Endoscopic images of a duodenal ulcer

A flexible endoscope.

Overview

Endoscopy is a minimally invasive diagnostic medical procedure that is used to assess the interior surfaces of an organ by inserting a tube into the body. The instrument may have a rigid or flexible tube and not only provide an image for visual inspection and photography, but also enable taking biopsies and retrieval of foreign objects. Endoscopy is the vehicle for minimally invasive surgery, and patients may receive conscious sedation so they do not have to be consciously aware of the discomfort.

Many endoscopic procedures are considered to be relatively painless and, at worst, associated with mild discomfort; for example, in esophagogastroduodenoscopy, most patients tolerate the procedure with only topical anaesthesia of the oropharynx using lignocaine spray. ^[1] Complications are not common (only 5% of all operations) but can include perforation of the organ under inspection with the endoscope or biopsy instrument. If that occurs open surgery may be required to repair the injury.

Components

An endoscope can consist of

• a rigid or flexible tube
• a light delivery system to illuminate the organ or object under inspection. The light source is normally outside the body and the light is typically directed via an optical fiber system
• a lens system transmitting the image to the viewer from the fiberscope
• an additional channel to allow entry of medical instruments or manipulators

Uses

Endoscopy can involve

• The gastrointestinal tract (GI tract):
  • esophagus, stomach and duodenum (esophagogastroduodenoscopy)
  • small intestine
  • colon (colonoscopy,proctosigmoidoscopy)
  • Bile duct
    • endoscopic retrograde cholangiopancreatography (ERCP), duodenoscope-assisted cholangiopancreatoscopy, intraoperative cholangioscopy
• The respiratory tract
  • The nose (rhinoscopy)
  • The lower respiratory tract (bronchoscopy)
• The urinary tract (cystoscopy)
• The female reproductive system
  • The cervix (colposcopy)
  • The uterus (hysteroscopy)
  • The Fallopian tubes (Falloscopy)
• Normally closed body cavities (through a small incision):
  • The abdominal or pelvic cavity (laparoscopy)
  • The interior of a joint (arthroscopy)
  • Organs of the chest (thoracoscopy and mediastinoscopy)
• During pregnancy
  • The amnion (amnioscopy)
  • The fetus (fetoscopy)
• Plastic Surgery
• Panendoscopy (or triple endoscopy)
  • Combines laryngoscopy, esophagoscopy, and bronchoscopy
• Non-medical uses for endoscopy
  • The planning and architectural community have found the endoscope useful for pre-visualization of scale models of proposed buildings and cities (architectural endoscopy)
  • Internal inspection of complex technical systems (borescope)
  • Endoscopes are also a tool helpful in the examination of improvised explosive devices by bomb disposal personnel.
  • The FBI uses endoscopes for conducting surveillance via tight spaces.

History

The first endoscope, of a kind, was developed in 1806 by Philip Bozzini with his introduction of a "Lichtleiter" (light conductor) "for the examinations of the canals and cavities of the human body". However, the Vienna Medical Society disapproved of such curiosity. An endoscope was first introduced into a human in 1822 by William Beaumont, an army surgeon at Mackinac Island, Michigan. The use of electric light was a major step in the improvement of endoscopy. The first such lights were external. Later, smaller bulbs became available making internal light possible, for instance in a hysteroscope by Charles David in 1908. Hans Christian Jacobaeus has been given credit for early endoscopic explorations of the abdomen and the thorax with laparoscopy (1912) and thoracoscopy (1910). Laparoscopy was used in the diagnosis of liver and gallbladder disease by Heinz Kalk in the 1930s. Hope reported in 1937 on the use of laparoscopy to diagnose ectopic pregnancy. In 1944, Raoul Palmer placed his patients in the Trendelenburg position after gaseous distention of the abdomen and thus was able to reliably perform gynecologic laparoscopy.

Karl Storz began producing instruments for ENT specialists in 1945. His intention was to develop instruments which would enable the practitioner to look inside the human body. The technology available at the end of the Second World War was still very modest: The area under examination in the interior of the human body was illuminated with miniature electric lamps; alternatively, attempts were made to reflect light from an external source into the body through the endoscopic tube. Karl Storz pursued a plan: He set out to introduce very bright, but cold light into the body cavities through the instrument, thus providing excellent visibility while at the same time allowing objective documentation by means of image transmission. With more than 400 patents and operative samples to his name, many of which were to play a major role in showing the way ahead, Karl Storz played a crucial role in the development of modern endoscopy.

In the early 1950s Harold Hopkins designed a ?fibroscope? (a flexible bundle of glass fibres), which proved useful both medically and industrially, paving the way for modern fibre optic cables. Hopkins refined his ideas with a German manufacturer, resulting in a design breakthrough in 1967 which enabled surgeons to view and photograph inaccessible areas of the body in detail.

Risks

• Infection
• Punctured organs
• Allergic reactions due to Contrast agents or dyes (such as those used in a CT scan)
• Over-sedation

After the endoscopy

After the procedure the patient will be observed and monitored by a qualified individual in the endoscopy or a recovery area until a significant portion of the medication has worn off. Occasionally a patient is left with a mild sore throat, which promptly responds to saline gargles, or a feeling of distention from the insufflated air that was used during the procedure. Both problems are mild and fleeting. When fully recovered, the patient will be instructed when to resume his/her usual diet (probably within a few hours) and will be allowed to be taken home. Because of the use of sedation, most facilities mandate that the patient is taken home by another person and not to drive on his/her own or handle machinery for the remainder of the day.

Recent developments

With the application of robotic systems, telesurgery was introduced as the surgeon could operate from a site physically removed from the patient. The first transatlantic surgery has been called the Lindbergh Operation.

See also

• Angiography
• Fiberscope
• Robotic surgery

References

• Armin Gärtner; medical technics and information technologie, Band II. Medizintechnik und Informationstechnologie, Band II. ISBN 3-8249-0941-3.
• Obituary: Professor Harold Hopkins, FRS, The Times, 3 Nov 1994.

Footnotes

Bittner JG, et al. Resident training in flexible gastrointestinal endoscopy: a review of current issues and options. J Surg Educ. 2007 Nov-Dec;64(6):399-409. PMID: 18063277

External links

• Resources for people who use endoscopes.
• Diagnostic and Therapeutic Endoscopy - Open-Access Journal
• DAVE Project, Digital Atlas of Video Education - Gastroenterology
• Global Rating Scale, GRS - Quality Assurance for Endoscopy
• Endoscope Repair Parts
• "How I Do It" ? Removing large or sessile colonic polyps. Dr. Brian Saunders MD FRCP; St. Mark?s Academic Institute; Harrow, Middlesex, UK. Retrieved April 9, 2008.

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