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Study Objective: Hypoxemia is one of the most frequent adverse events during sedated gastroscopy, and there is still no effective means to prevent and cure it. Therefore, we conducted this randomized trial to confirm our hypothesis that, compared with the nasal cannula group, bilevel positive airway pressure (BPAP) would decrease the incidence of hypoxemia in patients with obstructive sleep apnea (OSA) or overweight status undergoing gastroscopy., Design: In a single-center, prospective, randomized controlled clinical trial, 80 patients aged 18-65 years and with OSA or overweight status who underwent gastroscopy with sedation were randomly assigned to two groups: the nasal cannula and BPAP groups. The primary outcome was the incidence of hypoxemia (75% < peripheral oxygen saturation [SpO2] < 90% for >5 sand <60 s)., Main Results: Compared to the nasal cannula group, BPAP therapy significantly decreased the incidence of hypoxemia from 40.0% to 2.5% (absolute risk difference [ARD], 37.5% [95% confidence interval (CI), 21.6 to 53.4], p < 0.001), decreased subclinical respiratory depression from 52.5% to 22.5% (ARD, 30.0% [95% CI, 9.8 to 50.2], p = 0.006), and decreased severe hypoxemia from 17.5% to 0% (ARD, 17.5% [95% CI, 5.7 to 29.3], p = 0.006). The BPAP intervention also decreased the total propofol dosage and operation time and improved anesthesiologist's satisfaction., Conclusion: BPAP therapy significantly decreased the incidence of hypoxemia in patients with OSA or overweight status who underwent gastroscopy., Competing Interests: Declaration of Competing Interest The authors declare no conflicts of interest., (Copyright © 2022. Published by Elsevier Inc.)

Competing Interests: Disclosure Speaking/Teaching: Cook Biotech, Inc; C.R. Bard, Inc, Boston Scientific Corp; Research Support: C.R. Bard, Inc. Consultant: Boston Scientific Corp; Actuated Medical, Inc, Medtronic, Baxter; Royalties: UpToDate, Inc, Springer.

Endoscopic submucosal dissection (ESD) is a useful tool for the treatment of early gastric neoplasms, however post-ESD bleeding and perforation restrict its widespread application. In this study, we developed the chitosan/β-glycerophosphate/collagen (CS/GP/Col) thermo-sensitive systems to satisfy the requirements for the endoscopic treatment for ESD-induced ulcer. The results indicated that the addition of collagen to CS/GP system did not lead to remarkable changes on the physicochemical properties of the systems, which can transform from solution to hydrogels under physiological temperature within 90s, technically makes it suitable to be applied through catheter to gastric ulcer during ESD operation. Besides, hydrogels with high collagen concentration showed better biocompatibility, effectively protected L929, GES-1, HVSMC and CCD-18Co cells from acidic condition, induced more growth factors such as EGF, VEGF and FGF in those cells, and promoted coagulation. These results indicated that the CS/GP/Col thermo-sensitive hydrogel might be a promising biomaterial for the endoscopic treatment of ESD-induced ulcer, and further research can be carried out., (Copyright © 2019 Elsevier B.V. All rights reserved.)

The Amplatzer family of vascular devices has been used off-label for the treatment of complex gastrointestinal and airway fistulas. We report a case in which closure of a benign gastrobronchial fistula with the use of an Amplatzer device resulted in massive hemoptysis and death., (Copyright © 2018 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

Background: Spontaneous pneumomediastinum (SPM) is classified as free air in the mediastinum in the absence of any precipitating cause. It is relatively uncommon, and the clinical significance and risk associated with SPM is not well understood and has not been widely documented in the literature. Our goals were to determine the outcomes of patients who presented with SPM and to determine predictors of severe pathology associated with SPM., Methods: From 2004 through 2013, a retrospective review was conducted of patients who presented with SPM to our institution. Patient demographics, comorbidities, laboratory tests, and esophageal perforation were recorded., Results: In all, 249 patients were discovered to have SPM on chest radiograph or computed tomography scan. Mean age was 38.7 years (range, 17 to 81). Sixty-one percent of patients (151 of 249) were male. Ten percent of all patients (24 of 249) were ultimately discovered to have esophageal perforation, determined by upper endoscopy, upper gastrointestinal series, or intraoperatively during emergent surgery. Age (p < 0.01), pleural effusion (p < 0.01), and elevated white blood cell count (p < 0.01) were the only significant risk factors for esophageal perforation on multivariate analysis., Conclusions: Spontaneous pneumomediastinum is usually associated with a benign clinical course. Risk factors for esophageal perforation in these patients include age, elevated white blood cell count, and a pleural effusion. In the absence of abnormal laboratory values or associated radiologic findings, the majority of patients with SPM may be safely observed without the need for further diagnostic testing., (Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

Background: Atrophic gastritis (AG) is at increased risk of gastric neoplasia, thus surveillance gastroscopy has been proposed., Aims: To assess cost of detecting gastric neoplasias by surveillance endoscopy according to identified risk factors in Italy., Methods: Post-hoc analysis of a cohort study including 200 AG-patients from Italy followed up for a mean of 7.5 (4-23.4) years was done. Considered risk factors were: age >50years, extensive atrophy, pernicious anaemia, OLGA-OLGIM scores 3-4 at diagnosis. The number of 4-year-surveillance endoscopies needed to be performed to detect one gastric neoplasia (NNS) was calculated., Results: In 19 patients neoplasias (4 gastric cancers, 8 type 1 gastric carcinoids, 7 dysplasias) were detected at the 361 surveillance gastroscopies, corresponding to NNS of 19 and a cost per gastric neoplastic lesion of €2945. By restricting surveillance to pernicious anaemia patients, reduction of NNS and cost per neoplasia to 13.8 and €2139 may be obtained still detecting 74% of neoplasias. By limiting the surveillance to pernicious anaemia patients and OLGA 3-4, 5 (26.3%) neoplasias would have been detected with a corresponding NNS of 5.4 and a cost per lesion of €837., Conclusion: Risk factors may allow an efficient allocation of financial and medical resources for endoscopic surveillance in AG in a low risk country., (Copyright © 2016 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.)

Endoscopy is an inherent and an invaluable tool in every gastroenterologist's armamentarium. The prerequisite for quality and safety remains foremost. Adverse events should be minimized and proactive steps should taken before, during and after the endoscopic procedure. Upper endoscopy and colonoscopy are part of basic endoscopy and their major complications will be reviewed here, together with those of enteroscopy. The most common of all endoscopy related complications are cardiopulmonary and thus they will be addressed in detail first. Colonoscopy's major complications are bleeding and perforation. Their epidemiology, mechanisms/risk factors, diagnosis, treatment and prevention will be addressed. The incidence of both of these complications increases significantly with polypectomy. Thus clinical judgment and experience in both polypectomy techniques and the ways to treat these complications, especially with the advanced endoscopic options advanced in the last decade, are of paramount importance. Post-polypectomy syndrome, infection and gas explosion are less frequent and will be reviewed briefly. Bleeding and perforation are upper endoscopy's major complications as well. Advances in endoscopic techniques in recent years offer endoscopic treatment instead of directly resorting to surgery, as was used to be the case and still is if the first fails. Enteroscopy is generally a more advanced procedure and overall complication rate is often quoted as 1%, most of them have been attributed to the passage of the overtube. Perforation and bleeding are the major complications, and a unique upper enteroscopy-associated complication is pancreatitis., (Copyright © 2016. Published by Elsevier Ltd.)

Percutaneous endoscopic gastrostomy (PEG) has become the method of choice for mid-to long-term enteral feeding. The majority of complications that occur are minor, but the rare major complications may be life threatening. Some complications occur soon after tube placement, others develop later, when the gastrostomy tract has matured. Older patients with comorbidities and infections appear to be at a greater risk of developing complications. Apart from being aware of indications and contraindications, proper technique of PEG placement, including correct positioning of the external fixation device, and daily tube care are important preventive measures. Adequate management of anticoagulation and antithrombotic agents is important to prevent bleeding, and administration of broad spectrum antibiotics prior to the procedure helps prevent infectious complications. Early recognition of complications enables prompt diagnosis and effective therapy., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Gastrointestinal (GI) endoscopy is profoundly utilized for diagnostic and therapeutic purposes. The therapeutic potential of GI endoscopy has amplified many folds with the evolution of novel techniques as well as equipments. However, with the augmentation of therapeutic endoscopy, the extent, likelihood and severity of adverse events have increased as well. The attendant risks and adverse events with therapeutic endoscopy are many folds that of diagnostic endoscopy. Besides endoscopic resection, therapeutic endoscopy is widely utilized for hemostasis in GI bleeds, dilatation of stenosis, enteral stenting, foreign body removal, ablation of Barrett's esophagus etc. Major adverse events associated with interventional endoscopic procedures include bleeding and perforation. Adverse events of endoscopic interventions are diverse and related to the underlying disease, therapeutic modality used and operator's experience. Many of these adverse events can be prevented. Early recognition of an unavoidable adverse event is important to minimize the associated morbidity and mortality., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Submucosal endoscopy essentially regroups peroral endoscopic esophageal myotomy (POEM) and, more recently, pyloromyotomy and tunnel tumor resections. The complication rate of POEM is between 5% and 10%. Complications include gas-related complications, mucosal tears, and bleeding, and are usually managed conservatively or with non-surgical procedures. Only one case of death has been reported. The most commonly identified risk factors for complicated procedures in POEM are short experience with the technique and sigmoid-type esophagus. The rate of gastro-esophageal reflux (GERD) is between 10% and 30% depending on the definitions, with a good clinical response to proton pump inhibitors. For the techniques other than POEM, the number of cases reported is too small to allow identification of the complications, which, in addition, probably vary depending on the organ involved. The management of gas-related complications is conservative and sometimes requiring percutaneous exsufflation (capnoperitoneum) or drainage. The endoscopic management of mucosal tears essentially involves clip placement and, in case of bleeding, the usual hemostasis techniques including stent placement. Importantly, following a rigorous and appropriate learning program is essential to minimize the risk of complications, particularly for specialists with a short experience in the technique., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Background: The optimal amount of thromboembolic prophylaxis to use in bariatric surgery is still unresolved., Objective: The aim of this study was to determine the optimal pharmacologic prophylaxis with minimal bleeding complications for bariatric patients., Setting: A nonrandomized clinical study of 400 consecutive bariatric patients surgically treated between 2008 and 2013 at Peijas Hospital., Methods: The patients, who either underwent mainly a sleeve gastrectomy or a Roux-en-Y gastric bypass, were divided consecutively into 3 subgroups with different approaches to pharmacologic enoxaparin prophylaxis. For the first 100 operated patients (high-dose group), enoxaparin was given at a dose of 40 mg twice daily, starting 1 day before the operation. The next 100 patients (intermediate-dose group) received 40 mg of enoxaparin twice daily, without the dose on the morning of the operation. The last 200 patients (low-dose group) received enoxaparin 40 mg once daily, starting 1 day before the operation and without the dose on the morning of the operation. The primary endpoints in this study were a major bleeding complication and a venous thromboembolism., Results: There were no thromboembolic complications in this study. The difference in bleeding complications between the high-dose group and low-dose group was -10.5% (95% CI from -18.1% to -3.0%), and the difference between high-dose group and intermediate-dose group was -9% (95% CI from -17.4% to -.6%). Age and preoperative weight had no effect on bleeding complications, but hypertension significantly increased the amount of bleeding complications (P = .01, 95% CI from 1.55% to 29.7%)., Conclusion: Thromboembolic complications are avoidable. Enoxaparin (40 mg) given once daily was the safest with regard to bleeding complications. High blood pressure elevates the risk for bleeding., (Copyright © 2016 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.)

The incidence of esophageal perforation or confounding mechanisms of pneumomediastinum specifically introduced by the addition of percutaneous endoscopic gastrostomy (PEG) tube insertion to esophagogastroduodenoscopy have not been described, and pneumomediastinum in the absence of esophageal perforation after PEG has not been reported. Typically, pneumomediastinum is an ominous finding, although benign causes exist. We present two cases of post-PEG pneumomediastinum not correlated with esophageal perforation on follow-up imaging. When pneumomediastinum is detected after PEG, appropriate studies should be undertaken to confirm its cause and to determine treatment plans. Further investigation may be warranted to ascertain the true incidence, causes, and clinical significance of post-PEG pneumomediastinum., (Copyright © 2014 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

Background: Intragastric balloons are designed to occupy space within the stomach and induce satiety. The present study evaluated the safety and efficacy of an intragastric dual balloon as an adjunct to diet and exercise in obese patients compared with diet and exercise alone., Methods: After approval from the institutional review board, patients provided written consent and were randomized to the treatment group (TG) or control group (CG) in a 2:1 ratio. Three sites randomized a total of 30 patients to the TG (n = 21) or CG (n = 9). Patients randomized to the TG underwent endoscopic placement of the dual balloon. Both groups received similar diet and exercise counseling. After 24 weeks, the device was removed. Patient weight, adverse events, and quality of life data were evaluated throughout the 48-week study duration., Results: Our patient population included 26 women and 4 men aged 26-59 years. At 24 weeks, the mean excess weight loss in the TG and CG was 31.8% ± 21.3% and 18.3% ± 20.9%, respectively (P = .1371). At 48 weeks, 24 weeks after device removal, the TG maintained 64% of their weight loss. No deaths, unanticipated adverse effects, early removals, balloon deflations, or balloon migrations occurred. In the TG, 4 patients were readmitted for severe nausea, 1 had asymptomatic gastritis at balloon removal, and 1 patient experienced transient hypoxia during device removal., Conclusion: In the present small study, the dual balloon proved easy to use, was associated with a trend toward greater weight loss than the CG, and demonstrated a good safety profile., (Copyright © 2013 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved.)

The authors report the first case of gas embolism arising during an upper gastrointestinal endoscopy to a patient carrier of a biliary drain placed by radiological way. The hypothesis of a biliary-vascular fistula with abnormal connection between the biliary tree and the hepatic vascular system and finally an arteriovenous intrapulmonary shunt was retained to explain the physiopathology. The immediate stop of the endoscopic procedure and the implementation of symptomatic treatment allowed a favorable neurological outcome without sequelas. The realization of an upper gastrointestinal endoscopy to a patient carrier of a biliary drain has to lead the anaesthesiologists and the gastroenterologists to take care given the incurred risk of gas embolism., (Copyright © 2012 Société française d'anesthésie et de réanimation (Sfar). Published by Elsevier SAS. All rights reserved.)

Unlabelled: Although no clear recommendations are given about when percutaneous endoscopic gastrostomy (PEG) should be placed in amyotrophic lateral sclerosis (ALS) patients, some experts underline the risk of respiratory complications when patients had severe ventilatory muscle impairment (SVMI)., Aim: To evaluate the efficacy of noninvasive ventilation (NIV) and mechanically assisted cough (MAC) to avoid respiratory complications related to PEG placement in ALS patients with SVMI., Material and Methods: Prospective study including ALS patients who had chosen to have PEG placement timed by swallowing dysfunction with the aid of NIV and MAC if needed. PEG was carried out under volume-cycled NIV through a nasal mask. MAC was applied prior to and at the end of the procedure., Results: Thirty ALS patients (60.43±12.03years) were included. Prior to PEG placement: BMI 25.0±4.6kg/m(2), ALSRFS-R 19.5±5.0, Norris bulbar sub-score 15.1±6.6, %FVC 35.9±18.1%, PCF 2.3±1.2L/s, PImax -35.6±24.6cmH(2)O, and PEmax 40.5±23.9cmH(2)O. Three patients had PEG placement under tracheotomy ventilation because NIV SpO(2) was below 88%. No patient died during the procedure nor did any have respiratory complications. Survival at 1month was 100%., Conclusion: Respiratory support provided by volume-cycled NIV and MAC permits successful PEG placement in most ALS patients with SVMI., (Copyright 2010 Elsevier B.V. All rights reserved.)

A 72-year-old woman underwent gastric endoscopic mucosal resection with a cap-fitted endoscope for an adenocarcinoma in situ. She was scheduled for endoscopic follow-up at 1 and 3 months after the procedure. By the third month of follow up, biopsies of a slightly depressed scar area showed an high grade epithelial dysplasia. For this reason a second endoscopic resection (ER) was performed using the oblique soft cap. A perforation in the site of endoscopic resection was immediately observed. The complication was treated successfully by the application of seven clips.

Background: To achieve en bloc resection for large lesions, endoscopic mucosal resection after circumferential precutting and endoscopic submucosal dissection techniques have been developed., Aim: To compare endoscopic submucosal dissection with endoscopic mucosal resection after circumferential precutting in terms of the clinical efficacy and safety., Patients and Methods: 346 consecutive patients underwent their first endoscopic mucosal resection after circumferential precutting (103 patients) or endoscopic submucosal dissection (243 patients) for early gastric cancer and their clinical outcomes were compared., Results: For early gastric cancer >or=20mm endoscopic submucosal dissection group demonstrated significantly higher en bloc resection and en bloc plus R0 resection rate compared with endoscopic mucosal resection after circumferential precutting group. For early gastric cancer with size of 10-19 mm, endoscopic submucosal dissection group also showed significantly higher en bloc resection rate. For early gastric cancer <20mm, however, en bloc plus R0 resection rate for endoscopic mucosal resection after circumferential precutting group was comparable to that for endoscopic submucosal dissection group. In case of R0 resection of intramucosal differentiated cancer, neither group showed local recurrence during the median 29 and 17 months of follow-up. Two groups did not show significant difference in the bleeding or perforation rates., Conclusion: For early gastric cancer <20mm endoscopic mucosal resection after circumferential precutting may be considered as an alternative choice to endoscopic submucosal dissection. However, for early gastric cancer >or=20mm endoscopic submucosal dissection should be considered as the first choice for treating early gastric cancer.

Each year, increasing numbers of bariatric surgeries are being performed to reduce health risks related to obesity. The improvement in health for these patients has promoted an increase in the possibility of pregnancy for some woman. Because there are lifelong adjustments and the possibility of unique complications from bariatric surgery, pregnancy presents special nursing concerns. Very few cases have been identified in nursing literature discussing pregnancy after complications following a bariatric surgery. This article presents a successful pregnancy after a partial pancreatectomy was performed secondary to acute pancreatitis and ischemic enterocolitis as a complication of laparoscopic gastric banding.

Objective: The aim of the present study was to test the potential beneficial effects of an information brochure on undergoing a gastrointestinal endoscopy for the first time. The information provided was based on self-regulation theory, and patients could restrict themselves to reading the summary only., Methods: Patients were randomly assigned to an experimental group receiving the brochure at least 1 day before the gastroscopy (N=47), or to a control group not receiving the brochure (N=48)., Results: The results show that all experimental subjects, except one, fully read the brochure. Those receiving the brochure experienced less anxiety before the gastroscopy and, afterwards, they reported greater satisfaction with the preparation for it. With regard to coping style there were some small moderating effects into the direction expected: low blunters (those not seeking distraction under impending threat) as compared to high blunters showed extra reduced anxiety after reading the brochure. They also tended to read the brochure more often. High monitors (those seeking information under impending threat) receiving the brochure showed reduced anxiety during the gastroscopy as compared to low monitors (tendency)., Conclusion: We conclude that providing patients with the developed brochure constitutes an efficient, beneficial intervention., Practice Implications: The brochure could easily be implemented in standard practice without the necessity to take the patient's coping style into account.

Background: Perforation and bleeding are major complications associated with gastric endoscopic mucosal resection. Evident perforation during endoscopic mucosal resection can be managed by endoscopic clipping. However, management of microperforation is not well established., Patient and Method: From January 2002 to June 2004, 109 early gastric cancers and 300 adenomas were treated with endoscopic mucosal resection. Iatrogenic perforations occurred in 4.16% (n=17) patients. Following exclusion of four evident perforations, microperforation was observed in 3.18% (n=13) patients. The clinical features of microperforation in patients were retrospectively reviewed., Results: In a total of 13 microperforation cases, 2 patients were managed surgically. The remaining patients successfully recovered without surgical management. In the case of 11 patients without surgery, 7 experienced abdominal pain, which required analgesics, 2 patients experienced mild discomfort and 2 patients experienced no symptoms. A body temperature above 37.5 degrees C was observed in 9.1% (n=1) patients and leucocytosis above 9000 microL-1 was in 72.7% (n=8) patients. The mean duration of nasogastric tube drainage was 2.36+/-1.03 days, of fasting 4.18+/-1.17 days, of intravenous antibiotics 5.55+/-1.44 days and of hospitalisation 7.45+/-1.04 days., Conclusion: Microperforation induced by gastric endoscopic mucosal resection can be managed successfully using a non-surgical approach including fasting, nasogastric tube drainage and intravenous antibiotics.

Aim: We studied the use of premixed nitrous oxide and oxygen in 80 patients with neurologic diseases., Patients and Methods: Mean ages ranged 10 +/- 5 yrs. Twenty-three patients (29%) were mentally retardated among which 17 of them presented with severe epilepsy. Painful procedures consisted of: lumbar punctures (80%), intravenous access (7), gastric endoscopy (6), skin biopsy (4), gastrostomy tube management (3). High-risk children were continuously monitored using ECG, non invasive blood pressure and transcutaneous oxygen saturation. We studied acceptation of the inhalation, vital signs, satisfaction of children, parents, medical and nursing staffs; side effects were compared with a group of healthy children undergoing venous access before induction of anesthesia., Results and Discussion: Acceptation increased with age. No significant changes in vital signs variables were observed. Satisfaction rate regarding the method was 88% for all children, parents, physicians and nurses. No serious undesirable event (as respiratory depression, seizure, inhalation of gastric content) occurred in these patients. The more frequent side-effects were: drowsiness during and after inhalation (35 and 9% respectively in the handicapped patients); nausea and vomiting (8%), headaches (3%), were more frequent than reported in literature but there were 25% of meningitis among our patients., Conclusion: Premixed nitrous oxide and oxygen was effective for reducing procedural pain and anxiety in children with neurological disorders, even in severely handicapped patients, with minor side-effects.

The role of percutaneous endoscopic gastrostomy (PEG) in patients undergoing resection of head and neck malignancy is well established. The procedure may be performed pre- or post-operatively with intravenous sedation or alternatively under general anaesthesia at the time of tumour resection. There are concerns as to the safety of PEG, particularly when performed under intravenous sedation. Elderly patients with poor general health and those with airway compromise may be at significant risk. We believe that patients with advanced oral malignancy often fall into such groups and, therefore, we routinely perform PEG at the time of resection. The aim of this study was to determine the potential risk factors for PEG insertion in patients with advanced oral malignancy and present our experience with insertion at the time of resection. A retrospective study was undertaken of the risk factors for PEG insertion in 72 consecutive patients with stage IV oral cancer treated between April 1993 and March 2000. Age, sex, tumour site, past medical history, American Society of Anaesthesiologists (ASA) and laryngoscopy grade, as an assessment of potential airway compromise, were recorded. There were 72 patients, 40 males and 32 females, with a mean age of 63 years (27-90). Eighteen patients (25%) scored 3 or 4 on the ASA scores of physical status. Laryngoscopy grades were recorded in 65 patients; of these, 18 (25%) had reduced visualisation of the larynx and in two patients not even the epiglottis could be seen. It is concluded that patients with advanced oral cancer have significant risk factors for PEG placement. However, PEG can be safely performed at the time of ablative surgery and has the advantage of avoiding an additional operative event for the patient.

The aim of this retrospective study was to evaluate the cost and benefit of percutaneous fluoroscopic gastrostomy feeding (PFG) in 70 cancer patients with advanced stage disease of the upper-aero digestive tract; we retrospectively analyzed the consequences in terms of nutritional status (evaluated by weight and body mass index), the possibility to lead a treatment by high dose chemo-radiotherapy to the end of the therapeutic schedule, the feasibility, complications and cost ratios. Three weeks after the procedure, no major complication was observed, the initial nutritional threshold was conserved. PFG is a safe and effective technique; the additional cost is low (2%) compared with the total cost of hospitalization.

Hypoxaemia during oesophagogastroduodenoscopy is well documented and contributes to cardiac arrhythmias and occasional deaths from endoscopy. In 50 patients sedated with intravenous midazolam and examined with a large-diameter endoscope, oxygen desaturation was abolished by giving oxygen (2 litres/min) by way of nasal cannulae throughout the procedure.

Contamination of twenty endoscopes used in patients with AIDS was assessed. The suction-biopsy, air, and water channels and the insertion tube were sampled after use, after washing in detergent, and after disinfection for 2 min in 2% alkaline glutaraldehyde. The polymerase chain reaction with Southern blotting, cell cultures, and antigen immunoassay were used to detect human immunodeficiency virus (HIV). Samples were also examined for cytomegalovirus, adenoviruses, enteroviruses, herpes simplex virus, myxoviruses, hepatitis B surface antigen, fungi, and bacteria. Seven of twenty unwashed endoscopes were contaminated by HIV. Commensal bacteria were found in all endoscopes, Candida albicans in six, Staphylococcus aureus in five, and Pseudomonas aeruginosa in five. Washing alone removed all detectable organisms from 66 of 68 contaminated sites; Neisseria spp were recovered from two air channels after washing but not after disinfection. Washing achieved a mean reduction of 4.93 (95% confidence interval 3.69-6.17) colony forming units per ml.