[Indications for gastroscopy].
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The report discusses a computerized system of early detection of gastrointestinal diseases and risk group formation using special formalized questionnaires to be filled by industrial enterprise personnel. Endoscopic examination of 1,240 followed-up patients detected stomach cancer in 32 cases, gastric and duodenal ulcer--195, gastric polyps--37 and various forms of gastritis--in 766 cases. As a result of a computerized processing of the questionnaire-based data, 1,084 subjects were referred to group I. An endoscopic examination of this group carried out at a plant's medical station identified stomach cancer in 13 cases, gastric and duodenal ulcer--110, gastric polyp--46 and various forms of gastritis--in 803 cases.
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A considerable diagnostic value of endoscopy for the detection of recurrent ulcers and other postoperative syndromes was shown on the basis of the experience with endoscopies in 21 patients after gastroenterostomies , 281 patients after gastric resection and 96 patients after vagotomies performed for the ulcer disease of the stomach and duodenum. The methods of examining and the endoscopic picture after different operations are found to be of particular character. To study the state of the afferent loop after Bilroth -II resection of the stomach it is expedient to associate endoscopy with rentgenological examination. Endoscopy can be also used for some postoperative complications.
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Midazolam (Ro 21-3981; Dormicum ) is a new water-soluble benzodiazepine. Compared with diazepam and flunitrazepam, it has the advantage of a short half-life and good tolerability after intravenous administration. It induces light sleep 1/2 to 2 min after injection, and anterograde amnesia. It has minimal hemodynamic and respiratory effects. We administered midazolam by intravenous injection in a dose of 3-7 mg to 100 patients about to undergo esophago-, gastro-, or duodenoscopy. The patient became quiet and relaxed, falling into a light sleep but remaining capable of following simple instructions. After completion of the endoscopy, the patients were half awake, and listened attentively to the report. They subsequently usually slept for 1-2 h, afterwards remembering nothing of the procedure. Two (at most, 3) hours after injection, the patients were again completely awake and able to go home or back to work. In some cases, concentration was slightly impaired for the rest of the day. Compared with other premedications , midazolam is better suited for use in endoscopy, owing to its rapid onset and short duration of action.