Overheating of fiberoptic endoscopes

Shooting polyps through a sigmoidoscope To the Editor: One of the most frustrating experiences for colonoscopists is retrieving a large polyp from the rectum. These polyps tend to fall off the colonoscope suction tip or grasping forceps. They are knocked off passing the prominent haustrations in diverticulosis, at the rectosigmoid, Houston's valves, and particularly the anus. Manual extraction and tap water enemas are unkind finales for a colonoscopic polypectomy. We accidently stumbled upon an extraction method after inserting a rigid 25-cm sigmoidoscope into the rectum in order to extract a polyp. In the first instance, the polyp was seen at the sigmoidoscope tip. Some room air was inflated for a better view. The glass lens was slipped aside andpoomph, the polyp shot across the table and almost landed in the biopsy jar. The next time the same procedure resulted in a blackout as an even larger polyp popped up into the 'scope barrel occluding the view. If this method becomes widely practiced, may we predict yet another complication of colonoscopy? Polyposis amaurosis.

Maurice Barancik, MD Rockford Memorial Hospital Rockford, Illinois

Overheating of fiberoptic endoscopes To the Editor: The recent letter by E. N. Fraiberg (Gastrointest Endosc 28:43,1982) prompts this note on our recent experience with a newly purchased olympus ClV light source and GIF-Q and GIF-P3 fiberoptic gastroscopes. During and endoscopic examination with the GIF-Q, light intensity suddenly dimmed requiring patient reintubation with the GIF-P3. Dimming of light intensity recurred. Examination of the gastroscopes after withdrawal revealed marked overheating of the connector light guide attachments as well as the ClV light source. In addition, the connecting covers at the tips of the light guides had become crystallized and fragmented (Fig. 1). The problem was further investigated with the assistance of our biomedical engineering department. No irregularities in power outage in our endoscopy unit were detected with continuous monitoring. In discussions with Olympus Corporation, it was believed that the power or cooling mechanism in the ClV light source malfunctioned, possibly related to damage during shipping of equipment to our hospital. Additional ClV and ClE-4U light sources have posed no difficulties. Damaged equipment was repaired by Olympus Corporation and there has been no recurrence or requirement for photographic heat filters. Other endoscopists should be aware of this potential for overheating of the ClV light source, especially after receipt from the manufacturer. Transportation of endoscopy equipment within the hospital might also lead to ClV light source malfunction. Subtle dimming of light intensity during endoscopic examination may be a clue to overheating. This 272

Figure 1. Olympus GIF-P3 with crystallized and fragmented connecting cover on light guide attachment.

might prevent patient injury, as suggested by Fraiberg, and possible delays associated with instrument repairs.

Hugh Freeman, MD Paula Masterson, RN, SGA University of British Columbia Health Sciences Center Hospital Vancouver, British Columbia, Canada

The reward for cognitive skills To the Editor: Although the A/S/G/E has expressed concern about the cost effectiveness of endoscopic procedures, this concern has not been applied to the physician's fee for those procedures. From my experience of attending national meetings, I am impressed by the wide range of these charges. This variation may reflect local cost of living or the cost of office instead of hospital location for the procedure. The gastroenterologist is an internist specializing in gastrointestinal disease. What distinguishes us along with all other internists is the ability to perform a creditable history and physical examination and institute a plan of diagnosis and treatment. This is a skill that requires much more study and experience than any endoscopic procedure. Why not recognize that skill as the basic unit of the fee structure and GASTROINTESTINAL ENDOSCOPY