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Endoscopy

 
Dictionary: En·dos·co·py
Home > Library > Literature & Language > Webster 1913

n.

(Med.) The art or process of examination or treatment by means of an endoscope.

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World of the Body: endoscopy
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Endoscopy is the process whereby an optical instrument is introduced into one or other of the body tubes or cavities so that the organs of the body may be directly inspected. The instruments of endoscopy are most usually inserted through existing orifices, such as the mouth and rectum, but in certain cases an incision may be made so that otherwise inaccessible body cavities may be examined. The word is derived from the Greek endon ‘within’ and scopeo ‘examine’.

The earliest endoscopic examinations, introduced in the mid nineteenth century, were of the throat and larynx. Using mirrors placed carefully at the back of the throat it became possible to examine the vocal cords directly. The key technological advance was the ability to develop a light source which could be directed at the organ or tissues to be examined. Laryngoscopy became the technique which encouraged the development of ear, nose, and throat surgery.

Gradually, other endoscopic techniques were introduced. Examination of the rectum and colon were made possible by the development of colonoscopes, but in the early days the rigidity of the instruments available limited examination to the lower colon and rectum. Similarly, at the upper end of the alimentary tract, rigid instruments were used for the examination of the oesophagus (oesophagoscopy) and for the stomach, the earliest gastroscopes were introduced in Germany during the 1930s. During the next two decades, bronchoscopy (introducing an instrument into the bronchial tree via the locally anaesthetized throat, larynx, and trachea) became a significant technique because of the increasing incidence of cancer of the lung, for which this was for some time the most important tool in diagnosis. At the same time, urologists were using comparable instruments to examine the bladder, a technique of great importance in the diagnosis of cancer or of prostatic disease. Since there was no direct access to the thoracic or abdominal cavities, instruments were inserted through incisions made in the chest wall or abdomen, enabling operators to examine the lungs directly and to carry our surgical procedures (thoracoscopy), or to examine the liver and other abdominal organs (peritoneoscopy: looking within the peritoneal cavity). Peritoneoscopy also became an important technique which enabled the gynaecologist to examine the pelvic organs of women. By the 1950s there were therefore a wide range of endoscopic techniques available which greatly improved the methods of diagnosis of a variety of illnesses. The rigidity of the instruments, however, limited their use for the doctor and were in many instances particularly unpleasant for the patient, the passage of a rigid or semi-rigid gastroscope requiring the skills of a sword-swallower. Nevertheless, a whole generation of gastroenterologists became proficient in the technique, which was widely used for the diagnosis of peptic ulcer or cancer of the stomach.

A revolution in endoscopic techniques, however, followed the discovery of fibre optic instruments, since their flexibility permitted a far wider application than hitherto. Such techniques were to be of particular value in gastroenterology. It was at a social meeting in London that a physician, Hugh Gainsborough, met the physicist Harold Hopkins. He was pretty well appalled at the use of the rigid instruments in use for gastroscopy at that time and wondered whether Hopkins, already the discoverer of the zoom lens, could make an instrument that was flexible and therefore much more tolerable for the patient. Hopkins, then working at Imperial College in London, recruited a young research student (N. S. Kapany), and together they were able to develop a flexible fibreoptic bundle of glass fibres through which it was possible to examine an object. The significance of their invention was at once apparent to a distinguished British gastroenterologist, Sir Francis Avery Jones, who encouraged a young South African research worker, Dr Basil Hirschowitz, to try to explore the technique for clinical studies. It was not, however, possible to obtain the help of British industrial firms in this venture, and Hirschowitz later went to work in the US. There, he successfully pioneered the use of a fibreoptic bundle which could be introduced with relative ease into the stomach and, for the first time, beyond that into the duodenum, enabling duodenal ulcers to be directly examined. His work was at once followed up by Japanese workers in association with companies such as Olympus. It was they who introduced the new range of gastrointestinal endoscopes that have enabled clinicians directly to examine virtually the entire alimentary tract, as well as making it possible to visualize, with associated radiological techniques, organs such as the pancreas, which had until then been examined only by a major operation involving the opening of the alimentary tract. In addition, skilled operators were able to remove gallstones from the bile ducts. Flexible colonoscopy in particular brought the entire colon within view, as well as making it feasible to remove lesions such as polyps, considered to be premalignant, through the endoscope.

The use of fibreoptic endoscopy has been extended to other organs since its introduction, initially for the alimentary tract, so that it is now possible, for example, to introduce such instruments into the joints or major blood vessels to carry out surgical procedures.

There is little doubt that, in the history of endoscopy, the invention of the fibreoptic bundle by Hopkins and Kapany was a technological achievement that has transformed the practice of medicine in the modern era. Endoscopic ‘key-hole’ surgery continues to advance.

— Christopher Booth

Bibliography

  • Hirschowitz, B. I. (1961). Endoscopic examination of the stomach and duodenal cap with a fiberscope. Lancet, i. 1074-8.
  • Hopkins, H. H. and Kapany, N. S. (1956). A flexible fibrescope using static scanning. Nature, 173, 39-41

See also alimentary system; surgery.

Dental Dictionary: endoscopy
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n

The visualization of the interior of organs and cavities of thebody with an illuminated, flexible optical tube.

Britannica Concise Encyclopedia: endoscopy
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Examination of the body's interior through an instrument inserted into a natural opening or an incision, usually as an outpatient procedure. Endoscopes include the upper gastrointestinal endoscope (for the esophagus, stomach, and duodenum), the colonoscope (for the colon), and the bronchoscope (for the bronchial tubes). With fibre optics, much more maneuverable instruments can reach formerly inaccessible sites, while causing much less discomfort. Attachments can take tissue samples, excise polyps and small tumours, and remove foreign objects.

For more information on endoscopy, visit Britannica.com.

Veterinary Dictionary: endoscopy
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Visual examination of interior structures of the body with an endoscope.

Wikipedia: Endoscopy
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For endoscopy in mathematics, see endoscopic group.
Endoscopic images of a duodenal ulcer
An example of a flexible endoscope.
A physician using an endoscope.

Endoscopy means looking inside and typically refers to looking inside the body for medical reasons using an instrument called an endoscope. Endoscopy can also refer to using a borescope in technical situations where direct line-of-sight observation is not feasible.

Contents

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 moderate discomfort; in esophagogastroduodenoscopy, for example, most patients tolerate the procedure with only topical anaesthesia of the oropharynx. [1] Complications are rare 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

History

Early

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[citation needed]. 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[citation needed]. Hans Christian Jacobaeus has been given credit for early endoscopic explorations of the abdomen and the thorax with laparoscopy (1912) and thoracoscopy (1910)[citation needed]. Laparoscopy was used in the diagnosis of liver and gallbladder disease by Heinz Kalk in the 1930s[citation needed]. Hope reported in 1937 on the use of laparoscopy to diagnose ectopic pregnancy[citation needed]. 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[citation needed].

Storz

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, which were to play a major role in showing the way ahead, Karl Storz played a crucial role in the development of endoscopy. It was however, the combination of his engineering skills and vision, coupled with the work of optical designer Harold Hopkins that ultimately would revolutionize the field of medical optics.

Development of the Gastroscope

The gastroscope was first developed in 1952 by a Japanese team of a doctor and optical engineers. Mutsuo Sugiura, in association with Olympus Corporation, worked with Dr. Tatsuro Uji and his subordinate, Shoji Fukami, to develop what he first called a "gastro camera". It consisted of a tiny camera attached to a flexible tip with a light bulb. With it, they were able to photograph stomach ulcers that were undetectable by X-ray and find stomach cancers in early stage.[2]

Fibre Optics

In the early 1950s Harold Hopkins designed a “fibroscope” (a coherent bundle of flexible glass fibres able to transmit an image), which proved useful both medically and industrially. The subsequent research and development of these fibres, led to further improvements in image quality. Further innovations included using additional fibres to channel light to the objective end from a powerful external source - thereby achieving the high level of full spectrum illumination that was needed for detailed viewing and colour photography. (The previous practice of a small filament lamp on the tip of the endoscope had left the choice of either viewing in a dim red light or increasing the light output at the risk of burning the inside of the patient.) Alongside the advances to the optical side, came the ability to 'steer' the tip via controls in the endoscopists hands and innovations in remotely operated surgical instruments contained within the body of the endoscope itself. It was the beginning of key-hole surgery as we know it today. Fernando Alves Martins, from Portugal, invents the first fibre optics endoscope (1963/64)

Rod-lens Endoscopes

However, there were physical limits to the image quality of a fibroscope. In modern terminology, a bundle of say 50,000 fibres gives effectively only a 50,000 pixel image - in addition to which, the continued flexing in use, breaks fibres and so progressively loses pixels. Eventually so many are lost that the whole bundle must be replaced (at considerable expense). Hopkins realised that any further optical improvement would require a different approach. Previous rigid endoscopes suffered from very low light transmittance and extremely poor image quality. The surgical requirement of passing surgical tools as well as the illumination system actually within the endoscope's tube - which itself is limited in dimensions by the human body - left very little room for the imaging optics. The tiny lenses of a conventional system required supporting rings that would obscure the bulk of the lens' area; they were incredibly hard to manufacture and assemble and optically nearly useless. The elegant solution that Hopkins produced (in the late 1960s) was to fill the air-spaces between the 'little lenses' with rods of glass. These fitted exactly the endoscope's tube - making them self-aligning and requiring of no other support and allowed the little lenses to be dispensed with altogether. The rod-lenses were much easier to handle and utilized the maximum possible diameter available. With the appropriate curvature and coatings to the rod ends and optimal choices of glass-types, all calculated and specified by Hopkins, the image quality was transformed - even with tubes of only 1mm. in diameter. With a high quality 'telescope' of such small diameter, the tools and illumination system could be comfortably housed within an outer tube. Once again, it was Karl Storz who produced the first of these new endoscopes as part of a long and productive partnership between the two men. Whilst there are regions of the body that will forever require flexible endoscopes (principally the gastrointestinal tract), the rigid rod-lens endoscopes have such exceptional performance that they are to this day the instrument of choice and in reality have been the enabling factor in modern key-hole surgery. (Harold Hopkins was recognized and honoured for his advancement of medical-optic by the medical community world-wide. It formed a major part of the citation when he was awarded the Rumford Medal by the Royal Society in 1984.)

Disinfection: Of essential importance is the disinfection of the fibre endoscopes within a suitable time. The first disinfection device was constructed by S.E.Miederer 1976 at the University of Bonn/Germany.

Risks

  • Infection
  • Punctured organs
  • 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 their 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 their own or handle machinery for the remainder of the day.

Recent developments

Capsule Endoscopy.

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

Notes

  1. ^ National Digestive Diseases Information Clearinghouse (November 2004). "Upper Endoscopy". National Institutes of Health. http://digestive.niddk.nih.gov/ddiseases/pubs/upperendoscopy/index.htm. Retrieved 2007-10-07. 
  2. ^ Kawai, K.; Niwa, H.; Fujita, R.; Shimizu, S. (2002). "The History of Endoscopy: the Japanese Perspective". in Classen, Meinhard; Tytgat, G. N. J.; Lightdale, Charles J.. Gastroenterological endoscopy. Thieme. p. 33. ISBN 1588900134. http://books.google.com/books?id=sp0istaUg1AC&pg=PA33. 

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

References

External links


This entry is from Wikipedia, the leading user-contributed encyclopedia. It may not have been reviewed by professional editors (see full disclaimer)

 
 

 

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Dictionary. Webster 1913 Dictionary edited by Patrick J. Cassidy  Read more
World of the Body. The Oxford Companion to the Body. Copyright © 2001, 2003 by Oxford University Press. All rights reserved.  Read more
Dental Dictionary. Mosby's Dental Dictionary. Copyright © 2004 by Elsevier, Inc. All rights reserved.  Read more
Britannica Concise Encyclopedia. Britannica Concise Encyclopedia. © 2006 Encyclopædia Britannica, Inc. All rights reserved.  Read more
Veterinary Dictionary. Saunders Comprehensive Veterinary Dictionary 3rd Edition. Copyright © 2007 by D.C. Blood, V.P. Studdert and C.C. Gay, Elsevier. All rights reserved.  Read more
Wikipedia. This article is licensed under the Creative Commons Attribution/Share-Alike License. It uses material from the Wikipedia article "Endoscopy".  Read more