Endoscopic Surgery
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An endoscopy is a procedure used in
medicine Medicine is the science and Praxis (process), practice of caring for patients, managing the Medical diagnosis, diagnosis, prognosis, Preventive medicine, prevention, therapy, treatment, Palliative care, palliation of their injury or disease, ...
to look inside the body. The endoscopy procedure uses an
endoscope An endoscope is an inspection instrument composed of image sensor, optical lens, light source and mechanical device, which is used to look deep into the body by way of openings such as the mouth or anus. A typical endoscope applies several modern ...
to examine the interior of a hollow organ or cavity of the body. Unlike many other
medical imaging Medical imaging is the technique and process of imaging the interior of a body for clinical analysis and medical intervention, as well as visual representation of the function of some organs or tissues (physiology). Medical imaging seeks to revea ...
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 a doctor or a
surgeon In medicine, a surgeon is a medical doctor who performs surgery. Even though there are different traditions in different times and places, a modern surgeon is a licensed physician and received the same medical training as physicians before spec ...
. During the procedure, a patient may be fully conscious or anaesthetised. Most often, the term ''endoscopy'' is used to refer to an examination of the upper part of the
gastrointestinal tract The gastrointestinal tract (GI tract, digestive tract, alimentary canal) is the tract or passageway of the Digestion, digestive system that leads from the mouth to the anus. The tract is the largest of the body's systems, after the cardiovascula ...
, known as an
esophagogastroduodenoscopy Esophagogastroduodenoscopy (EGD) or oesophagogastroduodenoscopy (OGD), also called by various other names, is a diagnostic endoscopic procedure that visualizes the upper part of the gastrointestinal tract down to the duodenum. It is considered ...
. Similar instruments are called borescopes for nonmedical use.


History

Adolf Kussmaul Adolf Kussmaul (; 22 February 1822 – 28 May 1902) was a German physician and a leading clinician of his time. Biography Adolf Kussmaul was born as the son and grandson of physicians in Graben near Karlsruhe and studied at Heidelberg. He ente ...
was fascinated by
sword swallowers Sword swallowing is a skill in which the performer passes a sword A sword is an edged and bladed weapons, edged, bladed weapon intended for manual cutting or thrusting. Its blade, longer than a knife or dagger, is attached to a hilt and can ...
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. The term ''endoscope'' was first used on February 7, 1855, by engineer-optician Charles Chevalier, about the ''uréthroscope'' of Désormeaux, who himself began using the former term a month later. The self-illuminated endoscope was developed at
Glasgow Royal Infirmary The Glasgow Royal Infirmary (GRI) is a large teaching hospital. With a capacity of around 1,000 beds, the hospital campus covers an area of around , and straddles the Townhead and Dennistoun districts on the north-eastern fringe of the city cen ...
in
Scotland Scotland is a Countries of the United Kingdom, country that is part of the United Kingdom. It contains nearly one-third of the United Kingdom's land area, consisting of the northern part of the island of Great Britain and more than 790 adjac ...
(one of the first hospitals to have mains electricity) in 1894/5 by
John Macintyre John Macintyre or Mcintyre FRSE (2 October 1857 – 29 October 1928) was a Scottish medical doctor who set up the world's first radiology department at the Glasgow Royal Infirmary, in Glasgow. Endoscopy may be used to investigate symptoms in the
digestive system The human digestive system consists of the gastrointestinal tract plus the accessory organs of digestion (the tongue, salivary glands, pancreas, liver, and gallbladder). Digestion involves the breakdown of food into smaller and smaller compone ...
including
nausea Nausea is a diffuse sensation of unease and discomfort, sometimes perceived as an urge to vomit. It can be a debilitating symptom if prolonged and has been described as placing discomfort on the chest, abdomen, or back of the throat. Over 30 d ...
,
vomiting Vomiting (also known as emesis, puking and throwing up) is the forceful expulsion of the contents of one's stomach through the mouth and sometimes the nose. Vomiting can be the result of ailments like food poisoning, gastroenteritis, pre ...
,
abdominal pain Abdominal pain, also known as a stomach ache, is a symptom associated with both non-serious and serious medical issues. Since the abdomen contains most of the body's vital organs, it can be an indicator of a wide variety of diseases. Given th ...
,
difficulty swallowing Dysphagia is difficulty in swallowing. Although classified under " symptoms and signs" in ICD-10, in some contexts it is classified as a condition in its own right. It may be a sensation that suggests difficulty in the passage of solids or li ...
, and
gastrointestinal bleeding Gastrointestinal bleeding (GI bleed), also called gastrointestinal hemorrhage (GIB), is all forms of bleeding in the gastrointestinal tract, from the mouth to the rectum. When there is significant blood loss over a short time, symptoms may includ ...
. It is also used in diagnosis, most commonly by performing a biopsy to check for conditions such as
anemia Anemia (also spelt anaemia in British English) is a blood disorder in which the blood has a reduced ability to carry oxygen. This can be due to a lower than normal number of red blood cells, a reduction in the amount of hemoglobin availabl ...
, bleeding,
inflammation Inflammation (from ) is part of the biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or irritants. The five cardinal signs are heat, pain, redness, swelling, and loss of function (Latin ''calor'', '' ...
, and cancers of the digestive system. The procedure may also be used for treatment such as
cauterization Cauterization (or cauterisation, or cautery) is a medical practice or technique of burning a part of a body to remove or close off a part of it. It destroys some tissue in an attempt to mitigate bleeding and damage, remove an undesired growth, o ...
of a bleeding vessel, widening a narrow esophagus, clipping off a polyp, or removing a foreign object.
Specialty Specialty or speciality may refer to: * Deed, a contract in law * Index of speciality, a geometrical invariant * ''Speciality'' (album), an album by J-Pop singer Nami Tamaki * Specialty (medicine), a field within medicine * Specialty (dentistry), ...
professional organizations A professional association (also called a professional body, professional organization, or professional society) is a group that usually seeks to further a particular profession, the interests of individuals and organisations engaged in that prof ...
that specialize in digestive problems advise that many patients with
Barrett's esophagus Barrett's esophagus is a condition in which there is an abnormal ( metaplastic) change in the mucosal cells that line the lower part of the esophagus. The cells change from stratified squamous epithelium to simple columnar epithelium, intersper ...
receive endoscopies too frequently. 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.


Applications

Health care providers can use endoscopy to review any of the following body parts: * The
gastrointestinal tract The gastrointestinal tract (GI tract, digestive tract, alimentary canal) is the tract or passageway of the Digestion, digestive system that leads from the mouth to the anus. The tract is the largest of the body's systems, after the cardiovascula ...
(GI tract): **
oesophagus The esophagus (American English), oesophagus (British English), or œsophagus ( archaic spelling) ( see spelling difference) all ; : ((o)e)(œ)sophagi or ((o)e)(œ)sophaguses), colloquially known also as the food pipe, food tube, or gullet, ...
,
stomach The stomach is a muscular, hollow organ in the upper gastrointestinal tract of Human, humans and many other animals, including several invertebrates. The Ancient Greek name for the stomach is ''gaster'' which is used as ''gastric'' in medical t ...
and
duodenum The duodenum is the first section of the small intestine in most vertebrates, including mammals, reptiles, and birds. In mammals, it may be the principal site for iron absorption. The duodenum precedes the jejunum and ileum and is the shortest p ...
(
esophagogastroduodenoscopy Esophagogastroduodenoscopy (EGD) or oesophagogastroduodenoscopy (OGD), also called by various other names, is a diagnostic endoscopic procedure that visualizes the upper part of the gastrointestinal tract down to the duodenum. It is considered ...
) **
small intestine The small intestine or small bowel is an organ (anatomy), organ in the human gastrointestinal tract, gastrointestinal tract where most of the #Absorption, absorption of nutrients from food takes place. It lies between the stomach and large intes ...
(
enteroscopy Enteroscopy is the procedure of using an endoscope for the direct visualization of the small bowel. Etymologically, the word could potentially refer to any bowel endoscopy ('' entero-'' + '' -scopy''), but idiomatically it is conventionally rest ...
) **
large intestine The large intestine, also known as the large bowel, is the last part of the gastrointestinal tract and of the Digestion, digestive system in tetrapods. Water is absorbed here and the remaining waste material is stored in the rectum as feces befor ...
/ colon (
colonoscopy Colonoscopy () or coloscopy () is a medical procedure involving the Endoscopy, endoscopic examination of the large bowel (colon) and the distal portion of the small bowel. This examination is performed using either a Charge-coupled device, CCD ...
,
sigmoidoscopy Sigmoidoscopy ("sigma", the Greek term for letter " s/ς" + "eidos" + "scopy": namely, to look inside an "s"/"ς"-like object) is the minimally invasive medical examination of the large intestine from the rectum through to the nearest part of th ...
) ** Magnification endoscopy **
bile duct A bile duct is any of a number of long tube-like structures that carry bile, and is present in most vertebrates. The bile duct is separated into three main parts: the fundus (superior), the body (middle), and the neck (inferior). Bile is requ ...
***
endoscopic retrograde cholangiopancreatography Endoscopic retrograde cholangiopancreatography (ERCP) is a technique that combines the use of endoscopy An endoscopy is a procedure used in medicine to look inside the body. The endoscopy procedure uses an endoscope to examine the interior ...
(ERCP), duodenoscope-assisted cholangiopancreatoscopy, intraoperative cholangioscopy **
rectum The rectum (: rectums or recta) is the final straight portion of the large intestine in humans and some other mammals, and the gut in others. Before expulsion through the anus or cloaca, the rectum stores the feces temporarily. The adult ...
(rectoscopy) and
anus In mammals, invertebrates and most fish, the anus (: anuses or ani; from Latin, 'ring' or 'circle') is the external body orifice at the ''exit'' end of the digestive tract (bowel), i.e. the opposite end from the mouth. Its function is to facil ...
(
anoscopy An anoscopy is a medical examination using a small, rigid, tubular instrument called an anoscope (also called a rectal speculum). This is inserted a few centimeters into the anus in order to evaluate problems of the anal canal. Anoscopy is use ...
), both also referred to as (
proctoscopy Proctoscopy, or rectoscopy, is a common medical procedure in which an instrument called a proctoscope (also known as a rectoscope, although the latter may be a bit longer) is used to examine the anal cavity, rectum, or sigmoid colon. A proctoscop ...
) * The
respiratory tract The respiratory tract is the subdivision of the respiratory system involved with the process of conducting air to the alveoli for the purposes of gas exchange in mammals. The respiratory tract is lined with respiratory epithelium as respirato ...
** The
nose A nose is a sensory organ and respiratory structure in vertebrates. It consists of a nasal cavity inside the head, and an external nose on the face. The external nose houses the nostrils, or nares, a pair of tubes providing airflow through the ...
(
rhinoscopy A rhinoscope (or nasoscope) is a thin, tube-like instrument used to examine the inside of the nose. A rhinoscope has a light and a lens for viewing and may have a tool to remove tissue. Types Rhinoscopy is performed by two procedures. * Anterio ...
) ** The upper
respiratory tract The respiratory tract is the subdivision of the respiratory system involved with the process of conducting air to the alveoli for the purposes of gas exchange in mammals. The respiratory tract is lined with respiratory epithelium as respirato ...
(
laryngoscopy Laryngoscopy () is endoscopy of the larynx, a part of the throat. It is a medical procedure that is used to obtain a view, for example, of the vocal folds and the glottis. Laryngoscopy may be performed to facilitate tracheal intubation during ge ...
) ** The lower
respiratory tract The respiratory tract is the subdivision of the respiratory system involved with the process of conducting air to the alveoli for the purposes of gas exchange in mammals. The respiratory tract is lined with respiratory epithelium as respirato ...
(
bronchoscopy Bronchoscopy is an endoscopic technique of visualizing the inside of the airways for diagnostic and therapeutic purposes. An instrument (bronchoscope) is inserted into the airways, usually through the nose or mouth, or occasionally through a tr ...
) * The
ear In vertebrates, an ear is the organ that enables hearing and (in mammals) body balance using the vestibular system. In humans, the ear is described as having three parts: the outer ear, the middle ear and the inner ear. The outer ear co ...
(
otoscope An otoscope or auriscope is a medical device used by healthcare professionals to examine the ear canal and eardrum. This may be done as part of routine Physical examination, physical examinations, or for evaluating specific ear complaints, such ...
) * The
Urinary bladder The bladder () is a hollow organ in humans and other vertebrates that stores urine from the Kidney (vertebrates), kidneys. In placental mammals, urine enters the bladder via the ureters and exits via the urethra during urination. In humans, the ...
(
cystoscopy Cystoscopy is endoscopy of the urinary bladder via the urethra. It is carried out with a cystoscope. The urethra is the tube that carries urine from the bladder to the outside of the body. The cystoscope has lenses like a telescope or microscop ...
) ** The
Ureter The ureters are tubes composed of smooth muscle that transport urine from the kidneys to the urinary bladder. In an adult human, the ureters typically measure 20 to 30 centimeters in length and about 3 to 4 millimeters in diameter. They are lin ...
(
ureteroscopy Ureteroscopy is an examination of the upper urinary tract, usually performed with a ureteroscope that is passed through the urethra and the bladder, and then directly into the ureter. The procedure is useful in the diagnosis and treatment of dis ...
) * The
female reproductive system The human female reproductive system is made up of the internal and external sex organs that function in the reproduction of new offspring. The reproductive system is immature at birth and develops at puberty to be able to release matured ov ...
(gynoscopy) ** The
cervix The cervix (: cervices) or cervix uteri is a dynamic fibromuscular sexual organ of the female reproductive system that connects the vagina with the uterine cavity. The human female cervix has been documented anatomically since at least the time ...
(
colposcopy Colposcopy ( + ''skopos'' 'look at') is a medical diagnostic procedure to visually examine the cervix as well as the vagina and vulva using a colposcope. The main goal of colposcopy is to prevent cervical cancer by detecting and treating precanc ...
) ** The
uterus The uterus (from Latin ''uterus'', : uteri or uteruses) or womb () is the hollow organ, organ in the reproductive system of most female mammals, including humans, that accommodates the embryonic development, embryonic and prenatal development, f ...
(
hysteroscopy Hysteroscopy is the inspection of the uterine cavity by endoscopy with access through the cervix. It allows for the diagnosis of intrauterine pathology and serves as a method for surgical intervention (operative hysteroscopy). Hysteroscope A hyst ...
) ** The
fallopian tube The fallopian tubes, also known as uterine tubes, oviducts or salpinges (: salpinx), are paired tubular sex organs in the human female body that stretch from the Ovary, ovaries to the uterus. The fallopian tubes are part of the female reproduct ...
s (
falloposcopy Falloposcopy (occasionally also falloscopy) is the inspection of the fallopian tubes through a micro- endoscope. The falloposcope is inserted into the tube through its opening in the uterus at the proximal tubal opening via the uterotubal junction; ...
) * Normally closed body cavities (through a small incision): ** The abdominal or pelvic cavity (
laparoscopy Laparoscopy () is an operation performed in the abdomen or pelvis using small incisions (usually 0.5–1.5 cm) with the aid of a camera. The laparoscope aids diagnosis or therapeutic interventions with a few small cuts in the abdomen.Medli ...
) ** The interior of a joint (
arthroscopy Arthroscopy (also called arthroscopic or keyhole surgery) is a minimally invasive surgical procedure on a joint in which an examination and sometimes treatment of damage is performed using an arthroscope, an endoscope that is inserted into the j ...
) ** Organs of the chest (
thoracoscopy Thoracoscopy is a medical procedure involving internal examination, biopsy and/or resection/drainage of disease or masses within the pleural cavity, usually with video assistance. Thoracoscopy may be performed either under general anaesthesia o ...
and
mediastinoscopy Mediastinoscopy is a procedure that enables visualization of the contents of the mediastinum, usually for the purpose of obtaining a biopsy. Mediastinoscopy is often used for staging of lymph nodes of lung cancer or for diagnosing other condition ...
) Endoscopy is used for many procedures: * During
pregnancy Pregnancy is the time during which one or more offspring gestation, gestates inside a woman's uterus. A multiple birth, multiple pregnancy involves more than one offspring, such as with twins. Conception (biology), Conception usually occurs ...
** The
amnion The amnion (: amnions or amnia) is a membrane that closely covers human and various other embryos when they first form. It fills with amniotic fluid, which causes the amnion to expand and become the amniotic sac that provides a protective envir ...
(amnioscopy) ** The
fetus A fetus or foetus (; : fetuses, foetuses, rarely feti or foeti) is the unborn offspring of a viviparous animal that develops from an embryo. Following the embryonic development, embryonic stage, the fetal stage of development takes place. Pren ...
(
fetoscopy Fetoscopy is an endoscopic procedure during pregnancy to allow surgical access to the fetus, the amniotic cavity, the umbilical cord, and the fetal side of the placenta. A small (3–4 mm) incision is made in the abdomen, and an endoscope i ...
) * Plastic surgery * Panendoscopy (or triple endoscopy) ** Combines
laryngoscopy Laryngoscopy () is endoscopy of the larynx, a part of the throat. It is a medical procedure that is used to obtain a view, for example, of the vocal folds and the glottis. Laryngoscopy may be performed to facilitate tracheal intubation during ge ...
,
esophagoscopy Esophagogastroduodenoscopy (EGD) or oesophagogastroduodenoscopy (OGD), also called by various other names, is a diagnostic endoscopic procedure that visualizes the upper part of the gastrointestinal tract down to the duodenum. It is considered ...
, and
bronchoscopy Bronchoscopy is an endoscopic technique of visualizing the inside of the airways for diagnostic and therapeutic purposes. An instrument (bronchoscope) is inserted into the airways, usually through the nose or mouth, or occasionally through a tr ...
*
Orthopedic surgery Orthopedic surgery or orthopedics ( alternative spelling orthopaedics) is the branch of surgery concerned with conditions involving the musculoskeletal system. Orthopedic surgeons use both surgical and nonsurgical means to treat musculoskeletal ...
**
Hand surgery Hand surgery deals with both surgical and non-surgical treatment of conditions and problems that may take place in the hand or upper extremity (commonly from the tip of the hand to the shoulder), American Society for Surgery of the Hand. Retriev ...
, such as endoscopic carpal tunnel release ** Knee surgery, such as
anterior cruciate ligament reconstruction Anterior cruciate ligament reconstruction (ACL reconstruction) is a surgical tissue graft replacement of the anterior cruciate ligament, located in the knee, to restore its function after an injury. The torn ligament can either be removed from ...
**
Epidural space In anatomy, the epidural space is the potential space between the dura mater and vertebrae ( spine). The anatomy term "epidural space" has its origin in the Ancient Greek language; , "on, upon" + dura mater also known as "epidural cavity", "e ...
(epiduroscopy) **
Bursae A synovial bursa, usually simply bursa (: bursae or bursas), is a small fluid-filled sac lined by synovial membrane with an inner capillary layer of viscous synovial fluid (similar in consistency to that of a raw egg white). It provides a cushi ...
(
bursectomy A bursectomy is the removal of a bursa, which is a small sac filled with synovial fluid that cushions adjacent bone structures and reduces friction in joint movement. This procedure is usually carried out to relieve chronic inflammation (bursitis ...
) *
Endodontic Endodontics () is the dental specialty concerned with the study and treatment of the dental pulp. Overview Endodontics encompasses the study (practice) of the basic and clinical sciences of normal dental pulp, the etiology, diagnosis, prevent ...
surgery **
Maxillary sinus The pyramid-shaped maxillary sinus (or antrum of Nathaniel Highmore (surgeon), Highmore) is the largest of the paranasal sinuses, located in the maxilla. It drains into the middle meatus of the noseHuman Anatomy, Jacobs, Elsevier, 2008, page 209- ...
surgery **
Apicoectomy A root end surgery, also known as apicoectomy ('' apico-'' + ''-ectomy''), apicectomy ('' apic-'' + ''-ectomy''), retrograde root canal treatment (''cf.'' orthograde root canal treatment) or root-end filling, is an endodontic surgical procedure w ...
*
Endoscopic endonasal surgery Endoscopic endonasal surgery is a minimally invasive technique used mainly in neurosurgery and otolaryngology. A neurosurgeon or an otolaryngologist, using an endoscope that is entered through the nose, fixes or removes brain defects or tumors ...
*
Endoscopic spinal surgery Minimally invasive spine surgery, also known as MISS, has no specific meaning or definition. It implies a lack of severe surgical invasion. The older style of open-spine surgery for a relatively small disc problem used to require a 5-6 inch incisi ...
* Endoscopic
nerve decompression A nerve decompression is a neurosurgical procedure to relieve chronic, direct pressure on a nerve to treat nerve entrapment, a pain syndrome characterized by severe chronic pain and muscle weakness. In this way a nerve decompression targets the ...
for
peripheral nerves The peripheral nervous system (PNS) is one of two components that make up the nervous system of bilateral animals, with the other part being the central nervous system (CNS). The PNS consists of nerves and ganglia, which lie outside the brain a ...
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

* 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 Architectural endoscopy or architectural envisioning is used to photograph and film models of new buildings' exterior and interior in the planning stage. An architectural model of a new building in a 1:500 scale is thus correctly visualized from the ...
for pre-visualization of scale models of proposed buildings and cities * Endoscopes are also a tool helpful in the examination of
improvised explosive devices An improvised explosive device (IED) is a bomb constructed and deployed in ways other than in conventional warfare, conventional military action. It may be constructed of conventional military explosives, such as an artillery shell, attached t ...
by
bomb disposal Bomb disposal is an explosives engineering profession using the process by which hazardous explosive devices are disabled or otherwise rendered safe. ''Bomb disposal'' is an all-encompassing term to describe the separate, but interrelated fun ...
personnel. * Law enforcement uses endoscopes for conducting surveillance via tight spaces.


Risks

The main risks are infection, over-sedation, perforation, or a tear of the stomach or esophagus lining and bleeding. 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. Surgery became 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 A sedative or tranquilliser is a substance that induces sedation by reducing irritability or Psychomotor agitation, excitement. They are central nervous system (CNS) Depressant, depressants and interact with brain activity, causing its decelera ...
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 occur, each of them occurs quite infrequently. A doctor can further discuss risks with the patient about the particular need for gastroscopy.


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 can leave unassisted.


References


External links


The Atlas of Gastrointestinal Endoscopy
endoatlas.com



* ttps://web.archive.org/web/20110513090434/http://www.massdevice.com/blogs/massdevice/preventing-cross-contamination-flexible-endoscopes Preventing cross-contamination from flexible endoscopesmassdevice.com
Advances in Endoscopy
advancedimagingpro.com {{Authority control Diagnostic gastroenterology