S.E. Silvis

Esophagogastroduodenoscopy (211,410 examinations) had a complication rate of 1.3/1,000 cases. Duodenoscopy with cannulation was performed 3,884 times and had a complication rate of 21.6/1,000 examinations. Diagnostic coloscopy (25,298 examinations) had a complication rate of 3.4/1,000. Polypectomies during coloscopy (6,124 cases) had a complication rate of 23.3/1,000 cases. Esophageal dilations (13,139 cases) had a complication rate of 4.25 with mercury bougies, and in 9,431 cases metal olives produced a complication rate of 6.1/1,000 treatments. Dilation for achalasia in 1,224 patients produced a complication rate of 18.4/1,000 procedures. Peritoneoscopy (4,404 examinations) produced a complication rate of 5.4/1,000 patients. The value of these diagnostic and therapeutic procedures is now well established but must be weighed against a potential risk of complications.

Cachectic patients infused with hypertonic amino acids and dextrose ("parenteral hyperalimentation") are subject to severe hypophosphatemia and recurrent fungal and bacterial septicemia. We observed a relation between the two. Severe hypophosphatemia, induced in a total of 18 mongrel dogs, resulted in a 50 per cent depression of chemotactic, phagocytic and bactericidal activity of their granulocytes. There was a concomitant reduction in leukocyte ATP content. The motility defect was corrected if cellular ATP was repleted by phosphate supplementation of animals in vivo or by incubation of leukocytes with adenosine and phosphate in vitro. Analogously, severe hypophosphatemia in a hyperalimented patient was associated with a 45 per cent impairment of chemotactic responsiveness and was reversed by similar in vivo and in vitro manipulations. The studies provide an additional explanation for the high rate of sepsis in patients undergoing hyperalimentation therapy, secondary to an acquired granulocyte dysfunction induced by hypophosphatemia. (N Engl J Med 290:1403–1407, 1974)