High-frequency ultrasound probe is a useful tool for accurately determining the depth of invasion of early gastric cancer when its limitations are understood.

Ultrasonographic findings of FD sign are correlated with the existence of deep longitudinal ulcers, which are most frequently found in CD. US is a useful diagnostic modality for detecting longitudinal ulcers in patients with CD.

Background and Aims: To confirm the utility of a newly-devised endoscopic ultrasonography (EUS) echogenicity classification system, which is based on the normal five-layer structure of the gastrointestinal wall, for the differential diagnosis of gastrointestinal neoplasms. Methods: A total of 275 patients with gastrointestinal disease detected by endoscopy, 53 with submucosal tumor (22 esophageal, 27 gastric, and 4 duodenal), 208 with cancer (58 esophageal, 150 gastric), and 14 with gastric malignant lymphoma, were examined. In each case, we performed standard EUS with 7.5, 12, or 20 MHz to evaluate the echogenicity of the lesion. Echogenicity was classified into seven levels that is based on the echogenicity of the normal five-layer structure of the gastrointestinal wall. The levels are stratified from anechoic (level 0) to hyperechoic (level 6), muscularis propria and deep mucosa being referred to as level 2 and level 4, respectively. Level 6 was equivalent to or higher than the echogenicity of submucosa. Results: EUS findings revealed several distinct echogenicities among the diseases. In submucosal tumor, levels 0, 2, and 6 were observed only in patients with cyst, myogenic tumor, and lipoma, respectively. In malignancies, levels 0, 5, and 6 were not observed in this study. The echo level of malignant lymphoma was markedly lower than that of epithelial cancer. Conclusion: Our classification system of echogenicity can be a useful method in the differential diagnosis of gastrointestinal neoplasms.

In active CD, patients with bowel segments showing a loss of stratification and rich perfusion by H-FEI are likely to need surgical treatment.

KEY WORDS: gastrointestinal stromal tumor; ultrasonography; double-balloon enteroscopy; contrast-enhancing agent.Gastrointestinal stromal tumors (GISTs) in the small intestine are rare and are sometimes incidentally detected by sudden gastrointestinal bleeding. The patients often undergo surgery without an accurate diagnosis, because most of these lesions are inaccessible by conventional endoscopy. Ultrasonography (US) has become an effective diagnostic modality for gastrointestinal diseases. In addition, recent studies have revealed that the microcirculation of the gastrointestinal wall can be assessed by contrastenhanced imaging using the agent SHU 508A (Levovist; Schering, Berlin, Germany) (1, 2). However, there have been few reports of the sonographic features of GISTs. We report a patient with GIST in the jejunum that was diagnosed by US as a screening tool and that was confirmed preoperatively by double-balloon enteroscopy. CASE REPORTA 75-year-old man was admitted to our hospital because of general fatigue. On hematologic testing, carcinoembryonic antigen (CEA) was slightly increased (7.8 ng/ml), but results of other examinations were normal. He was 159 cm in height and 60 kg in weight, with stable vital signs. Routine abdominal US performed using the SSA-390A system (Toshiba, Tokyo), with 3.5-MHz curved and 7.5-MHz linear array transducers, showed a solid mass with an uneven irregular surface and clear boundaries,