Endoscopy

Endoscopy is a minimally invasive diagnostic medical procedure used to evaluate the interior surfaces of an organ by inserting a small scope in the body, usually through a natural body opening. Through the scope, one is able to see lesions, take small biopsies and retrieve foreign objects. Endoscopy is also employed in minimally invasive surgery.

Many endoscopic procedures are relatively painless and only associated with mild discomfort, though patients are sedated for most procedures. Complications are rare but may include perforation of the stomach or intestine with the endoscope or biopsy instrument. If this occurs, surgery is required to repair the injury.

Endoscopic equipment can be used to visualize and collect specimens from:

• The gastrointestinal tract:
  • esophagus, stomach and duodenum (esophagogastroduodenoscopy)
  • colon (colonoscopy), the endoscope is used to examine the colon.
    • sigmoid colon: (proctosigmoidoscopy)
  • in an endoscopic retrograde cholangiopancreatography (ERCP), an endoscope is used to introduce radiographic contrast medium into the bile ducts so they can be visualized on x-ray.
• The respiratory tract
  • The nose (rhinoscopy)
  • The lower respiratory tract (bronchoscopy)
• The urinary tract (cystoscopy)

• 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)

History

The first endoscope, of a kind, was developed in 1806 by Philip Bozzini but such a device was not introduced into a human until 1853. Of limited value even in diagnosis the procedure was named laparothorakoskopie in 1911. Its use in the diagnosis of liver and gallbladder disease was extended by the German Heinz Kalk in the 1930s. Its diagnostic use in gynaecology is dated from the 1940s and Raoul Palmer, who placed his patients in the Trendelenburg position so air could inflate the pelvic area. Surgery as well as examination did not begin until the late 1970s and then only with young and 'healthy' patients. By 1980 laparoscopy training was required by obstetrics and gynecology. The first laparoscopic cholecystectomy was performed in 1984 and the first video-laparoscopic cholecystectomy in 1987. During the 1990s laparoscopic surgery was extended to the appendix, spleen, colon, stomach, kidney, and liver and robotic assistance was introduced.