POSSIBILITIES IN IMPROVEMENT OF ACCEPTATION OF GASTROSCOPY, J.-F. Rey, D. Duforest, P. Termate, Institut Arnauh Tzanek, D~partement de GastrcentErologie, Avenue dn Dr Donat, 067130 Saint Laurent du Var, France. Endoscopic examination is the method of choice in the diagnosis of upper gastrointestinal symptoms. However, many general practitioners send their patients for barium meal examination because of the inacceptability of an endoscopy or the request for intravenous sedation. But sedation means an increase of direct and indirect cost. The aim of the study was to establish the tolerance of endoscopy performed with a thin endoscope using different possible insertion methods. tO healthy volunteers (7 females, 3 males) underwent an endoscopic examination. An Olympus GIF XP 200 endoscope with external diameter of 6 mm was used for these procedures. No biopsy specimen was taken. Each examination was recorded. Volunteers were given a local anesthesia. Each volunteer underwent 2 randomized examinations on consecutive days. After removal of the endoscope, patients completed a first qnestionnaire, then, the second 1 week later). The questionnaire was formed by two separated items concerning the tolerance of the way uf endoscope insertion and the tolerance of endoscopy procedure itself. 20 consecutive procedures (l failure due to deviation of nasal wall) were performed. Mean time of endoscopy was 185 seconds. The control of quality of examination was assured by a second look at the video tape recording. The degree of satisfaction was significantly higher in the oral insertion technique than in transnasal insertion (8.2 VS 4.6). It is important to note that in these series, 3 voluntee~ls did not differentiate the type of insertion. 3 volunteers pret'erred nasal intubation, and 3oral.insertions. The last volunteer demanded an intravenous sedation for further examination. Since then, dais technique has been applied for routine gastruscopy in 34 patients. Tolerance of the examination was satisfactory in 29 cases. In 5 cases a LV sedation was performed due to marked discomfort. The evaluation of factors influencing the acceptance of endoscopic procedures without sedation was the aim of this study : 1) the role of patient selection, 2) the influence of endoscope diameter, 3) the influence of video images on the examination tolerance, 4) the control of the results of endoscopy by a second look at the video tape. Th6 final target of the presented report was to improve the acceptance of upper gastrointestinal endoscopy while reducing the costs and maintaining the same quality of information.