Fiberoptic Endoscopy of the Gastrointestinal Tract in Infants and Children

Fiberoptic endoscopy of the upper gastrointestinal tract was performed on 53 patients without incident, ranging in age between two months and 18 years, of whom 35 were out patients at the time of examination. Of 27 patients with recurrent abdominal pain and normal upper gastrointestinal series, eight had abnormal findings at endoscopy: a duodenal ulcer in four, a gastric ulcer in two and duodenitis in two. Of 18 patients with hematemesis and/or melena, esophageal varices were demonstrated both by endoscopy and x-ray in two, gastric ulcer by endoscopy in three and x-ray in one, duodenal ulcer by endoscopy in three and by x-ray in two, esophagitis by endoscopy only in one patient, erosive gastritis by endoscopy in five and by x-ray in two and duodenitis by endoscopy in three and by x-ray in two. Of the remaining eight patients with abnormal x-rays findings and other symptomatology, endoscopy demonstrated foreign bodies in two (coins, esophagus and stomach), duodenitis in two, a gastric ulcer in one, a duodenal ulcer in one and normal examination in two. The data indicate that fiberoptic endoscopy significantly improves diagnostic accuracy in the evaluation of disorders of the upper gastrointestinal tract in children and is a safe and effective procedure in ambulatory pediatric patients.     

Deformity of duodenal bulb, gastric metaplasia of duodenal regenerating mucosa and recurrence of duodenal ulcer： A correlated study

AIM: To investigate the correlation among the presence and degree of gastric metaplasia of duodenal regenerating mucosa, the deformity of bulb and the recurrence of duodenal ulcer. METHODS: A total of 99 patients with duodenal ulcer were treated with H2-antagonist with or without antimicrobial therapy. All patients received follow-up endoscopic examinations 6 wk after treatment. When the ulcer(s) were noted to be healed, two biopsies were taken from the ulcer scar for histological study of gastric metaplasia, and 4 biopsies were taken from antrum for Helicobacter pylori (H pylori) study. Out of these cases, 44 received further follow-up endoscopic examinations after 3,6 and 12 mo respectively for studying the recurrence rate of duodenal ulcers. The correlation among ulcer recurrence, degree of gastric metaplasia of regenerating mucosa, bulbar deformity, and colonization of H pylori in the stomach was then studied. RESULTS: The results showed that there was a strong correlation between the deformity of duodenal bulb and the degree of gastric metaplasia of regenerating duodenal mucosa. The recurrence rate of duodenal ulcer had a significant difference between patients with and without H pylori colonization in the stomach (P<0.001). The greater the degree of gastric metaplasia of duodenal regenerating mucosa, the higher the recurrence rate of duodenal ulcer (P= 0.021). The more deformed the duodenal bulb, the higher the incidence of recurrence of duodenal ulcer (P = 0.03). CONCLUSION: There is a correlation among deformity of duodenal bulb, gastric metaplasia of duodenal regenerating mucosa and recurrence of duodenal ulcer. A more severely deformed duodenal bulb is closely related to a greater extent of gastric metaplasia. Both factors contribute to the recurrence of duodenal ulcer.     

CLINICAL INVESTIGATION OF UPPER GASTROINTESTINAL HEMORRHAGE AFTER PERCUTANEOUS ENDOSCOPIC GASTROSTOMY

Background: Upper gastrointestinal (GI) hemorrhage after percutaneous endoscopic gastrostomy (PEG) is sometimes reported as one of the serious complications. Our purpose was to clarify the cause of upper GI hemorrhage after PEG. Patients and Methods: We retrospectively investigated the causes of upper GI hemorrhage among a total of 416 patients out of 426 consecutive patients who underwent PEG in our institution, excluding 10 patients who showed upper GI tumors on PEG placement. Results: Among 17 patients who developed upper GI hemorrhage after PEG, three and four patients showed PEG tube placement and replacement‐related hemorrhage, respectively; these lesions were vascular or mucosal tears around the gastrostomy site. Ten patients experienced 12 episodes of upper GI hemorrhage during PEG tube feeding. The lesions showing bleeding were caused by reflux esophagitis (five patients), gastric ulcer (two patients), gastric erosion due to mucosal inclusion in the side hole of the internal bolster (two patients), and duodenal diverticular hemorrhage (one patient). Anticoagulants were administered in six patients, including four patients with replacement‐related hemorrhage and one patient each with reflux esophagitis and gastric ulcer. Conclusions: Reflux esophagitis was the most frequent reason for upper GI hemorrhage after PEG. The interruption of anticoagulants should be considered for the prevention of hemorrhage on the placement as well as replacement of a gastrostomy tube.     

Nasogastric feeding tube placement in patients with esophageal cancer: application of ultrathin transnasal endoscopy

BACKGROUND: Patients with esophageal cancer often present with dysphagia and malnutrition. Obstructive symptoms may improve after radiotherapy and chemotherapy. Nutrition support via a nasogastric tube (NG) or gastrostomy is very important during treatment. The newly developed ultrathin endoscope (Olympus, GIF-N230, outer diameter: 6 mm) has a smaller diameter than the standard endoscope and can be introduced into the esophagus via the nasal cavity. This article reports on the use of an ultrathin endoscope for NG placement for patients with esophageal cancer who presented with dysphagia and failed traditional NG tube placement. METHODS: A consecutive series of 40 patients with esophageal cancer were referred to our hospital from November 2001 to October 2002 for endoscopic placement of NG tubes due to failure of traditional methods of NG placement. An ultrathin endoscope was used to advance the guidewire into the stomach via the nasal cavity. After withdrawal of the scope, the NG tube was inserted over the guidewire under fluoroscopy. OBSERVATIONS: A total of 71 procedures were performed in 40 patients (37 males, 3 females), age 57 +/- 15 years (range, 37-91 y). Seventy procedures (99%) were successful in completing NG tube placement by using an ultrathin transnasal endoscope. Only one procedure failed because the esophageal lumen was completely occluded and the guidewire was not able to be passed through the obstructed site. The average duration that the NG tube was left in place was 49 +/- 35 days (range, 2-144 days). No procedure-related complications, such as bleeding or perforation, occurred. CONCLUSIONS: Using ultrathin transnasal endoscopy to place an NG tube for esophageal cancer patients is effective and safe. It simplifies the procedures and increases the success rate.     

Mini-laparoscopically guided percutaneous gastrostomy and jejunostomy

BACKGROUND: Percutaneous endoscopic tube placement can be problematic under certain circumstances: absence of transillumination of the abdominal wall, percutaneous jejunostomy in patients with a PEG tube and recurrent aspiration, enteral feeding access after gastrectomy, and obstruction of the upper GI tract. As an alternative in these problematic situations, a technique was developed for placing feeding tubes under visual control by using mini-laparoscopy. METHODS: Placement of a feeding tube with mini-laparoscopy with the patient under conscious sedation was considered for 17 patients in whom standard PEG placement was impossible. Techniques used were the following: combined mini-laparoscopy/endoscopy for placement of a percutaneous gastrostomy or jejunostomy, and mini-laparoscopic-guided direct tube placement in cases of obstruction of the upper GI tract. OBSERVATIONS: In 13 patients, mini-laparoscopic-assisted tube placement was successful. In 4 patients, adhesions or peritoneal carcinomatosis prevented laparoscopic visualization of the stomach or small bowel. The combined mini-laparoscopic/endoscopic approach allowed a successful insertion of gastric tubes in 6 patients and jejunal tubes in 4 patients. Direct insertion of a percutaneous endoscopic jejunostomy tube without enteroscopy was feasible in all 3 patients with obstruction of the upper GI tract. No complication occurred. CONCLUSIONS: Mini-laparoscopy-assisted tube placement is a simple and safe alternative when endoscopic percutaneous tube placement is problematic or not feasible.     

Is esophagoscopy alone sufficient for patients with reflux symptoms?

BACKGROUND: Unsedated esophagoscopy with ultrathin endoscopes is a valuable screening modality for Barrett's esophagus, but the stomach and the duodenum cannot be examined completely with the smallest and best tolerated of these endoscopes. There are no data as to how often disease in the stomach and the duodenum would be missed when using this screening strategy. Our hypothesis is that patients with reflux symptoms, in the absence of daily abdominal pain, nausea, or history of ulcer, were unlikely to have clinically significant gastroduodenal disease. METHODS: Patients scheduled for upper endoscopy at a single outpatient endoscopy unit in a tertiary referral center were screened. The inclusion criterion was reflux symptoms as the primary indication for upper endoscopy. Patients with another valid indication were excluded. A detailed history was recorded and symptom questionnaire completed for each patient before endoscopy; these data were compared with the endoscopy findings. RESULTS: A total of 175 patients were included. Indications for upper endoscopy were the following: worsening symptoms (n=74), ongoing reflux despite therapy (n=27), and long-standing reflux (n=74). Major esophageal findings were discovered in 95 patients. In 10 patients, major gastric or duodenal findings were detected as follows: erosive gastritis (n=8), gastric ulcer (n=2), duodenal ulcer (n=2), erosive duodenitis (n=2), and duodenal polyp (n=1). Daily abdominal pain (p=0.014) or possibly daily nausea (p=0.028 unadjusted, 0.197 adjusted) was associated with major gastric/duodenal disease. Patients without daily abdominal pain, nausea, or a history of gastric/duodenal ulcer were much less likely to have major disease (0.9%) than patients with one of these predictors (13.2%, p=0.00097). CONCLUSIONS: Daily abdominal pain and nausea, in combination with a history of ulcer disease, are strong predictors of major gastric or duodenal disease. Patients with reflux without these predictors are highly unlikely to have a major disease involving the stomach or duodenum, and are suitable candidates for esophagoscopy alone.     

病毒性肝炎患者的胃镜表现

目的：探讨病毒性肝炎患者的胃镜表现。方法：２６４例肝炎病人中肝硬变１７３例,慢性肝炎６１例,急性肝炎３０例,分别观察其胃镜下胃粘膜改变的特征及其与临床的关系。结果：门脉高压性胃病、消化道溃疡及糜烂性胃炎、浅表性胃炎、Ｈｐ阳性等均为病毒性肝炎患者的常见胃镜表现。门脉高压性胃病多发性在胃底、胃体;溃疡多发生于胃窦及球部。门脉高压性胃病及胃粘膜糜烂的范围和程度与食道静脉曲张程度相关。结论：病毒性肝炎患者     

Technical modifications for improving the success rate of PEG tube placement in patients with head and neck cancer.

BACKGROUND: Patients with head and neck cancer (HNC) benefit from nutritional support by means of PEG tubes, but endoscopy may be impossible when there is partial or complete trismus and/or stenosis or occlusion of the upper aerodigestive tract. METHODS: PEG tubes were placed in 277 patients with HNC. Oral insertion of an endoscope into the esophagus was impossible in 27 patients. Transnasal endoscopy was performed (n = 4). In the cases of high-grade tumor obstruction, the endoscope was introduced into the esophagus through a straight laryngoscope (n = 9). When upper aerodigestive tract occlusion was present, endoscopy with PEG placement was successfully performed during surgery by means of the opened pharynx after tumor resection (n = 12). RESULTS: In 25 of the 27 cases PEG tubes could be placed by using the above alternative techniques. There were no immediate complications, and no complications occurred within 30 days of PEG placement. CONCLUSIONS: Transnasal, straight laryngoscopic, or intraoperative open endoscopy can improve the success rate for PEG tube placement in patients with HNC.     

Extrusion of PEG tube from the stomach with fistula formation: an unusual complication of percutaneous endoscopic gastrostomy

Percutaneous endoscopic gastrostomy (PEG) has become an accepted technique for providing long-term enteral feeding. We report two cases of extrusion of the PEG tube into a short fistulous tract that communicates with the stomach. Although this unusual complication led to difficulty with tube feedings, both patients were asymptomatic, and, in one case, it was possible to reposition another catheter in the stomach via the fistula.     

CASE REPORT OF TRICHOBEZOAR CAUSING GASTRIC PERFORATION

A 17‐year‐old girl with trichophagia (hair eating) habits was admitted to our hospital because of severe acute epigastralgia in June 1997. Abdominal computed tomography showed free air in the abdominal cavity and a heterogeneous mass in the stomach and the duodenum. A perforation on the anterior wall of the lower gastric body was found by urgent laparoscopic surgery and thus a laparoscopic omental patch repair was performed. Endoscopic examination after the operation revealed a large trichobezoar and gastric ulcers. An attempt made by us to extract the bezoar by endoscopy using a flexible outer‐tube was unsuccessful. The gastric ulcer relapsed in November 1997. Another attempt was made to extract the bezoar with laparoscopic instrumentation using a percutaneous gastrostomy port associated with oral gastroendoscopy. Only the part of the bezoar in the duodenum was extracted, and multiple superficial ulcers and erosions in the second part of the duodenum were found. Removal of the entire bezoar in the stomach required surgical gastrostomy. An endoscopic examination after the operation revealed healing of the gastric ulcer and duodenal erosions. Gastric perforation due to trichobezoar is a rare complication. Since the attempt to remove the trichobezoar in a minimally invasive manner failed, a surgical gastrostomy was required.     

Cervical inlet patch-optical coherence tomography imaging and clinical significance

AIM: To demonstrate the feasibility of optical coherence tomography (OCT) imaging in differentiating cervical inlet patch (CIP) from normal esophagus, Barrett’s esophagus (BE), normal stomach and duodenum.METHODS: This study was conducted at the Veterans Affairs Boston Healthcare System (VABHS). Patients undergoing standard esophagogastroduodenoscopy at VABHS, including one patient with CIP, one representative patient with BE and three representative normal subjects were included. White light video endoscopy was performed and endoscopic 3D-OCT images were obtained in each patient using a prototype OCT system. The OCT imaging probe passes through the working channel of the endoscope to enable simultaneous video endoscopy and 3D-OCT examination of the human gastrointestinal (GI) tract. Standard hematoxylin and eosin (H and E) histology was performed on biopsy or endoscopic mucosal resection specimens in order to compare and validate the 3D-OCT data.RESULTS: CIP was observed from a 68-year old male with gastroesophageal reflux disease. The CIP region appeared as a pink circular lesion in the upper esophagus under white light endoscopy. OCT imaging over the CIP region showed columnar epithelium structure, which clearly contrasted the squamous epithelium structure from adjacent normal esophagus. 3D-OCT images obtained from other representative patients demonstrated distinctive patterns of the normal esophagus, BE, normal stomach, and normal duodenum bulb. Microstructures, such as squamous epithelium, lamina propria, muscularis mucosa, muscularis propria, esophageal glands, Barrett’s glands, gastric mucosa, gastric glands, and intestinal mucosal villi were clearly observed with OCT and matched with H and E histology. These results demonstrated the feasibility of using OCT to evaluate GI tissue morphology in situ and in real-time.CONCLUSION: We demonstrate in situ evaluation of CIP microstructures using 3D-OCT, which may be a useful tool for future diagnosis and follow-up of patients with CIP.     

Unsedated transnasal percutaneous endoscopic gastrostomy carried out by a single physician

Aim: The present prospective observational study investigates the safety of transnasal percutaneous endoscopic gastrostomy (T‐PEG) carried out by a single physician using an ultrathin endoscope. Methods: A single endoscopist attempted the unsedated transnasal insertion of a 20‐Fr PEG tube using a pull‐method in 31 dysphagic patients: 11 females and 20 males aged 76.5 ± 10.6 (46–96) years, using a 5‐mm‐diameter endoscope. The indications for PEG, cardiopulmonary function before and after T‐PEG, operation time, success or failure, and any immediate adverse events that occurred during each procedure were recorded. Complications, including peristomal infection, systemic infection, tube lifespan, and patient mortality were monitored throughout the post‐T‐PEG follow‐up period. Results: Thirty (96.8%) of the transnasal PEG insertions were successful. The mean operation time was 14.7 ± 2.9 (10–20) min, and cardiopulmonary function did not change before and after T‐PEG. Complications included three (10%) cases of epistaxis, eight (26.6%) cases of minor Pseudomonas wound infection and two cases of Foley‐related urinary tract infection (UTI). No self‐extubation was observed, and the mean lifespan of the PEG tubes was 10.7 ± 2.2 months. Four patients died from pneumonia 10 months after T‐PEG insertion. Conclusion: Unsedated T‐PEG insertion carried out by a single physician is a feasible and safe procedure. No major complications or mortality were observed following the procedures; only minor Pseudomonas aeruginosa wound infections were noted. It is an alternative method for dysphagic patients when transoral insertion of endoscopy is impossible.     

Gastric metaplasia of regenerating duodenal mucosa and deformity of duodenal bulb: A correlative study

The correlation between the presence and degree of gastric metaplasia of regenerating duodenal mucosa and the deformity of duodenal bulb was studied. Based on the endoscopically morphological patterns of bulb, the duodenal ulcers were divided into three types: type I, with a normal-shaped bulb; type II, with a mildly deformed bulb; and type III, with a markedly deformed bulb. A total of 159 patients with active duodenal ulcers were scheduled to be treated with H₂-receptor antagonists. Of these patients, 124 proved to have a healed duodenal ulcer 4 weeks after initial treatment upon follow-up endoscopic examinations. Two biopsies were taken from the centre of the ulcer scar when the ulcer was found to be healed for light microscopic study. Histologically, the degree of gastric metaplasia was divided into three grades: grades 0, 1 and 2. The results show that a healed duodenal ulcer with a normal-shaped bulb is not frequently accompanied by gastric metaplasia. However, a healed ulcer with a markedly deformed bulb has a high incidence and degree of gastric metaplasia, which may be easily colonized by Helicobacter pylori and thus develop an environment of easy recurrence. Therefore, a cycle of healing and recurrence may exist in patients with a duodenal ulcer and a markedly deformed bulb. Eradication of H. pylori may be the best way to break this cycle.     

Radiography and endoscopy in the diagnosis of the gastroduodenal ulcer]

In the clarification of circumscribed processes in stomach and duodenal bulb radiodiagnostics and endoscopy supplement themselves in an ideal way. The endoscopy seems to have advantages in recognition and explanation of findings on the cardial and subcardial parts of the stomach as well as on the operated stomach. Deformation of the duodenal bulb and changes of the post-stenotic parts can be better judged radiologically. The complete healing of an ulcer is exactly recognisable only by means of endoscopy. Linear ulcers are often not to be seen in radiodiagnostics. With the help of the aimed biopsy the decision on benignity or malignity of the ulcerating process has become easier. Every radiologically not certainly explainable findings and every discrepancy between X-ray picture and complaints of the patients should bring about an endoscopic examination.     

Usefulness of a novel observation method using a small‐diameter rigid telescope through the gastrostomy catheter at exchange

Background and Aim: During catheter exchange for percutaneous endoscopic gastrostomy (PEG), endoscopic or radiological observation is widely used to confirm that the catheter is placed correctly. However, to carry out these procedures in all patients at every catheter exchange costs time and money. It is therefore important to develop a reliable and safe method, which can also be used outside the clinic, to check the exchanged catheter. We examined the usefulness and safety of intragastric observation using a small‐diameter rigid telescope, which can be inserted through the catheter lumen of a PEG tube. Methods: Before and after catheter exchange, observation was carried out using the rigid telescope E02700 (external diameter: 2.7 mm; Nisco Co., Tokyo, Japan). After air insufflation by the novel air‐supplying adaptor, the rigid telescope was inserted through the button catheter for observation of the fistula and gastric lumen with guidewire introduction. Next, the old gastrostomy catheter was replaced by a new one, using the guidewire technique. Subsequently, the telescope was re‐inserted to check the fistula and gastric lumen. Results: With this technique, observation inside the stomach as well as inside the fistula was achieved without any complication during all 80 exchange trials in the 55 patients studied. A homemade adaptor was used effectively to convey air and water into the stomach during the observation. Conclusion: It is suggested that observation inside the stomach using a small‐diameter rigid telescope at the time of gastrostomy exchange is useful and safe for checking the location of the newly fixed catheter.     

Somatostatin in mucosa of stomach and duodenum in gastroduodenal disease.

In order to study the distribution of somatostatin in the upper digestive tract in man, biopsies were taken through endoscopy or at surgery from the fundus, antrum, and duodenal bulb in 15 subjects with no gastroduodenal lesion, 12 patients with severe antral and/or fundic atrophy in the sampling area, 28 patients with an active duodenal ulcer, and 14 patients with a nonmalignant gastric ulcer. The specimens were extracted in 2 N acetic acid and tested for somatostatin content with a specific radioimmunoassay. In the control subjects, the somatostatin concentration (nanograms per milligram of wet weight) was 0.60 +/- 0.12 in the fundus, 1.68 +/- 0.33 in the antrum, and 1.35 +/- 0.30 in the duodenal bulb. Atrophy of the gastric mucosa was associated with a reduction of the somatostatin concentration in the fundus and the antrum. No significant variation was observed in the present series of patients with gastric ulcer. Duodenal ulcer was associated with a reduction of the somatostatin concentration in the antrum (P less than 0.02). These results indicate that somatostatin is widely distributed from fundus to duodenal bulb in adult human subjects, and that lower antral concentrations are observed in patients with duodenal ulcer.     

Endoscopic examination of the duodenal bulb: clinical evaluation of forward- and side-viewing fibreoptic systems in 200 cases

Two-hundred fibreoptic examinations of the duodenal bulb were carried out on 149 patients. The importance of combining the initial examination with a general endoscopic survey of the oesophagus and stomach is stressed. At the present time full examination of the duodenal bulb requires the use of both a side-viewing and forward-viewing endoscope in more than a quarter of cases. The safety and acceptability to the patient of multiple endoscopic examinations carried out as an outpatient procedure has been demonstrated, and the value of the procedure in x-ray negative dyspepsia, in the follow up of ulcer therapy, and in acute upper gastrointestinal haemorrhage has been shown.     

Successful biliary drainage using a metal stent through the gastric stoma

We report a case of biliary drainage for malignant stricture using a metal stent with an ultrathin endoscope through the gastric stoma. A 78-year-old female was referred to our hospital for jaundice and fever. She had undergone percutaneous endoscopic gastrostomy (PEG) for esophageal obstruction after radiation therapy for cancer of the pharynx. Abdominal contrast-enhanced computed tomography showed a 3-cm enhanced mass in the middle bile duct and dilatation of the intra-hepatic bile duct. We initially performed endoscopic retrograde cholangiopancreatography (ERCP) with a trans-oral approach. However, neither the side-viewing endoscope nor the ultrathin endoscope passed through the esophageal orifice. Thus, we eventually performed ERCP via the PEG stoma using an ultrathin endoscope. We performed biliary drainage with a 6F introducer self-expanding metal stent. The cytology findings obtained by brush cytology showed malignancy. Her laboratory results were restored to normal levels after drainage and no complication occurred.     

Multiple giant duodenal ulcers associated with duodenal gastrinoma

A 59-year-old Japanese man with a history of chronic hepatitis C and cirrhosis was admitted to hospital because of severe abdominal pain and diarrhea. His discomfort had begun 2 months earlier and was localized to the upper abdomen. Upper gastrointestinal endoscopy showed multiple ulcerative lesions from the duodenal bulb to the descending part of the duodenum, one of which was a giant ulcer that filled half of the intestinal lumen. Despite continuous intravenous lansoprazole therapy, his abdominal symptoms did not improve. Upper gastrointestinal endoscopy was again performed to detect the tumor, but it was difficult to observe the tumor with a conventional endoscope. We then inverted a transnasal endoscope into the duodenum, and this enabled us to detect a 15-mm submucosal tumor in the upper wall of the duodenal bulb. Examination of specimens from endoscopic ultrasonography fine-needle aspiration biopsy of the tumor revealed gastrinoma in the duodenal bulb. We decided to perform an operative resection. The patient’s symptoms resolved after surgery, and he remained asymptomatic at follow-up 18 months later. Therefore, when it is difficult to detect the tumor directly by conventional endoscopy, we recommend that attempts be made to detect the tumor by inverting a transnasal endoscope into the duodenal bulb.     

Effectiveness of outpatient percutaneous endoscopic gastrostomy replacement using esophagogastroduodenoscopy and propofol sedation

AIM: To evaluate the effectiveness of outpatient percutaneous endoscopic gastrostomy (PEG) replacement using esophagogastroduodenoscopy (EGD) and propofol sedation. METHODS: We retrospectively assessed the outcome and complications of consecutive patients referred for PEG replacement which was performed using EGD under propofol sedation in the outpatient setting. The success rate, the mean dose of propofol, procedure time, EGD findings, discharge time from endoscopy unit, respiratory depression, and complications within 72 h of the procedure were evaluated. In a subset of these patients, the blood concentrations of propofol were measured.RESULTS: All 221 patients underwent successful PEG replacement. The mean dose of propofol was 34 mg (range, 20-60 mg) with a mean procedure time of 5.9 min (range, 3-8 min). Reflux esophagitis (12 patients), gastric ulcer (5), gastric neoplasm (2), and duodenal ulcer (1) were newly diagnosed at replacement. Discharge from endoscopy unit was possible in 100% of patients 45 min after the procedure. Only 3.6% (8) required transient supplemental oxygen. No complications occurred within 72 h of the procedure. During EGD the level of sedation and propofol blood concentrations after administration of propofol (30 mg) in these PEG patients corresponded to those of propofol (60 mg) in middle aged subjects (control).