Two years ago, Joan Rivers died a week after suffering cardiac arrest during a medical procedure. In August 2014, Ms. Rivers underwent a sedated upper endoscopy which is a very commonly performed medical procedure that examines the esophagus and stomach when someone is suspected of having acid reflux disease. She suffered an untoward event during the procedure and ultimately succumbed a few days later.

What lurks lies behind her death, however, is a sinister force of monetary self interest that is conspiring to minimize the risks associated with the use of sedated endoscopies-and forestall the use of a safer alternative. This conspiracy of silence must be exposed before more and more people die unnecessarily.

That is why Citizens for Safe Endoscopy has been formed to educate the public about the health threats posed by traditional and expensive endoscopic procedures. ( As CSE spokesman David Schwartz says:

“New and safer approaches to the diagnosis of esophageal cancer have been developed and perfected over the past twenty years, but their utilization has been stymied by special interests. CSE was created in order to break the conspiracy of silence and insure that patients know that there are better diagnostic tools available to them, ones that pose a much less significant threat to their health and longevity.”


Was Rivers’ demise a shock-an event that could never have been predicted because it was such an anomaly? Not at all. As NBC News reported; “Doctors perform about 8 million endoscopies every year in this country. They are very common but they also entail risks…” (

How risky are they? There is approximately a 5% risk for “cardiopulmonary unplanned events”-with a percentage resulting in fatalities- and this risk is elevated for older patients like the famed comedian. At 8-10 million upper endoscopies performed per year in the USA, we are talking about 50,000 people annually who suffer these complications.

While far fewer die as a result of these adverse events, it is nevertheless a huge number of near catastrophic events involving a large amount of morbidity-and this is particularly true for elderly patients.(

This is especially tragic in the Rivers case because, in TransNasal Esophagoscopy (TNE), a safe, effective and cheaper alternative to endoscopies exists-but its use is restricted by vested interests that stand to lose billions of dollars if patients begin to opt for TNE instead. As NBC reported after Rivers’ untimely demise;

“There are two ways to examine the esophagus. One uses a skinny scope inserted into the nose. The patient is seated and not sedated. Another way inserts a larger scope in the mouth with the patient lying on his side under IV sedation. The optics is amazing. Today I spoke with Dr. Jamie Kauffman who says she tries to avoid sedation with older patients because of the risk involved. Almost all complications are related to the induction and the use of anesthetic.”

A prominent medical web site underscores this point: “There are risks associated with anesthesia, and preparations by the health-care team and patient are two ways to minimize the risks. However, even the best planning cannot reduce the risks of undergoing anesthesia to zero.” (

The dominance of the use of patient sedated endoscopies can be simply reduced to one salient factor: money. The facilities where the sedated endoscopies are performed receive a facility fee of up to $3,000/procedure. So, at revenues of 30 BILLION per year, the facility owners/managers have a strong financial disincentive to offer an unsedated exam that doesn’t require a facility.  Conservatively, over half of the sedated endoscopies performed annually can be performed in a physician’s office using TNE without sedation, thereby saving the health care industry over 15 billion per year.

Money, of course, isn’t everything, but the use of TNE has other important non-monetary benefits as well. TNE is performed with the patient wide awake, sitting upright in a chair in a doctor’s office, and gives the same information, and is as well tolerated, as traditional sedated upper endoscopy-and the patient can walk out of the office as soon as the procedure is completed. Because no sedation is necessary, it is not only much safer for the patient, it is also much less costly to the healthcare industry. (

The public has a right to know about alternatives when sedated endoscopy is suggested by their doctors. As 60 million Americans suffer from acid reflux disease, and esophageal cancer due to acid reflux is the fastest growing cancer in America (and Europe), and sedated upper endoscopy is performed to make the diagnosis, it is imperative that the monetary wall of silence be forcefully breached.

What we need are legislative investigations into the existence of a medical cartel that is actively conspiring to restrict the public’s knowledge and therefore the use of the TNE alternative. If collusion can be proven, law enforcement needs to become actively engaged.

Lastly, we need to media to step us so that the untimely death of Joan Rivers can have a positive outcome as more and more patients-and their doctors-resist the cartel’s insistence on the use of sedated endoscopies. Dr. Jonathan Aviv, a long time and forceful advocate of TNE, makes the case-and he deserves the last word:

“Media coverage of TNE in the New York Times, Good Morning America, and other outlets over the past year has helped to increase the popularity of the procedure among patients, said Jonathan E. Aviv, MD, Clinical Director of the Voice and Swallowing Center at ENT and Allergy Associates in New York. Because esophageal cancer incidence is growing, physician and patients are looking for better ways to diagnose the disease, and TNE is one of most convenient and safe methods of doing so, he explained.” (

Citizens for Safe Endoscopy is an organization dedicated to give every patient a safe endoscopic experience by demanding that the medical profession offers safer alternatives and adheres to the safest standards possible when reprocessing endoscopes. There are safer ways of reprocessing and safer procedures which patients are not aware of. For more information log onto or contact David Schwartz at 917-566-5425.