Bleeding from Dieulafoy lesions can be managed successfully by endoscopic methods, and these should be regarded as the first choice in their management. We emphasize the role of hemoclipping, a mechanical method, for the endoscopic treatment of these lesions.

Endoscopic retrograde cholangiopancreatography is essential in the management of postoperative biliary leaks. Endoscopic sphincterotomy alone can be the initial procedure in the treatment of LGL from the CDS due to cholecystectomy.

We describe 50 patients with suppurative regional lymphadenitis following intradermal BCG vaccination. For non‐drained suppurations we performed needle aspiration in twenty‐three patients (aspiration group). Of the remaining 27 patients (drainage group) 16 had spontaneous drainage and 11 incisional drainage. In the drainage group, 17 patients were followed up conservatively. Ten patients from the drainage group and 3 patients from the aspiration group (drained after needle aspiration) accepted total surgical excision to terminate the drainage. Twenty of twenty‐three patients in the aspiration group recovered after needle aspiration. Average period of cessation of drainage and healing of wound was 7.5 weeks in patients with drainage (spontaneous and incisional). Healing was complete after total surgical excision of draining suppurations in all of 11 patients. We concluded that simple needle aspiration was sufficient for the treatment of suppurating but non‐drained BCG lymphadenitis. For suppurating lymph nodes that were surgically (not recommended) or spontaneously drained, a more invasive procedure, total surgical excision, was proposed to terminate the long and disturbing drainage period.

IntroductionEndoscopic retrograde cholangiopancreatography (ERCP) is used in the diagnosis and therapy of biliary tract diseases. The ERCP is an invasive procedure that does not increase complications in the elderly. Few studies have assessed the safety of ERCP in the elderly. Life expectancy is rising, which causes an increasing demand for ERCP in the elderly.AimTo show that therapeutic ERCP is safe and we compared the level of complications among the elderly (> 80 years of age) and the level among a younger group (< 65 years of age).Material and methodsThe study was designed retrospectively. The details of all patients 80 years of age and older undergoing ERCP were analysed. One hundred and fifty patients were included in each of the groups: > 80 years of age, older group A; and < 65 years of age, younger group B.ResultsIn group A, 4 cases (2.7%) of bleeding (all mild) was observed, and perforation was not observed. The ERCP-related mild pancreatitis was observed in 7 patients (4.6%). There were no cases of mortality during procedures of ERCP in group A. In group B 6 bleeding cases (4%) (all mild) were observed. Perforation was not observed in group B. ERCP-related mild pancreatitis occurred in 11 patients (7.3%). There were no cases of mortality during procedures of ERCP in group B. Our study showed that ERCP is a safe and effective procedure in elderly patients.ConclusionsOutcomes of ERCP for diagnostic and therapeutic success, and complication rates, are similar to those in younger patients. The ERCP is effective and safe in the elderly.

We herein report an unusual adult patient with a congenital choledochal cyst. A 28-year-old woman presented with recurrent episodes of abdominal pain in the right upper quadrant. Abdominal ultrasonography showed fusiform dilatation of the common bile duct without any obstruction. Endoscopic retrograde cholangiopancreatography (ERCP) and magnetic resonance cholangiopancreatography (MRCP) were performed to make a precise diagnosis. No abnormal pancreatobiliary junction was detected on ERCP. The MRCP images more clearly defined the type and extent of the choledochal cyst as observed at surgery. The cyst and gallbladder were excised and a Roux-en-Y hepaticojejunostomy was performed. We also reviewed the relevant English literature and concluded that MRCP offers diagnostic information that is equivalent or superior to that of ERCP for the evaluation of type I choledochal cysts in adults and because this modality is noninvasive, it should therefore be the preferred imaging technique for an examination of adult patients with choledochal cysts.

A 74-year-old male patient had a full-thickness laceration of the mid-rectum during transurethral urologic surgery. The perforation site was 8-cm above the dentate line and 15 x 6 mm in size. Transanal direct access to the injury site was difficult and endoscopic repair with hemoclips was performed without any further intervention. He was discharged from the hospital uneventfully and complete healing was observed 6 weeks after the procedure. We concluded that endoscopic repair with hemoclips may offer a successful and simple closure method for extraperitoneal high lying rectal lacerations.

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We studied 25 cases of minute (less than 5 mm in a diameter) superficial depressed neoplastic lesions during the period of March 1990 to September 1991. These depressed neoplastic lesions were recognized by colonoscopy as asteroid redness with surrounding elevation. The thickness and height of the surrounding elevations were modified by air volume. Occasionally, they seemed according to the air volume to be elevated lesions, though their fundamental form was confirmed as being superficial depressed lesions from observations of histopathological sections and using a dissecting microscope. The endoscopic figures were emphasized by sprinkling them with Methylene Blue. All of the minute depressed neoplastic lesions were histopathologically diagnosed as being tubular adenoma. For the purpose of confirming the histopathological character of the depressed neoplastic lesions (n = 25) and distinguishing them from conventional elevated adenomas (n = 71) of the same diameter, we compared the incidences of glandular crowding, nuclear stratification, nuclear pleomorphism and loss of nuclear polarity in two groups. Glandular crowding and nuclear pleomorphism were recognized significantly more often in the depressed neoplastic lesions than in the elevated adenomas. Although most of the minute depressed neoplastic lesions were fundamentally adenomas, because of their unique histopathologic character, they could give new insight into the development of colon cancer.