Complications in relation to fiberoptic gastrointestinal endoscopy were recorded prospectively during the five-year period 1980-1984. Diagnostic esophago-gastroduodenoscopy (EGD) had non-fatal complications in ten out of 7,314 procedures (0.14%) and three deaths (0.04%). Therapeutic EGD had non-fatal complications in eight out of 440 procedures (1.8%) and two deaths (0.5%). Diagnostic endoscopic retrograde cholangiopancreatography (ERCP) had non-fatal complications in 15 out of 1,930 procedures (0.8%) and one death (0.05%). Therapeutic ERCP had non-fatal complications in 14 out of 554 procedures (2.5%) and six deaths (1.1%). Diagnostic colonoscopy had non-fatal complications in five out of 3,538 procedures (0.14%) and therapeutic colonoscopy in 21 out of 1,055 procedures (2.0%). There were no deaths in connection with diagnostic or therapeutic colonoscopy. The recommendations based on this series are: Put greater emphasis on a proper evaluation of indications and contraindications. Avoid sedation of patients with respiratory failure. If possible, postpone procedures which may cause bleeding in patients with impaired hemostasis until proper correction has been achieved.

60 mg lansoprazole once daily for 5 days is an easy to use method for diagnosing GORD in endoscopy-negative patients. Using 24-h oesophageal pH monitoring as the reference method, the sensitivity was relatively high, while the specificity was lower. Further studies are needed to determine how a PPI could be used as a diagnostic test in GORD.

Serum immunoglobulins and C3 levels, auto-antibodies to smooth muscle (SMA), mitochondria (MA), and nuclei (ANA), rheumatoid factors (RF), HB-antigen and HB-antibody were studied in 9 groups of liver disease. Hypergammaglobulinaemia was a prominent feature in most groups, IgG being particularly raised in active chronic hepatitis, IgM in primary biliary cirrhosis, and IgA in alcoholic liver disease, respectively. IgE was often increased in alcoholic liver disease and was frequently low in hepatic tumours, whereas IgD showed no typical pattern in any liver disorder. SMA was most frequently found in active chronic hepatitis (68%), and MA in primary biliary cirrhosis (58%), while ANA was detected in 50% of the patients with active chronic hepatitis. However, a pronounced over-lap of tissue antibodies was observed among the various groups of liver disease, particularly in active chronic hepatitis and primary biliary cirrhosis. The concurrent presence of SMA and ANA was most frequent in active chronic hepatitis. It was not excluded that antibody titres might have provided better diagnostic discrimination, since titration of antibodies was not performed. Low C3 levels in active chronic hepatitis were correlated with low levels of other liver-synthetized proteins, and no evidence was found of increased consumption by immunologic reactions.

Endoscopic treatment is a safe procedure with a low mortality, and, if successful, the need for emergency surgery is substantially reduced. In the relatively few patients requiring surgery after unsuccessful endoscopy, the mortality remains high.