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During Operation Desert Shield/Desert Storm, the 8th Evacuation Hospital (400 beds) evaluated the efficacy of endoscopy in the desert environment. Standard off-the-shelf fiber-optic endoscopes met the criteria of being rugged, versatile, portable, and easy to maintain. Over a 3-month period, 36 procedures (Esophagogastroduodenoscopy, 25; colonoscopy, 7; flexible sigmoidoscopy, 4) were performed in soldiers both in the garrison and in combat. Of these. 24 (67%) revealed normal findings; the remaining 33% demonstrated pathology (6 cases of peptic ulcers, 3 cases of esophageal ulcers, 2 cases of acute ulcerative colitis, and 1 case of proctitis). Two-thirds of the patients could immediately be returned to duty because they demonstrated either a normal examination or pathology that would resolve with medical management. Another 17% of the subjects were promptly air-evacuated out of the combat theater, and 17% were Iraqi prisoners of war in whom the proper medication was begun. Although no indication for surgical endoscopy was found that was unique to a combat theater, these procedures greatly enhanced the conservation of the fighting force, especially in determining which soldiers could be immediately returned for a combat mission.