In Reply.—Dr Kibelbek is concerned with the potential risk of aspiration of gastric contents utilizing the technique described for removal of blunt esophageal foreign bodies by flexible endoscopy without general anesthesia.1 He attempts to substantiate this fear by making reference to animal studies in which critical values of gastric volume and pH were established.2 I would seriously question the significance of these values in regard to human subjects and avoid making sweeping statements based on this evidence alone.
The ability to perform upper intestinal endoscopy does not necessarily imply the abolishment of the cough and gag reflexes, as stated by Dr Kibelbek. The patients are not rendered unresponsive by the sedation regimen, as was outlined in the "Methods" section of the article.1 The gastric juices and air are aspirated before removal of the endoscope at the end of the procedure, and the patients are placed in
Bendig DW. Gastric Acid Aspiration Possible During Flexible Endoscopy Without General Anesthesia-Reply. Am J Dis Child. 1987;141(2):128-129. doi:10.1001/archpedi.1987.04460020018016