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Endoscopy

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Endoscopic images of a duodenal ulcer

Image:Flexibles Endoskop.jpg

Endoscopy means looking inside and refers to looking inside the human body for medical reasons. Endoscopy, using a borescope, is also used in engineering and techical situations such as the inspection of nuclear fuel elements, aircraft or engines where direct line-of-sight observation is not feasible. The instrument used is called an endoscope.

Contents

[edit] Overview

Endoscopy is a minimally invasive diagnostic medical procedure used to evaluate the interior surfaces of an organ by inserting a small tube into the body, often, but not necessarily, through a natural body opening. Through the scope one is able to see lesions and other surface conditions.

The instrument may have a rigid or a 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.

Many endoscopic procedures are relatively painless and, at worst, associated with mild discomfort although patients are sedated for most procedures. Complications are rare (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.

[edit] Components

One can distinguish:

  • the endoscope itself consisting of either a rigid or flexible tube containing one or more optical fibre systems and, possibly, a channel for mechanical devices (see below).
  • 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.
  • in operative endoscopes (human or veterinary), an additional channel to allow entry of medical instruments to biopsy or to facilitate tissue and other operations.

[edit] Types

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

  • Plastic Surgery
  • 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)

[edit] 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. Apparently 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 David in 1908. Jacobeus 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 the German 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 gaseuos distention of the abdomen and thus was able to reliably perform gynecologic laparoscopy.

For diagnostic endoscopy Basil Hirschowitz invented a superior glass fiber for flexible endoscopes. The technology resulted in not only the first useful medical endoscope, but the invention revolutionized other endoscopic uses and led to practical fiberoptics.

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 gynecologists to perform tubal ligation procedures and diagnostic evaluations of the pelvis. 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.

[edit] Risks

Physical: Introduction of unsterilised instruments into the body is always a possibility. Inexpert handling of the endoscope, both rigid and flexible, or the equipment supported by it can lead to punctured organs with variable effects.

Dyes: Contrast agents or dyes (such as those used in a CT scan) are used to allow the physician to image the organs but they can cause allergic reactions. Iodine is a component of one of these dyes and, if the patient is allergic to shellfish, there will be a risk with the dye. Also, the dyes can be harmful to the kidneys. If your kidneys have poor function, the dye could cause renal failure. If there is such a risk the physician needs to be questioned about the necessity of the procedure. The patient should also ask about how to promote flushing the dye and how to recover from kidney damage. Patients on dialysis should be dialyzed after the procedure to flush out the dyes.

Sedation: Experienced anesthesiologists will provide sedation only in an "as needed" amount to keep the patient comfortable. Oversedation can result in dangerously low blood pressure and nausea and vomiting. Nausea and vomiting are especially dangerous as these prevent the patient from drinking to flush the dyes out of the kidneys.

[edit] 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. Another major development is the invenion of Miniature Ingestible Capsule in late 80's to view the inside of Gastrointestinal Tracts.The idea germinated in 1985 by a teenager but took four years to develop a workable Capsule and much longer to convince reputed Gastroenterologist .This Capsule is now produced and marketed by Olympus Corp.and Given Imaging Ltd.in many countries.US FDA has approved its usage for some applications and many professional societies have approved its benefits and usage after considerable testing.Several patents have been issued in this area.Olympus Sells it as EndoCapsule and Given Imaging sells it as PillCam.RFSystems of Japan demonstrated its Capsule three years ago and are working on battery less Capsule. 

        The key benefit is that it does not require anesthesia,hospital out patient visit and patient does not lose any time.It is a big cost saver for patient and insurers.This Capsule offers a Big application/opportunity for COLON SCREENING for CANCER which remains at 60% for people over 50,inspite of big publicity by Katie Couric and others on TV.
        This teenager perceived its broader use for Screening and possible minor surgey with this Capsule.Although the broader patent has been granted for Screening,other usage patents are pending for approval by  the US Patent Office.Several other groups are working on this expanded idea including Stanford Univ.Aeronautical dept.researchers as mentioned in ACG-2006 and DDW-2006 abstracts.
        This invention has been recognized a major invention by the Wall Street Journal.This is a Painless way to screen for Cancer and other problems.

[edit] See also

The invention of Miniature Ingestible Capsule or Pill Camera is likely to be a revolutionary product for Viewing the Gastrointestinal tract and Colon Screening to detect Cancer at much lower cost.

[edit] References

  • Siegler AM, Kemmann E: Hysteroscopy. Obstet Gynecol Survey 30:567-88, 1975.
  • Armin Gärtner; medical technics and information technologie, Band II. Medizintechnik und Informationstechnologie, Band II. ISBN 3-8249-0941-3.

[edit] External links

es:Endoscopia eo:Endoskopio fr:Endoscopie he:אנדוסקופיה nl:Endoscopie ja:内視鏡検査 (前立腺肥大症) pl:Endoskopia pt:Endoscopia sv:Endoskopi zh:內視鏡

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