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An '''endoscopy''' (''looking inside'') is a procedure used in [[medicine]] to look inside the body.<ref>{{cite encyclopedia |title=Endoscopy |encyclopedia=British Medical Association Complete Family Health Encyclopedia |year=1990 |publisher=Dorling Kindersley Limited }}</ref> The endoscopy procedure uses an [[endoscope]] to examine the interior of a hollow organ or cavity of the body. Unlike many other [[medical imaging]] techniques, endoscopes are inserted directly into the organ.
An '''endoscopy''' is a procedure used in [[medicine]] to look inside the body.<ref>{{cite encyclopedia |title=Endoscopy |encyclopedia=British Medical Association Complete Family Health Encyclopedia |year=1990 |publisher=Dorling Kindersley Limited |isbn=978-0-751-30161-8 }}</ref> The endoscopy procedure uses an [[endoscope]] to examine the interior of a hollow organ or cavity of the body. Unlike many other [[medical imaging]] techniques, endoscopes are inserted directly into the organ.


There are many types of endoscopies. Depending on the site in the body and type of procedure, an endoscopy may be performed by either a doctor or a [[surgeon]]. A patient may be fully conscious or [[anaesthesia|anaesthetised]] during the procedure. Most often, the term ''endoscopy'' is used to refer to an examination of the upper part of the [[human gastrointestinal tract|gastrointestinal tract]], known as an [[esophagogastroduodenoscopy]].<ref>{{cite web |title=Endoscopy |url=http://www.cancerresearchuk.org/about-cancer/cancers-in-general/tests/endoscopy |publisher=Cancer Research UK |access-date=5 November 2015}}</ref>
There are many types of endoscopies. Depending on the site in the body and type of procedure, an endoscopy may be performed by either a doctor or a [[surgeon]]. A patient may be fully conscious or [[anaesthesia|anaesthetised]] during the procedure. Most often, the term ''endoscopy'' is used to refer to an examination of the upper part of the [[human gastrointestinal tract|gastrointestinal tract]], known as an [[esophagogastroduodenoscopy]].<ref>{{cite web |title=Endoscopy |url=http://www.cancerresearchuk.org/about-cancer/cancers-in-general/tests/endoscopy |publisher=Cancer Research UK |access-date=5 November 2015 |archive-date=1 February 2017 |archive-url=https://web.archive.org/web/20170201224116/http://www.cancerresearchuk.org/about-cancer/cancers-in-general/tests/endoscopy |url-status=dead }}</ref>


For nonmedical use, similar instruments are called [[borescope]]s.
For nonmedical use, similar instruments are called [[borescope]]s.


==History==
==History==
[[Adolf Kussmaul]] was fascinated by [[sword swallowers]] who would insert a sword down their throat without gagging. This drew inspiration to insert a camera, the next problem to solve was how to insert a source of light, as they were still relying on candles and oil lamps.<ref>{{Cite web|url=https://www.entandaudiologynews.com/features/ent-features/post/the-pioneers-of-endoscopy-and-the-sword-swallowers|title = The pioneers of endoscopy and the sword swallowers}}</ref>
[[Adolf Kussmaul]] was fascinated by [[sword swallowers]] who would insert a sword down their throat without gagging. This drew inspiration to insert a hollow tube for observation; the next problem to solve was how to shine light through the tube, as they were still relying on candles and oil lamps as light sources.<ref>{{Cite web|url=https://www.entandaudiologynews.com/features/ent-features/post/the-pioneers-of-endoscopy-and-the-sword-swallowers|title=The pioneers of endoscopy and the sword swallowers|access-date=2022-01-26|archive-date=2022-01-27|archive-url=https://web.archive.org/web/20220127172040/https://www.entandaudiologynews.com/features/ent-features/post/the-pioneers-of-endoscopy-and-the-sword-swallowers|url-status=live}}</ref>


The term ''endoscope'' was first used on February 7, 1855, by engineer-optician Charles Chevalier, in reference to the ''uréthroscope'' of [[Antonin Jean Desormeaux|Désormeaux]], who himself began using the former term a month later.<ref name="auto">{{Cite journal|last=Janssen|first=Diederik F|date=2021-05-17|title=Who named and built the Désormeaux endoscope? The case of unacknowledged opticians Charles and Arthur Chevalier|url=http://journals.sagepub.com/doi/10.1177/09677720211018975|journal=Journal of Medical Biography|volume=29|issue=3|language=en|pages=176–179|doi=10.1177/09677720211018975|pmid=33998906|s2cid=234747817|issn=0967-7720}}</ref> The self-illuminated endoscope was developed at [[Glasgow Royal Infirmary]] in [[Scotland]] (one of the first hospitals to have mains electricity) in 1894/5 by Dr [[John Macintyre]] as part of his specialization in the investigation of the larynx.<ref>{{cite web | url = http://sshm.ac.uk/wp-content/uploads/2013/10/PROCEEDINGS-SESSION-1994-1995-and-1995-1996.pdf | title = The Scottish Society of the History of Medicine }}</ref>{{Failed verification|date=April 2019|reason=This source doesn't mention the years; it says: "Even before using X-rays he had pioneered the development of self-illuminated endoscopes"}}
The term ''endoscope'' was first used on February 7, 1855, by engineer-optician Charles Chevalier, in reference to the ''uréthroscope'' of [[Antonin Jean Desormeaux|Désormeaux]], who himself began using the former term a month later.<ref name="auto">{{Cite journal|last=Janssen|first=Diederik F|date=2021-05-17|title=Who named and built the Désormeaux endoscope? The case of unacknowledged opticians Charles and Arthur Chevalier|url=http://journals.sagepub.com/doi/10.1177/09677720211018975|journal=Journal of Medical Biography|volume=29|issue=3|language=en|pages=176–179|doi=10.1177/09677720211018975|pmid=33998906|s2cid=234747817|issn=0967-7720|access-date=2021-05-17|archive-date=2023-02-04|archive-url=https://web.archive.org/web/20230204054342/https://journals.sagepub.com/doi/10.1177/09677720211018975|url-status=live}}</ref> The self-illuminated endoscope was developed at [[Glasgow Royal Infirmary]] in [[Scotland]] (one of the first hospitals to have mains electricity) in 1894/5 by [[John Macintyre]] as part of his specialization in the investigation of the larynx.<ref>{{cite web | url = http://sshm.ac.uk/wp-content/uploads/2013/10/PROCEEDINGS-SESSION-1994-1995-and-1995-1996.pdf | title = The Scottish Society of the History of Medicine | access-date = 2017-07-11 | archive-date = 2016-12-20 | archive-url = https://web.archive.org/web/20161220090937/http://sshm.ac.uk/wp-content/uploads/2013/10/PROCEEDINGS-SESSION-1994-1995-and-1995-1996.pdf | url-status = live }}</ref>{{Failed verification|date=April 2019|reason=This source doesn't mention the years; it says: "Even before using X-rays he had pioneered the development of self-illuminated endoscopes"}}


==Medical uses==
==Medical uses==
[[File:PENTAX Colonoscope002.jpg|thumb|Operation part of the endoscope]]
[[File:PENTAX Colonoscope002.jpg|thumb|Operation part of the endoscope]]
[[File:Insertion tip of endoscope.jpg|thumb|Insertion tip of an endoscope]]
[[File:Insertion tip of endoscope.jpg|thumb|Insertion tip of an endoscope]]
Endoscopy may be used to investigate symptoms in the [[digestive system]] including [[nausea]], [[vomiting]], [[abdominal pain]], [[difficulty swallowing]], and [[gastrointestinal bleeding]].<ref name="mayoendo">{{cite web | url = http://www.mayoclinic.com/health/endoscopy/MY00138/METHOD=print |title=Upper endoscopy |author = Staff |work= Mayo Clinic |year=2012 |access-date=24 September 2012}}</ref> It is also used in diagnosis, most commonly by performing a biopsy to check for conditions such as [[anemia]], bleeding, [[inflammation]], and [[Digestive system neoplasm|cancers of the digestive system]].<ref name="mayoendo"/> The procedure may also be used for treatment such as [[cauterization]] of a bleeding vessel, widening a narrow esophagus, clipping off a polyp or removing a foreign object.<ref name="mayoendo"/>
Endoscopy may be used to investigate symptoms in the [[digestive system]] including [[nausea]], [[vomiting]], [[abdominal pain]], [[difficulty swallowing]], and [[gastrointestinal bleeding]].<ref name="mayoendo">{{cite web |url=http://www.mayoclinic.com/health/endoscopy/MY00138/METHOD=print |title=Upper endoscopy |author=Staff |work=Mayo Clinic |year=2012 |access-date=24 September 2012 |archive-date=25 May 2013 |archive-url=https://web.archive.org/web/20130525230502/http://www.mayoclinic.com/health/endoscopy/MY00138/METHOD=print |url-status=live }}</ref> It is also used in diagnosis, most commonly by performing a biopsy to check for conditions such as [[anemia]], bleeding, [[inflammation]], and [[Digestive system neoplasm|cancers of the digestive system]].<ref name="mayoendo"/> The procedure may also be used for treatment such as [[cauterization]] of a bleeding vessel, widening a narrow esophagus, clipping off a polyp or removing a foreign object.<ref name="mayoendo"/>


[[Specialty (medicine)|Specialty]] [[professional organizations]] that specialize in digestive problems advise that many patients with [[Barrett's esophagus]] receive endoscopies too frequently.<ref name="AGAfive">{{Citation|author1=American Gastroenterological Association |author1-link=American Gastroenterological Association |title=Five Things Physicians and Patients Should Question |publisher=[[American Gastroenterological Association]] |work=Choosing Wisely: an initiative of the [[ABIM Foundation]] |url=http://choosingwisely.org/wp-content/uploads/2012/04/5things_12_factsheet_AGA.pdf |access-date=August 17, 2012 |url-status=dead |archive-url=https://web.archive.org/web/20120809143636/http://choosingwisely.org/wp-content/uploads/2012/04/5things_12_factsheet_AGA.pdf |archive-date=August 9, 2012 }}</ref> Such societies recommend that patients with Barrett's esophagus and no cancer symptoms after two biopsies receive biopsies as indicated and no more often than the recommended rate.<ref name=pmid21376940>{{cite journal | vauthors = Spechler SJ, Sharma P, Souza RF, Inadomi JM, Shaheen NJ | title = American Gastroenterological Association medical position statement on the management of Barrett's esophagus | journal = Gastroenterology | volume = 140 | issue = 3 | pages = 1084–91 | date = March 2011 | pmid = 21376940 | doi = 10.1053/j.gastro.2011.01.030 }}</ref><ref name=pmid18341497>{{cite journal | vauthors = Wang KK, Sampliner RE | title = Updated guidelines 2008 for the diagnosis, surveillance and therapy of Barrett's esophagus | journal = The American Journal of Gastroenterology | volume = 103 | issue = 3 | pages = 788–97 | date = March 2008 | doi = 10.1111/j.1572-0241.2008.01835.x | pmid = 18341497 | s2cid = 8443847 }}</ref>
[[Specialty (medicine)|Specialty]] [[professional organizations]] that specialize in digestive problems advise that many patients with [[Barrett's esophagus]] receive endoscopies too frequently.<ref name="AGAfive">{{Citation|author1=American Gastroenterological Association |author1-link=American Gastroenterological Association |title=Five Things Physicians and Patients Should Question |publisher=[[American Gastroenterological Association]] |work=Choosing Wisely: an initiative of the [[ABIM Foundation]] |url=http://choosingwisely.org/wp-content/uploads/2012/04/5things_12_factsheet_AGA.pdf |access-date=August 17, 2012 |url-status=dead |archive-url=https://web.archive.org/web/20120809143636/http://choosingwisely.org/wp-content/uploads/2012/04/5things_12_factsheet_AGA.pdf |archive-date=August 9, 2012 }}</ref> Such societies recommend that patients with Barrett's esophagus and no cancer symptoms after two biopsies receive biopsies as indicated and no more often than the recommended rate.<ref name=pmid21376940>{{cite journal | vauthors = Spechler SJ, Sharma P, Souza RF, Inadomi JM, Shaheen NJ | title = American Gastroenterological Association medical position statement on the management of Barrett's esophagus | journal = Gastroenterology | volume = 140 | issue = 3 | pages = 1084–91 | date = March 2011 | pmid = 21376940 | doi = 10.1053/j.gastro.2011.01.030 | doi-access = free }}</ref><ref name=pmid18341497>{{cite journal | vauthors = Wang KK, Sampliner RE | title = Updated guidelines 2008 for the diagnosis, surveillance and therapy of Barrett's esophagus | journal = The American Journal of Gastroenterology | volume = 103 | issue = 3 | pages = 788–97 | date = March 2008 | doi = 10.1111/j.1572-0241.2008.01835.x | pmid = 18341497 | s2cid = 8443847 | doi-access = free }}</ref>


===Applications===
===Applications===
[[File:Anoscope, proctoscope and rectoscope.svg|thumb|250px|An [[anoscope]], a [[proctoscope]], and a [[rectoscope]] with approximate lengths]]
[[File:Anoscope, proctoscope and rectoscope.svg|thumb|250px|An [[anoscope]], a [[proctoscope]], and a [[rectoscope]] with approximate lengths]]
[[File:US Navy 081117-N-7526R-568 Cmdr. Thomas Nelson and Lt. Robert Roadfuss discuss proper procedures while performing a laparoscopic cholecystectomy surgery.jpg|thumb|250px|Endoscopy surgery]]
[[File:US Navy 081117-N-7526R-568 Cmdr. Thomas Nelson and Lt. Robert Roadfuss discuss proper procedures while performing a laparoscopic cholecystectomy surgery.jpg|thumb|250px|Endoscopy surgery]]
[[File:Esophageal Bougie Dilator.jpg|thumb|Esophageal Bougie Dilator]]
Health care providers can use endoscopy to review any of the following body parts:
Health care providers can use endoscopy to review any of the following body parts:
* The [[Human gastrointestinal tract|gastrointestinal tract]] (GI tract):
* The [[Human gastrointestinal tract|gastrointestinal tract]] (GI tract):
** [[File:Esophageal Bougie Dilator.jpg|thumb|Esophageal Bougie Dilator]] [[oesophagus]], [[stomach]] and [[duodenum]] ([[esophagogastroduodenoscopy]])
** [[oesophagus]], [[stomach]] and [[duodenum]] ([[esophagogastroduodenoscopy]])
** [[small intestine]] ([[enteroscopy]])
** [[small intestine]] ([[enteroscopy]])
** [[large intestine]]/[[colon (anatomy)|colon]] ([[colonoscopy]], [[sigmoidoscopy]])
** [[large intestine]]/[[colon (anatomy)|colon]] ([[colonoscopy]], [[sigmoidoscopy]])
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** [[bile duct]]
** [[bile duct]]
*** [[endoscopic retrograde cholangiopancreatography]] (ERCP), duodenoscope-assisted cholangiopancreatoscopy, intraoperative cholangioscopy
*** [[endoscopic retrograde cholangiopancreatography]] (ERCP), duodenoscope-assisted cholangiopancreatoscopy, intraoperative cholangioscopy
** [[rectum]] (rectoscopy) and [[anus]] ([[anoscopy]]), both also referred to as ([[proctoscopy]])
** [[rectum]] (rectoscopy) and [[Human anus|anus]] ([[anoscopy]]), both also referred to as ([[proctoscopy]])
* The [[respiratory tract]]
* The [[respiratory tract]]
** The [[human nose|nose]] ([[rhinoscopy]])
** The [[human nose|nose]] ([[rhinoscopy]])
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** The lower [[respiratory tract]] ([[bronchoscopy]])
** The lower [[respiratory tract]] ([[bronchoscopy]])
* The [[ear]] ([[otoscope]])
* The [[ear]] ([[otoscope]])
* The [[urinary tract]] ([[cystoscopy]])
* The [[Urinary bladder]] ([[cystoscopy]])
* The female [[reproductive system]] (gynoscopy)
** The [[Ureter]] ([[ureteroscopy]])
* The [[female reproductive system]] (gynoscopy)
** The [[cervix]] ([[colposcopy]])
** The [[cervix]] ([[colposcopy]])
** The [[uterus]] ([[hysteroscopy]])
** The [[uterus]] ([[hysteroscopy]])
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** [[Hand surgery]], such as [[endoscopic carpal tunnel release]]
** [[Hand surgery]], such as [[endoscopic carpal tunnel release]]
** [[Knee surgery]], such as [[anterior cruciate ligament reconstruction]]
** [[Knee surgery]], such as [[anterior cruciate ligament reconstruction]]
** [[Epidural space]] (Epiduroscopy)
** [[Epidural space]] (epiduroscopy)
** [[Bursa (anatomy)|Bursae]] ([[Bursectomy]])
** [[Bursa (anatomy)|Bursae]] ([[bursectomy]])
* [[Endodontic]] surgery
* [[Endodontic]] surgery
** [[Maxillary sinus]] surgery
** [[Maxillary sinus]] surgery
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* [[Endoscopic endonasal surgery]]
* [[Endoscopic endonasal surgery]]
* [[Endoscopic spinal surgery]]
* [[Endoscopic spinal surgery]]
* Endoscopic [[nerve decompression]] for [[Peripheral nervous system|peripheral nerves]]


An endoscopy is a simple procedure that allows a doctor to look inside human bodies using an instrument called an endoscope. A cutting tool can be attached to the end of the endoscope, and the apparatus can then be used to perform minor procedures such as tissue biopsies, banding of oesophageal varices or removal of polyps.
An endoscopy is a simple procedure that allows a doctor to look inside human bodies using an instrument called an endoscope. A cutting tool can be attached to the end of the endoscope, and the apparatus can then be used to perform minor procedures such as tissue biopsies, banding of oesophageal varices or removal of polyps.
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==Risks==
==Risks==
The main risks are infection, over-sedation, perforation, or a tear of the stomach or esophagus lining and bleeding.<ref name="NHS">{{cite web |url=http://www.nhs.uk/conditions/Endoscopy/Pages/Introduction.aspx |title=Endoscopy |author=<!--Not stated--> |website= NHS Choices|publisher=NHS Gov.UK |access-date=April 20, 2017}}</ref> Although perforation generally requires surgery, certain cases may be treated with antibiotics and intravenous fluids. Bleeding may occur at the site of a biopsy or polyp removal. Such typically minor bleeding may simply stop on its own or be controlled by cauterisation. Seldom does surgery become necessary. Perforation and bleeding are rare during gastroscopy. Other minor risks include drug reactions and complications related to other diseases the patient may have. Consequently, patients should inform their doctor of all allergic tendencies and medical problems. Occasionally, the site of the sedative injection may become inflamed and tender for a short time. This is usually not serious and warm compresses for a few days are usually helpful. While any of these complications may possibly occur, each of them occurs quite infrequently. A doctor can further discuss risks with the patient with regard to the particular need for gastroscopy.
The main risks are infection, over-sedation, perforation, or a tear of the stomach or esophagus lining and bleeding.<ref name="NHS">{{cite web |url=http://www.nhs.uk/conditions/Endoscopy/Pages/Introduction.aspx |title=Endoscopy |author=<!--Not stated--> |website=NHS Choices |publisher=NHS Gov.UK |access-date=April 20, 2017 |archive-date=May 2, 2017 |archive-url=https://web.archive.org/web/20170502024143/http://www.nhs.uk/conditions/endoscopy/pages/introduction.aspx |url-status=live }}</ref> Although perforation generally requires surgery, certain cases may be treated with antibiotics and intravenous fluids. Bleeding may occur at the site of a biopsy or polyp removal. Such typically minor bleeding may simply stop on its own or be controlled by cauterisation. Seldom does surgery become necessary. Perforation and bleeding are rare during gastroscopy. Other minor risks include drug reactions and complications related to other diseases the patient may have. Consequently, patients should inform their doctor of all allergic tendencies and medical problems. Occasionally, the site of the [[sedative]] injection may become inflamed and tender for a short time. This is usually not serious and warm compresses for a few days are usually helpful. While any of these complications may possibly occur, each of them occurs quite infrequently. A doctor can further discuss risks with the patient with regard to the particular need for gastroscopy.


==After the endoscopy==
==After the endoscopy==
After the procedure, the patient will be observed and monitored by a qualified individual in the endoscopy room, or a recovery area, until a significant portion of the medication has worn off. Occasionally the patient is left with a mild sore throat, which may respond to saline gargles, or chamomile tea. It may last for weeks or not happen at all. The patient may have 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. Where sedation has been used, most facilities mandate that the patient be taken home by another person and that they not drive or handle machinery for the remainder of the day. Patients who have had an endoscopy without sedation are able to leave unassisted.
After the procedure, the patient will be observed and monitored by a qualified individual in the endoscopy room, or a recovery area, until a significant portion of the medication has worn off. Occasionally the patient is left with a mild sore throat, which may respond to saline gargles, or chamomile tea. It may last for weeks or not happen at all. The patient may have 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. Where sedation has been used, most facilities mandate that the patient be taken home by another person and that they not drive or handle machinery for the remainder of the day. Patients who have had an endoscopy without sedation are able to leave unassisted.

==Endoscope==
{{main|Endoscope}}
An [[endoscope]] can consist of:
* a rigid or flexible tube.
* a light delivery system to illuminate the [[organ (anatomy)|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 (optics)|lens]] system transmitting the [[image]] from the [[objective lens]] to the viewer, typically a [[relay lens]] system in the case of rigid endoscopes or a bundle of fiberoptics in the case of a [[fiberscope]].
* an [[eyepiece]]. Modern instruments may be videoscopes, with no eyepiece. A camera transmits image to a screen for image capture.
* an additional channel to allow entry of [[medical instrument]]s or manipulators.

Patients undergoing the procedure may be offered [[sedation]], which includes its own risks.

==History==
[[File:Bozzini Lichtleiter.jpg|thumb|Drawings of Bozzini's "Lichtleiter", an early [[endoscope]]]]

The first endoscope was developed in 1806 by [[Philipp Bozzini]] in Mainz with his introduction of a "Lichtleiter" (light conductor) "for the examinations of the canals and cavities of the human body".<ref>{{cite journal |last1=Bozzini |first1=Philipp |year=1806 |url={{Google books|dn8tAAAAcAAJ|page=107|plainurl=yes}} |title=Lichtleiter, eine Erfindung zur Anschauung innerer Teile und Krankheiten, nebst der Abbildung |trans-title=Light conductor, an invention for examining internal parts and diseases, together with illustrations |language=de |journal=Journal der Practischen Arzneykunde und Wundarzneykunst |volume=24 |pages=107–24 }}</ref> However, the [[Gesellschaft der Ärzte in Wien|College of Physicians in Vienna]] disapproved of such curiosity.<ref>{{Cite book | url = https://books.google.com/books?id=U6BdMMytieQC&q=first+endoscope+developed+in+1806&pg=PA884 | title = Atlas of Gastroenterology | last=Yamada|first=Tadataka | name-list-style = vanc |date=2009-01-22|publisher=John Wiley & Sons|isbn=978-1-4443-0342-1}}</ref> The first to use an endoscope in a successful operation was [[Antonin Jean Desormeaux]] whose invention was the state of the art before the invention of electricity.<ref name="auto"/>

The use of electric light was a major step in the improvement of endoscopy. The first such lights were external although sufficiently capable of illumination to allow cystoscopy, hysteroscopy and sigmoidoscopy as well as examination of the nasal (and later thoracic) cavities as was being performed routinely in human patients by [[Sir Francis Cruise]] (using his own commercially available endoscope) by 1865 in the [[Mater Misericordiae University Hospital|Mater Misericordiae Hospital]] in Dublin, Ireland.<ref>{{cite journal | vauthors = Caniggia A, Nuti R, Lore F, Martini G, Turchetti V, Righi G | title = Long-term treatment with calcitriol in postmenopausal osteoporosis | journal = Metabolism | volume = 39 | issue = 4 Suppl 1 | pages = 43–9 | date = April 1990 | doi = 10.1136/bmj.1.223.345 | pmid = 2325571 | jstor = 25204557 | pmc = 2325571 }}</ref> Later, smaller bulbs became available making internal light possible, for instance in a [[hysteroscopy|hysteroscope]] by Charles David in 1908.<ref>{{cite book |first1=Osama |last1=Shawki |first2=Sushma |last2=Deshmukh |first3=Luis Alonso |last3=Pacheco | name-list-style = vanc | title = Mastering the Techniques in Hysteroscopy |url=https://books.google.com/books?id=0SYLDgAAQBAJ&pg=PA13 |year=2017 |publisher=Jaypee Brothers Medical Publishers |isbn=978-93-86150-49-3 |pages=13– }}</ref>

[[Hans Christian Jacobaeus]] has been given credit for the first large published series of endoscopic explorations of the abdomen and the thorax with [[laparoscopy]] (1912) and [[thoracoscopy]] (1910)<ref name=pmid9876654>{{cite journal | vauthors = Litynski GS | title = Laparoscopy--the early attempts: spotlighting Georg Kelling and Hans Christian Jacobaeus | journal = JSLS | volume = 1 | issue = 1 | pages = 83–5 | date = Jan–Mar 1997 | pmid = 9876654 | pmc = 3015224 }}</ref> although the first reported thoracoscopic examination in a human was also by Cruise.<ref>{{cite journal |doi=10.1007/BF02946459 |title=Art. VIII.—Clinical reports of rare cases, occurring in the Whitworth and Hardwicke Hospitals |journal=Dublin Quarterly Journal of Medical Science |volume=41 |issue=1 |pages=83–99 |year=2014 |last1=Gordon |first1=Samuel | name-list-style = vanc |url=https://zenodo.org/record/1865816 }}</ref>

Laparoscopy was used in the diagnosis of [[liver]] and [[gallbladder]] disease by Heinz Kalk in the 1930s.<ref>{{cite book | isbn = 978-3-428-00192-7 | first1 = Egmont | last1 = Wildhirt | last2 = Kalk | first2 = Heinrich-Otto | name-list-style = vanc | title = Neue Deutsche Biographie (NDB). Band 11 | publisher = Duncker & Humblot | location = Berlin | date = 1977 | page = 60 }}</ref> Hope reported in 1937 on the use of laparoscopy to diagnose [[ectopic pregnancy]].<ref>{{cite book | vauthors = Balen AH, Creighton SM, Davies MC, MacDougall J, Stanhope R | title = Paediatric and Adolescent Gynaecology: A Multidisciplinary Approach | url = https://books.google.com/books?id=pCUgAwAAQBAJ&pg=PA131 | date = 2004-04-01 | publisher = Cambridge University Press | isbn = 978-1-107-32018-5 | pages = 131– }}</ref> In 1944, [[Raoul Palmer]] placed his patients in the [[Trendelenburg position]] after gaseous distention of the abdomen and thus was able to reliably perform [[gynecology|gynecologic]] laparoscopy.<ref name="Litynski_1997">{{cite journal | vauthors = Litynski GS | title = Raoul Palmer, World War II, and transabdominal coelioscopy. Laparoscopy extends into gynecology | journal = Journal of the Society of Laparoendoscopic Surgeons | volume = 1 | issue = 3 | pages = 289–92 | date = Jul–Sep 1997 | pmid = 9876691 | pmc = 3016739 }}</ref>

===Wolf and Storz===
Georg Wolf (1873–1938) a Berlin manufacturer of rigid endoscopes, established in 1906, produced the Sussmann flexible gastroscope in 1911 (Modlin, Farhadi-Journal of Clinical Gastroenterology, 2000).<ref>{{cite web | url = https://www.richardwolfusa.com/company/100-years-of-innovation.html | title = About Richard Wolf Germany | publisher = Richard Wolf Medical Instruments }}</ref> [[Karl Storz]] began producing instruments for [[Otolaryngology|ENT]] specialists in 1945 through his company, [[Karl Storz GmbH]].<ref>{{cite web | last1 = Nezhat | first1 = Camran | name-list-style = vanc | title = Chapter 19. 1960's | url = http://laparoscopy.blogs.com/endoscopyhistory/chapter_19/index.html | work = Nezhat's History of Endoscopy | publisher = Society of Laparoendoscopic Surgeons | date = 2005 | access-date = 2016-01-07 | archive-date = 2018-07-27 | archive-url = https://web.archive.org/web/20180727115326/http://laparoscopy.blogs.com/endoscopyhistory/chapter_19/index.html | url-status = dead }}</ref>

===Fiber optics===
[[File:Storz Endoscopy Unit.png|thumb|upright=0.6|A Storz endoscopy unit used for [[laryngoscopy]] exams of the [[vocal folds]] and the [[glottis]]]]
[[Basil Hirschowitz]] and Larry Curtiss invented the first fiber optic endoscope in 1957.<ref name=pmid2044933>{{cite journal | vauthors = Edmonson JM | title = History of the instruments for gastrointestinal endoscopy | journal = Gastrointestinal Endoscopy | volume = 37 | issue = 2 Suppl | pages = S27–56 | date = March 1991 | pmid = 2044933 | doi = 10.1016/S0016-5107(91)70910-3 }}</ref> Earlier in the 1950s [[Harold Hopkins (physicist)|Harold Hopkins]] had designed a "fibroscope" consisting of a bundle of flexible glass fibres able to coherently transmit an image. This proved useful both medically and industrially, and subsequent research 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.{{citation needed|date=February 2018}}

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 - which carried the risk of burning the inside of the patient. Alongside the advances to the optics, the ability to 'steer' the tip was developed, as well as innovations in remotely operated surgical instruments contained within the body of the endoscope itself. This was the beginning of "key-hole surgery" as we know it today.<ref>{{Cite journal |last=Sun|first=Guoging |display-authors=etal |title=Comparison of keyhole endoscopy and craniotomy for the treatment of patients with hypertensive cerebral hemorrhage |journal=Medicine |location=Baltimore |date=January 2019 |volume=98 |issue=2 |page=e14123 |doi=10.1097/MD.0000000000014123|pmid=30633227 |doi-access=free |pmc=6336657 }}</ref>

===Rod-lens endoscopes===
There were physical limits to the image quality of a fibroscope. A bundle of say 50,000 fibers gives effectively only a 50,000-pixel image, and continued flexing from use breaks fibers and so progressively loses pixels. Eventually so many are lost that the whole bundle must be replaced (at considerable expense). [[Harold Hopkins (physicist)|Harold Hopkins]] realised that any further optical improvement would require a different approach. Previous rigid endoscopes suffered from low light transmittance and poor image quality. The surgical requirement of passing surgical tools as well as the illumination system 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 difficult to manufacture and assemble and optically nearly useless.{{citation needed|date=February 2018}}

The elegant solution that Hopkins invented 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 required no other support. This allowed the little lenses to be dispensed with altogether. The rod-lenses were much easier to handle and used the maximum possible diameter available.{{citation needed|date=February 2018}}

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.<ref>{{cite web | url = http://www.haroldhopkins.org/history.html | work = Harold Hopkins Society | title = History }}</ref>

Whilst there are regions of the body that will always require flexible endoscopes (principally the gastrointestinal tract), the rigid rod-lens endoscopes have such exceptional performance that they are still the preferred instrument and have enabled modern key-hole surgery. (Harold Hopkins was recognized and honoured for his advancement of medical-optic by the medical community worldwide. It formed a major part of the citation when he was awarded the Rumford Medal by the Royal Society in 1984.)

By measuring absorption of light by the blood (by passing the light through one fibre and collecting the light through another fibre) a doctor can estimate the proportion of haemoglobin in the blood and diagnose ulceration in the stomach.{{citation needed|date=February 2018}}

===Endoscope reprocessing===
High level disinfection of flexible endoscopes is required by all national guideline issuing bodies.<ref name=pmid28159069>{{cite journal | vauthors = Ofstead CL, Wetzler HP, Heymann OL, Johnson EA, Eiland JE, Shaw MJ | title = Longitudinal assessment of reprocessing effectiveness for colonoscopes and gastroscopes: Results of visual inspections, biochemical markers, and microbial cultures | journal = American Journal of Infection Control | volume = 45 | issue = 2 | pages = e26–e33 | date = February 2017 | pmid = 28159069 | doi = 10.1016/j.ajic.2016.10.017 | s2cid = 19079905 }}</ref> The high level disinfection of endoscopes occurs during a multi-step process called reprocessing. Reprocessing endoscopes involves over 100 individuals steps.<ref name=pmid20679783>{{cite journal | vauthors = Ofstead CL, Wetzler HP, Snyder AK, Horton RA | title = Endoscope reprocessing methods: a prospective study on the impact of human factors and automation | journal = Gastroenterology Nursing | volume = 33 | issue = 4 | pages = 304–11 | year = 2010 | pmid = 20679783 | doi = 10.1097/SGA.0b013e3181e9431a | s2cid = 206060013 }}</ref> These steps can be broken down into broad categories of pre-cleaning, leak testing, manual cleaning, cleaning verification, visual inspection, high level disinfection, rinsing, drying, and storage.<ref name=pmid27684640>{{cite journal | vauthors = Herrin A, Loyola M, Bocian S, Diskey A, Friis CM, Herron-Rice L, Juan MR, Schmelzer M, Selking S | s2cid = 37069977 | title = Standards of Infection Prevention in Reprocessing Flexible Gastrointestinal Endoscopes | journal = Gastroenterology Nursing | volume = 39 | issue = 5 | pages = 404–18 | year = 2016 | pmid = 27684640 | doi = 10.1097/SGA.0000000000000266 }}</ref> Failure to perform all of these steps correctly can lead to residual contamination remaining on endoscopes.

In the UK, stringent guidelines exist regarding the decontamination and disinfection of flexible endoscopes, the most recent being CfPP 01–06, released in 2013<ref>{{cite web | url = https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/148559/CFPP_01-06_Operational_mgmt_Final.pdf | title = Health Technical Memorandum 01-06: Decontamination of exible endoscopes Part C: Operational management | publisher = United Kingdom Department of Health | date = March 2016 }}</ref>

Rigid endoscopes, such as an Arthroscope, can be sterilized in the same way as surgical instruments, whereas heat labile flexible endoscopes cannot.<ref name=pmid24451088>{{cite journal | vauthors = Sabnis RB, Bhattu A, Vijaykumar M | title = Sterilization of endoscopic instruments | journal = Current Opinion in Urology | volume = 24 | issue = 2 | pages = 195–202 | date = March 2014 | pmid = 24451088 | doi = 10.1097/MOU.0000000000000034 | s2cid = 29328096 }}</ref>

==Recent developments==
[[File:Endoscope, USB, 2015-05-30.jpg|thumb|Low-cost waterproof USB endoscope for non-medical use.]]
With the application of robotic systems, telesurgery was introduced as the surgeon could be at a site far removed from the patient. The first transatlantic surgery has been called the [[Lindbergh Operation]].{{citation needed|date=February 2018}}

Wireless oesophageal pH measuring devices can now be placed endoscopically, to record ph trends in an area remotely.{{citation needed|date=February 2018}}

===Endoscopy VR simulators===
[[Virtual reality]] simulators are being developed for training doctors on various endoscopy skills.<ref>{{cite web | url = https://www.youtube.com/watch?v=ogMr5u5oqN8 | title = Overview of Endoscopy Haptics Simulator Project | work = M2D2 Laboratory, Indian Institute of Science | publisher = YouTube }}</ref>

===Disposable endoscopy===
Disposable endoscopy is an emerging category of endoscopic instruments. Recent developments<ref>{{cite web|url=http://www.fraunhofer.de/en/press/research-news/2010-2011/15/cameras-out-of-the-salt-shaker.jsp |title=Dokument nicht gefunden |url-status=dead |archive-url=https://web.archive.org/web/20110720064520/http://www.fraunhofer.de/en/press/research-news/2010-2011/15/cameras-out-of-the-salt-shaker.jsp |archive-date=2011-07-20 }}</ref> have allowed the manufacture of endoscopes inexpensive enough to be used on a single patient only. It is meeting a growing demand to lessen the risk of cross contamination and hospital acquired diseases. A European consortium of the [[SME (society)|SME]] is working on the DUET (disposable use of endoscopy tool) project to build a disposable endoscope.<ref>{{cite web|url=http://www.ist-world.org/ProjectDetails.aspx?ProjectId=6ad6814768374801b7401a5ae435dec6 |title=Development of a Disposable Use Endoscopy Tool |url-status=dead |archive-url=https://web.archive.org/web/20110723225345/http://www.ist-world.org/ProjectDetails.aspx?ProjectId=6ad6814768374801b7401a5ae435dec6 |archive-date=2011-07-23 |date=2018-03-26 }}</ref>

===Capsule endoscopy===
{{main|Capsule endoscopy}}
Capsule endoscopes are pill-sized imaging devices that are swallowed by a patient and then record images of the gastrointestinal tract as they pass through naturally. Images are typically retrieved via wireless data transfer to an external receiver.

===Augmented reality===
The endoscopic image can be combined with other image sources to provide the surgeon with additional information. For instance, the position of an anatomical structure or tumor might be shown in the endoscopic video.<ref>{{YouTube|i4emmCcBb4s|Augmented Reality: Path guidance to craniopharyngioma}}</ref>

===New imaging modalities===
Emerging endoscope technologies measure additional properties of light to improve contrast, such as optical polarization,<ref name=pmid25836165>{{cite journal | vauthors = Manhas S, Vizet J, Deby S, Vanel JC, Boito P, Verdier M, De Martino A, Pagnoux D | title = Demonstration of full 4×4 Mueller polarimetry through an optical fiber for endoscopic applications | journal = Optics Express | volume = 23 | issue = 3 | pages = 3047–54 | date = February 2015 | pmid = 25836165 | doi = 10.1364/OE.23.003047 | bibcode = 2015OExpr..23.3047M | doi-access = free }}</ref> optical phase,<ref name=pmid27279676>{{cite journal | last1=Gordon | first1=GSD | first2=J |last2=Joseph | first3=MP | last3= Alcolea | first4=T | last4= Sawyer | first5=AJ | last5=Macfaden | first6=C | last6=Williams | first7=CRM | last7=Fitzpatrick | first8 = PH | last8 = Jones | first9 = M | last9 = di Pietro | first10=RC | last10=Fitzgerald | first11=TD | last11= Wilkinson | first12 = SE | last12 = Bohndiek | title = Quantitative phase and polarisation endoscopy applied to detection of early oesophageal tumourigenesis | journal=Journal of Biomedical Optics | arxiv=1811.03977 | year=2018 | volume=24 | issue=12 | pages=1–13 | doi=10.1117/1.JBO.24.12.126004 | pmid=31840442 | pmc=7006047 }}</ref> and additional wavelengths of light ([[hyperspectral]] endoscopy).<ref name=pmid21639573>{{cite journal | vauthors = Kester RT, Bedard N, Gao L, Tkaczyk TS | title = Real-time snapshot hyperspectral imaging endoscope | journal = Journal of Biomedical Optics | volume = 16 | issue = 5 | pages = 056005–056005–12 | date = May 2011 | pmid = 21639573 | pmc = 3107836 | doi = 10.1117/1.3574756 | bibcode = 2011JBO....16e6005K }}</ref>

== See also ==
* [[Colonoscopy]]
* [[Enteroscopy]]
* [[Surgery]]
* [[Anesthesia]]


== References ==
== References ==

Latest revision as of 07:12, 18 September 2024

For the notion in mathematics, see Endoscopic group.
Endoscopy
An example of an endoscopic procedure
MeSHD004724
OPS-301 code1-40...1-49, 1-61...1-69
MedlinePlus003338

An endoscopy is a procedure used in medicine to look inside the body.[1] The endoscopy procedure uses an endoscope to examine the interior of a hollow organ or cavity of the body. Unlike many other medical imaging techniques, endoscopes are inserted directly into the organ.

There are many types of endoscopies. Depending on the site in the body and type of procedure, an endoscopy may be performed by either a doctor or a surgeon. A patient may be fully conscious or anaesthetised during the procedure. Most often, the term endoscopy is used to refer to an examination of the upper part of the gastrointestinal tract, known as an esophagogastroduodenoscopy.[2]

For nonmedical use, similar instruments are called borescopes.

History

[edit]

Adolf Kussmaul was fascinated by sword swallowers who would insert a sword down their throat without gagging. This drew inspiration to insert a hollow tube for observation; the next problem to solve was how to shine light through the tube, as they were still relying on candles and oil lamps as light sources.[3]

The term endoscope was first used on February 7, 1855, by engineer-optician Charles Chevalier, in reference to the uréthroscope of Désormeaux, who himself began using the former term a month later.[4] The self-illuminated endoscope was developed at Glasgow Royal Infirmary in Scotland (one of the first hospitals to have mains electricity) in 1894/5 by John Macintyre as part of his specialization in the investigation of the larynx.[5][failed verification]

Medical uses

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Operation part of the endoscope
Insertion tip of an endoscope

Endoscopy may be used to investigate symptoms in the digestive system including nausea, vomiting, abdominal pain, difficulty swallowing, and gastrointestinal bleeding.[6] It is also used in diagnosis, most commonly by performing a biopsy to check for conditions such as anemia, bleeding, inflammation, and cancers of the digestive system.[6] The procedure may also be used for treatment such as cauterization of a bleeding vessel, widening a narrow esophagus, clipping off a polyp or removing a foreign object.[6]

Specialty professional organizations that specialize in digestive problems advise that many patients with Barrett's esophagus receive endoscopies too frequently.[7] Such societies recommend that patients with Barrett's esophagus and no cancer symptoms after two biopsies receive biopsies as indicated and no more often than the recommended rate.[8][9]

Applications

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An anoscope, a proctoscope, and a rectoscope with approximate lengths
Endoscopy surgery
Esophageal Bougie Dilator

Health care providers can use endoscopy to review any of the following body parts:

Endoscopy is used for many procedures:

An endoscopy is a simple procedure that allows a doctor to look inside human bodies using an instrument called an endoscope. A cutting tool can be attached to the end of the endoscope, and the apparatus can then be used to perform minor procedures such as tissue biopsies, banding of oesophageal varices or removal of polyps.

Application in other fields

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  • For non-medical use, such as internal inspection of complex technical systems, borescopes are used. These are similar to endoscopes.
  • The planning and architectural community use architectural endoscopy for pre-visualization of scale models of proposed buildings and cities
  • Endoscopes are also a tool helpful in the examination of improvised explosive devices by bomb disposal personnel.
  • Law enforcement uses endoscopes for conducting surveillance via tight spaces.

Risks

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The main risks are infection, over-sedation, perforation, or a tear of the stomach or esophagus lining and bleeding.[10] Although perforation generally requires surgery, certain cases may be treated with antibiotics and intravenous fluids. Bleeding may occur at the site of a biopsy or polyp removal. Such typically minor bleeding may simply stop on its own or be controlled by cauterisation. Seldom does surgery become necessary. Perforation and bleeding are rare during gastroscopy. Other minor risks include drug reactions and complications related to other diseases the patient may have. Consequently, patients should inform their doctor of all allergic tendencies and medical problems. Occasionally, the site of the sedative injection may become inflamed and tender for a short time. This is usually not serious and warm compresses for a few days are usually helpful. While any of these complications may possibly occur, each of them occurs quite infrequently. A doctor can further discuss risks with the patient with regard to the particular need for gastroscopy.

After the endoscopy

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After the procedure, the patient will be observed and monitored by a qualified individual in the endoscopy room, or a recovery area, until a significant portion of the medication has worn off. Occasionally the patient is left with a mild sore throat, which may respond to saline gargles, or chamomile tea. It may last for weeks or not happen at all. The patient may have 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. Where sedation has been used, most facilities mandate that the patient be taken home by another person and that they not drive or handle machinery for the remainder of the day. Patients who have had an endoscopy without sedation are able to leave unassisted.

References

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  1. ^ "Endoscopy". British Medical Association Complete Family Health Encyclopedia. Dorling Kindersley Limited. 1990. ISBN 978-0-751-30161-8.
  2. ^ "Endoscopy". Cancer Research UK. Archived from the original on 1 February 2017. Retrieved 5 November 2015.
  3. ^ "The pioneers of endoscopy and the sword swallowers". Archived from the original on 2022-01-27. Retrieved 2022-01-26.
  4. ^ Janssen, Diederik F (2021-05-17). "Who named and built the Désormeaux endoscope? The case of unacknowledged opticians Charles and Arthur Chevalier". Journal of Medical Biography. 29 (3): 176–179. doi:10.1177/09677720211018975. ISSN 0967-7720. PMID 33998906. S2CID 234747817. Archived from the original on 2023-02-04. Retrieved 2021-05-17.
  5. ^ "The Scottish Society of the History of Medicine" (PDF). Archived (PDF) from the original on 2016-12-20. Retrieved 2017-07-11.
  6. ^ a b c Staff (2012). "Upper endoscopy". Mayo Clinic. Archived from the original on 25 May 2013. Retrieved 24 September 2012.
  7. ^ American Gastroenterological Association, "Five Things Physicians and Patients Should Question" (PDF), Choosing Wisely: an initiative of the ABIM Foundation, American Gastroenterological Association, archived from the original (PDF) on August 9, 2012, retrieved August 17, 2012
  8. ^ Spechler SJ, Sharma P, Souza RF, Inadomi JM, Shaheen NJ (March 2011). "American Gastroenterological Association medical position statement on the management of Barrett's esophagus". Gastroenterology. 140 (3): 1084–91. doi:10.1053/j.gastro.2011.01.030. PMID 21376940.
  9. ^ Wang KK, Sampliner RE (March 2008). "Updated guidelines 2008 for the diagnosis, surveillance and therapy of Barrett's esophagus". The American Journal of Gastroenterology. 103 (3): 788–97. doi:10.1111/j.1572-0241.2008.01835.x. PMID 18341497. S2CID 8443847.
  10. ^ "Endoscopy". NHS Choices. NHS Gov.UK. Archived from the original on May 2, 2017. Retrieved April 20, 2017.
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