For the past five years (Feb. 1993-Jan. 1998) , 42 handicapped patients with upper gastrointestinal complication underwent endoscopic examination at the institute.
To take a safe measure, at least four staff members were to assist the handicapped patients during the endoscopic examination. The incidence of esophageal hiatus hernia and reflux esophagitis were particularly high (73.7%) in patients associated with severe mentally and physically disorders who are lying in bed and tube feedings.
When performing endoscopic examination on mentally and physically patients, keeping the safety of the patient in mind, consideration while carring out sedation is important.
Therefore it is necessary to have at least four staff members namely the endoscopist, a sedation specialist, a nurse, and care-worker during the examination.
