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April 22, 1974

Ramrod or Fiberscope?

Author Affiliations

Baptist Memorial Hospital Memphis

JAMA. 1974;228(4):463. doi:10.1001/jama.1974.03230290019015

To the Editor.—  Certainly, one would not argue with Dr. Palmer's remarks (227:511, 1974) concerning the extremely rapid growth and popularity of fiberoptic endoscopy. Its use has had a profound effect on the diagnosis of upper gastrointestinal lesions. His implication that there may be overutilization of the fiberscope (or under-utilization of the rigid esophagoscope) would seem inappropriate now. His concern about patient welfare is realistic. We, too, have been interested in information pertaining to how well the patient fares as a result of having had endoscopy. We have therefore reviewed 148 cases of a single problem, gastric ulcer, in which both x-ray film and endoscopic information, as well as cytology and biopsy material, were available (all procedures performed by one endoscopist). In 61 (41%) of these cases, endoscopic evaluation either definitely changed or markedly influenced the decision regarding therapy. The x-ray diagnosis was refuted by endoscopy in 24% of