Blood and neoplastic diseases. Rational approach to the chemotherapy of human malignant disease-II.

There was good correlation between radiology and endoscopy in diagnosing duodenal deformity, but precise diagnosis of active ulceration requires direct vision at endoscopy.6 Should barium-meal examinations be abandoned as initial investigations in dyspepsia and replaced by endoscopy? The lack of trained staff and equipment for endoscopy in most areas at the district general hospital level makes this an unrealistic suggestion. This study emphasizes the importance of the availability of an endoscopy service for the investigation of the upper digestive tract as already recommended by the British Society for Digestive Endoscopy. 7 Generalpractitioner clinical assistants can contribute greatly to providing an adequate endoscopy service, but even with more staff the endoscopy department would not be able to carry out the many investigations for dyspepsia currently performed in the x-ray department. Moreover, initial screening by a combined barium-meal examination and cholecystogram with subsequent endoscopy in selected patients will provide the most accurate diagnostic approach to the problem of dyspepsia.