Failure of increased use of endoscopy to influence complication rate in peptic ulcer disease.

Abstract

and no further episodes of ventricular fibrillation occurred. Arterial blood gas tensions at this time were pH 7-3, oxygen pressure 50 7 kPa (380 mm Hg), and carbon dioxide pressure 6-4 kPa (48 mm Hg); standard bicarbonate concentration 21-5 mmol(mEq)/l; and base excess -2-5 mmol(mEq)/l.Amiodarone was continued as an intravenous infusion with 600 mg in 5% dextrose over 12 hours and 300 mg in 5% dextrose for a further 24 hours, during which time an electrocardiogram showed varying degrees of heart block and nodal rhythms. His clinical state improved, and he required only intravenous atropine on two occasions for bradycardia. Serum digoxin concentration was above 5 t&g/l on admission, but the sample was not retained for more accurate determination. Digoxin concentrations did not fall into the therapeutic range until day 5, when a concentration of 1-4 ,ug/l was recorded. As the plasma half life in overdosage is about 13 hours3 the peak digoxin concentration would have been over 40 /eg/l.

Improving the selection of patients for upper gastrointestinal endoscopy.

“…Others have concluded that there is a need to improve the use of endoscopy through better selection and targeting of patients."' 12 14 16 We undertook a retrospective study of elective upper gastrointestinal endoscopies performed in a single unit. Our primary aims were to investigate (1) whether patients undergoing endoscopies which show significant pathology differ a priori from patients in whom significant pathology is not found, and (2) whether endoscopies adjudged to have influenced patient management differ a priori from those adjudged not to have influenced patient management.…”

Endoscopists’ Opinions of Indications for Upper Gastrointestinal Endoscopy

“…It is unclear whether increased use of endoscopy has provided benefit to patients or society. Also, it has been suggested that the increased use of endoscopy does not influence the diagnosis or prognosis of gastric cancer (4) or the rate of major complications of peptic ulcer disease (5). The rate of increase in endoscopic procedures can be altered through the introduction of quality assurance programs (2).…”