rare and only 7 such cases have been reported. A 57-year-old male visited our hospital with his chief complaint being tarry stool. An UGI and endoscopy showed a submucosal tumor with a central depression in the posterior wall of the gastric body. Microscopically and immunohistochemically, lymphoid hyperplasia of the stomach was recognized, but it was very difficult to differentiate the condition from malignant lymphoma. The patient is in good health with no medication 2 years after surgery.