No abstract

Nasal introduction of thin endoscopes is better tolerated by patients than conventional gastroscopy, minimizing the need for sedation. However, technical improvements in thin endoscopes (a wider working channel, increased length and better image quality) would increase their usefulness.

No abstract

Topical pharyngeal anesthesia in unsedated patients undergoing diagnostic upper gastrointestinal endoscopy improves tolerance and makes examination easier.

In 78 patients with high-risk bleeding peptic ulcers (either with active bleeding or non-bleeding visible vessel) endoscopic hemostasis by injection of adrenaline and polidocanol was attempted. Sclerotherapy was performed in 70 (90%) patients. Initial hemostasis was achieved in 35 (94.5%) patients with active bleeding, and permanent hemostasis in 61 (87%). Efficacy of injection therapy was significantly lower in ulcers larger than 2 cm (p = 0.001), and in those located on the posteroinferior duodenal wall (p = 0.03). It was not possible to perform endoscopic injection in 8 (10%) patients due to difficulty of access, lesions located mainly high on the lesser gastric curvature and on the posteroinferior duodenal wall. From these results we conclude that endoscopic injection is a very useful technique for the initial treatment of high-risk bleeding peptic ulcer, although the size and anatomical location of the lesions may be a limitation of its use.