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endoscopy

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 and Kapany, N. S. (1956). A flexible fibrescope using static scanning. Nature, 173, 39–41.


See also alimentary system; surgery.

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Endoscope

Endoscope

An endoscope is an instrument that allows doctors to view the inner workings of the human body without having to perform surgery. Endoscopes are sometimes called fiberscopes. Endoscopes are primarily used in the health care field, but can also be used for industrial purposes. They make it easier to examine hard-to-reach places such as the inside of fuel tanks and nuclear reactors.

The endoscope is a flexible narrow tube. It contains several bundles of hair-thin glass fibers covered with a reflective coating. An intense light source, usually a halogen lamp, is part of the instrument. The light is transmitted along one bundle of fibers toward the target area and provides enough light to see inside of the human body. Another bundle of fibers carries an image of the target area back up the tube where it is viewed through an eyepiece.

Early Endoscope Research

Crude versions of the endoscope were used as early as the nineteenth century and included long, rigid tubes illuminated by candles. In 1854 Manuel Patricio Rodriguez Garcia, a Spanish-born vocal teacher, designed the forerunner of the laryngoscope that allowed a clear view of the glottis (the vocal cords and the opening between them) and made it possible to see obstructions in the larynx.

The first efforts to develop the kind of glass fibers that would eventually be used in endoscopes were made by the Atomic Energy Authority and by the Rank Organization in Britain. By 1965, a 25-micron (a micron is one-thousandth of a millimeter) fiber had been produced. An American company, Bausch and Lomb, subsequently developed a 15-micron fiber for their Flexiscope which could be used for industrial inspections because it gave off a "cold" light that was safe even in fuel tanks. When the American Cytoscopic Company succeeded in sterilizing glass fibers, the possibilities for medical uses of the endoscope increased greatly.

Medical Uses

The modern endoscope can perform an amazing variety of medical procedures. It can do much more than transmit light and a visual image. It also contains water and air channels for flushing water through or inflating targeted areas.

Tiny forceps (tweezers) can be placed at the tip of the endoscope. These can be used to take specimen samples for laboratory analysis and to perform simple operations such as removing colon polyps or gallstones. Endoscopes can also be used to stop hemorrhaging (heavy bleeding) by delivering laser beams directly to the point of bleeding. The blood thickens and the bleeding is stopped.

Different types of endoscopes are specially designed to examine specific parts of the body. Angioscopes pass through the arteries that carry blood to the heart, arthroscopes explore the interiors of joints, bronchoscopes are used with a special dye and fluorescent light to detect lung malignancies (cancers), gastroscopes probe the stomach and upper intestinal tract, and laparoscopes diagnose and treat abdominal conditions.

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endoscope

endoscope, any instrument used to look inside the body. Usually consisting of a fiber-optic tube attached to a viewing device, endoscopes are used to explore and biopsy such areas as the colon and the bronchi of the lungs. Endoscopes employing miniature television cameras and tiny surgical implements now allow exploration and endoscopic surgery through small incisions; such surgery is much less traumatic to the patient than traditional open surgery. Laparoscopic surgery, in which the endoscope is inserted through a small incision in the abdomen or chest, is used to correct abnormalities of the ovaries and as an alternative to traditional gall bladder and chest surgery. Arthroscopic surgery is endoscopic surgery performed on joints such as the knee or shoulder.

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endoscope

endoscope Instrument used to examine the interior of the body. Early types of endoscope, such as the opthalmoscope, were developed in the 19th century. Fibre optics has revolutionized the design of endoscopes. The modern endoscope is a flexible, fibreglass instrument that can be swallowed by a patient or introduced through a tiny incision in the body. Most endoscopy is for diagnostic purposes, but modern instruments are used in biopsy and minimal access surgery.

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endoscope

endoscope (end-oh-skohp) n. any instrument, such as an auriscope or a gastroscope, used to obtain a view of the interior of the body. Most endoscopes consist of a tube with a light at the end and an optical system or a miniature video camera for transmitting an image to the examiner's eye. See also fibrescope.
endoscopic (en-doh-skop-ik) adj. —endoscopy (en-dos-kŏ-pi) n.

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endoscope

en·do·scope / ˈendəˌskōp/ • n. Med. an instrument that can be introduced into the body to give a view of its internal parts. DERIVATIVES: en·do·scop·ic / ˌendəˈskäpik/ adj. en·do·scop·i·cal·ly adv. en·dos·co·py / enˈdäskəpē/ n.

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endoscopy

endoscopy The study of the interior of hollow organs, such as the intestines and the reproductive organs, using a flexible probe (endoscope), which contains optical fibres for transmitting images onto a screen.

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