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A case of a 13-year-old girl is reported. She swallowed her toothbrush accidentally, the surgeon suggested the endoscopic examination. The teen-age, well-developed girl did not have complaints, there were five hours between the accident, and the starting of the examination. After the pharynx anaesthetization by Lidocaine spray, the endoscopy was performed by a video endoscope of GIF-130 type. The brush was found in the stomach, but its handle went through the pylorus. Injury was not found on the esophagus and stomach mucosa. The patient and her mother were fully informed, and for their request, the removal of the toothbrush was attempted by using grasping forceps and polypectomy snare. It lasted nearly forty minutes and was ensured by the intensive care. The procedure was successful, the patient who tolerated it well, left the hospital after observation, without complaints.

Unlabelled: Patients who are not able to eat do need tube feeding. The most preferred way of artificial enteral nutritional support is feeding via percutaneous endoscopic gastrostomy (PEG) tubes. Head and neck cancer patients do represent a special group of patients needing a PEG. On the one hand at the time of admission to the hospital they are mainly undernourished. On the other hand the failure rate of placing a PEG is the highest among them. Furthermore in the perioperative period nasogastric tubes do cause a lot of complications in these settings. 188 PEG placements were carried out from July 1995 till November 1998., Indications: head and neck cancer (n = 171), neurologic disorders (n = 17). PEG tubes were placed 76 times during intratracheal narcosis and 112 times following local anaesthesia. 39 times there was a prior abdominal surgery in our patients medical history. The pull-through, the push-wire and the introducer techniques were used. Beside the usual oro-gastric way of endoscopying (n = 163), 25 times the following alternative ways of entering the upper gastrointestinal tract were used: transnasal route (n = 4), through a Kleinsasser type direct laryngoscope (n = 7) and via the opened pharynx (n = 14). No immediate or late onset procedure related complications occurred. During a follow-up of 22,480 tubedays 26 minor (dermatitis n = 24, ulcer n = 2) and 8 major (abscess n = 4, perforation/peritonitis n = 3, stomach and bowel wall necrosis n = 1) complications occurred. The success rate of placing a PEG was 98.9%. In head and neck cancer patients placing a PEG is suggested when there is a need for at least a 7 days time tube-feeding. Using the described alternative ways, a PEG tube can be placed almost always. Because of the uncertain outcome, nutritional support via PEG tubes is suggested also in cachectic patients and in vegetative state as well.

Chromoendoscopy is an intravital endoscopic mucosa dyeing method. Chromoendoscopical methods suitable for examination of gastric mucosa are described including the steps of premedication as well as the steps of Congo-red and methylene-blue tests. The Congo-red test is capable of estimating the extent of acid-secreting area of gastric mucosa. Large acid secreting areas were found in four-fifth of duodenal ulcer patients with the Congo-red test. An equal ratio of small and large acid-secreting areas was found in gastric ulcer patients. The extent of acid-secreting area decreased parallely with the increase of mucosal atrophy in chronic gastritis patients. Methylene-blue test is suitable for detecting mucosal areas containing intestinal metaplasia and cancer. Intestinal metaplasia was detected histologically in 80% of cases containing mucosal areas stained by methylene-blue test. According to the authors' observations chromoendoscopy is a time consumptive additional method, which requires careful premedication and accurate endoscopic technique. Chromoendoscopy is suitable to detect the accurate places of mucosal biopsies therefore it seems to be a valuable element of morpho-functional diagnostic methods.