[Case of esophageal perforation during gastroscopy].
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205-patients after partial resection of the stomach for benign gastroduodenal ulcers (104 patients for gastric ulcers, 81 patients for duodenal ulcers, 14 patients for combined ulcers) were examined gastroscopically from 1970--1976. The operation was performed more than 5 years ago. 35 carcinomas of the gastric stump could be found (17%). The operation was done in 695 of all cases more than 20 years ago and the male/female relation was estimated to be 6:1. --In 170 other patients with resection of the stomach (61 patients for primary gastric carcinoma, 103 for benign ulcers and 6 for other reasons) with a postoperative interval fewer than 5 years, 10 relapse of carcinoma and 4 carcinomas of the stump were observed. These 4 carcinomas of the stump must be seen as relapses of an carcinoma primarily diagnosed as an ulcer. Gastroscopic-bioptic examinations of patients with an operation performed more than 10 years ago for benign lesions should be done every year. If the cause of operation had been a carcinoma than from the first year after operation.
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To further improve quality assurance of gastrointestinal endoscopy, a computer assisted documentation system for gastroscopic data was assessed. In this context, for the structured written recording system, parameters "expenditure of time" and "acceptance by doctors" was evaluated. Contrary to free, unstructured data recording, the structured system employing predefined terms was able to promote doctors' acceptance of endoscopic terminology standards.
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In 50 patients, both outpatients and inpatients, electrocardiograms were recorded in different phases during esophagogastroscopy. The changes which occurred, such as tachycardia, arrhythmias, and disorders of repolarization are discussed. The increased frequency during the initial stage of the endoscopy, which may assume an already dangerous dimension for patients with coronary heart disease, merits particular attention.
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A prospective double blind randomized study was conducted to assess the efficacy and safety of flumazenil in patients for upper gastrointestinal endoscopy, sedated with midazolam or diazepam. Flumazenil significantly reduced the degree of sedation in both treatment groups without significant intergroup differences. There was no evidence of rebound sedation during the observation period of 4 hours. Anterograde amnesia was effectively antagonized in both groups. Flumazenil was a well tolerated safe and effective benzodiazepine antagonist. The combination of benzodiazepine with flumazenil makes it possible to reduce the recovery period and may be useful in outpatients undergoing endoscopy.
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