Endoscopy is a method of examining the human body through direct examination using special instruments. It is considered one of the most informative instrumental methods for diagnosing various diseases of internal organs and cavities. Endoscopy allows minimally invasive visualization of almost all hollow internal organs in real time and scale.
Endoscopic examinations are carried out using special devices - endoscopes, which are metal or plastic tubes of different flexibility. Depending on the organs being examined and the need for certain medical manipulations, the design of endoscopes can vary significantly. As a rule, endoscopes are equipped with an illumination and optical system. Undistorted images of the internal organs are recorded using photo and video cameras.
The endoscope is inserted into natural orifices or specially made small-diameter punctures. The examination is performed by specialist doctors under local or general anesthesia, designed to minimize the discomfort of the patient and reduce the risk of complications. Often, the diagnostic process is combined with targeted biopsy (tissue sampling for further research), probing, and drug administration. The technique is actively used in gastroenterology, pulmonology, urology, gynecology and surgery.
Endoscopy: description of the method
Endoscopy refers to instrumental methods for examining internal organs and cavities, characterized by relative safety and low invasiveness.
Since the invention of the first endoscope, more than 200 years, during which the method went through four stages of development, called rigid, semi-flexible, fiber optic and electronic periods.
Before the advent of endoscopy, it was impossible to examine the internal organs without surgery, so medical examinations were limited to palpation, percussion (tapping) and auscultation (listening). The first attempts to conduct endoscopic examinations date back to the end of the 18th century, and the first endoscope was designed in 1805 by physician F. Bozzini. The device was a metal tube with a system of lenses and mirrors, in which a candle was used for illumination. The inventor was punished for excessive curiosity, and the device was not used in clinical practice.
Due to the risk of injury during the examination, burns and serious complications, until the middle of the 19th century, endoscopy was rarely used to examine people. After the invention of the Edison lamp, a controlled endoscope with electric illumination was designed, which found application in rectoscopy and gastroscopy. The device for studying the digestive tract with photofixation of observations was called a gastrocamera. During the examination, local anesthesia with cocaine was used.
The invention of the semi-flexible endoscope marked the beginning of a new stage in the development of endoscopy. In the post-war period, a model of a fibrogastroscope was proposed, in which the lens system was replaced by an optical fiber. This device made it possible to conduct research in real time with image transmission to a television screen and perform medical manipulations, which significantly expanded the boundaries of endoscopy.
In the second half of the 20th century, the first electronic endoscope was created, capable of converting optical signals into electrical impulses. Electronic endoscopes had a high resolution, thanks to which it was possible to enlarge the image, transfer it to a computer screen and save it on electronic media. This made it possible to objectively analyze the results of research and study the dynamics of pathological processes for the timely and effective treatment of diseases.
Improved models of rigid and flexible endoscopes are used in modern clinical practice. Flexible endoscopes (fiberscopes) are fiber optic devices and consist of glass fibers through which the image is transmitted. Recently, fiberscopes have been replaced by video endoscopes - devices equipped with a miniature video camera located at the distal end. Video endoscopes are characterized by a small tube diameter and transmit information electronically, which makes it possible to obtain detailed images of the examined organs in high resolution.
The most common types of modern endoscopes and their areas of application:
|Type of endoscope||Examined organs and cavities|
|Arthroscope||Large joints and articular capsules|
|Colonoscope||Inner surface of the large intestine|
|Laparoscope||Outer surface of the abdominal organs (stomach, gallbladder, diaphragm, genitals, etc.)|
|Rectosigmoscope||Rectum and sigmoid colon|
|Tracheobronchoscope||Airways and bronchi|
|Esophagogastroduodenoscope||Gastrointestinal organs (esophagus, stomach, duodenum)|
|Cystoscope||Urinary tract and bladder|
The device is introduced into the cavity through a natural anatomical opening or a small-diameter puncture specially made in the required place. In addition to biopsy and transportation of drugs, endoscopy can be combined with surgery. To do this, with the help of an endoscope, miniature manipulator instruments controlled by the surgeon are introduced into the body.
Endoscopic technique is used to remove the appendix, gallbladder, tumors, lymph nodes, intervertebral hernias, to eliminate sclerotic vascular pathology and bypass the heart. Endoscopic surgery allows for surgical intervention without abdominal incisions, which minimizes the likelihood of complications in the postoperative period.
Endoscopy is a universal procedure that is suitable for both primary and differential diagnosis in order to study the condition of the mucosa in the disease. Detailed images of organs and cavities make it possible to fix pathological processes in the initial stages and facilitate the analysis of the effectiveness of treatment.
Diagnostic and therapeutic possibilities of endoscopy:
- early diagnosis of diseases of hollow organs with photo and video recording of changes;
- detection of tumors, inflammations, ulcers, erosions, polyps, diverticula, hemorrhoids and other pathologies;
- local administration of drugs, washing with antiseptics and antibiotics;
- physical impact with cryogen and laser radiation;
- performing a biopsy (tissue collection for research);
- installation of a catheter, shunting and minimally invasive surgery to remove tumors, polyps, nodes.
Depending on the organs of study and ongoing medical manipulations, there are such types of endoscopy:
|Types of endoscopy||Fields of study|
|Arthroscopy||Joints and articular capsules|
|Bronchoscopy||Respiratory tract, trachea, bronchi|
|Cardioscopy||Cavity of the heart (cardiac chambers)|
|Laparoscopy||External side of the abdominal organs and small pelvis|
|Nasopharyngoscopy||Nasal and laryngeal mucosa|
|Otoscopy||Outer ear and tympanic membrane|
|Sigmoidoscopy||Rectum, sigmoid colon|
|Thoracoscopy||Chest cavity and outer side of its organs|
|Esophagogastroduodenoscopy||Digestive tract (esophagus, stomach, duodenum)|
Proper preparation is important for an endoscopic examination. As a rule, all preparatory measures are aimed at cleaning the studied organs as much as possible before diagnosis and maintaining them in a state of rest. 2-3 days before the procedure, you must give up junk food and switch to a slag-free diet. Preparation for endoscopy is discussed with the specialist who conducts the examination.
Local anesthesia is used to reduce the pain of the examination and minimize post-exposure discomfort. To do this, the mucous membranes are lubricated or irrigated with anesthetic solutions. General anesthesia is used in cases where surgical examination is dangerous to human health and life or surgical intervention is necessary. Intravenous or inhalation anesthesia during endoscopy is also indicated for children under 4 years of age, people with an unbalanced psyche and ongoing internal bleeding.
Endoscopy of the digestive tract
Esophagogastroduodenoscopy (EGD) is one of the most important areas of endoscopic research, which arose at the beginning of the 19th century. Gastroscopy is a visual non-invasive examination of the mucous membranes of the esophagus, stomach and duodenum. The gastroscope is a flexible tube equipped with an optical system or a miniature video camera. The results of the survey using photo and video recording are recorded in the form of high-quality electronic images and stored in a computer database.
Indications for endoscopy:
- pain of unknown nature in the gastrointestinal tract;
- tumors and inflammation of the mucous membranes of the esophagus, stomach and duodenum;
- peptic ulcers, gastritis, colitis, duodenitis and esophagitis;
- need for biopsy or cauterization of ulcers;
- gastrointestinal bleeding.
Gastroscopy is performed strictly on an empty stomach, eating should be stopped 8-10 hours before the procedure. The gastroscope is inserted into the esophagus through the mouth and larynx, after treating the throat with a solution of lidocaine to reduce discomfort. Perhaps intramuscular administration of sedatives, general anesthesia is used extremely rarely. If necessary, perform a biopsy and measure the level of acidity.
The patient is advised to remain calm and breathe deeply to avoid vomiting. A simple study without additional manipulations takes only 2-3 minutes. The presence of diabetes mellitus and intolerance to the drugs used should be reported to the endoscopist.
Gastroscopy is contraindicated in severe pathologies of the heart and lungs, aortic stenosis, anemia. Patients with poor blood clotting and the elderly are at risk for complications after the procedure. Unpleasant sensations in the throat usually disappear within 24 hours after the examination.
Colonoscopy is another of the most common endoscopic methods that is aimed at examining the large intestine. The examination is performed using a flexible endoscope and allows you to identify various diseases and neoplasms, perform a biopsy and surgical procedures.
Indications for colonoscopy:
- recurrent pain of unknown etiology;
- gastrointestinal bleeding;
- intestinal polyps, tumors, inflammations and other neoplasms;
- ulcers, ulcerative colitis, Crohn's disease;
- ileus, constipation.
When skillfully performed, colonoscopy is safe, painless, and causes minimal discomfort, so the examination is performed without anesthesia. Colon examination is not recommended in active Crohn's disease and ulcerative colitis to avoid damage to the intestines. There are no other contraindications for colonoscopy.
Endoscopy of the rectum and sigmoid colon
Sigmoidoscopy is a type of endoscopy designed to diagnose pathologies of the rectum and distal sigmoid colon. The examination of these sections of the intestine is performed using a special device - a rectoscope, which is a tube containing a lighting device and an air supply device. Thus, it is possible to make a visual examination of the intestine at a distance of 20-25 cm from the anus.
Indications for sigmoidoscopy are suspicions of various neoplasms in the area under study and the need to take a biopsy. Sigmoidoscopy is not recommended in the presence of acute inflammation and fissures of the anal canal, bleeding and congenital pathologies of the rectum.
Diagnosis of diseases of the urinary tract
recognition of various kidney diseases. Cystoscopy existed before the advent of ultrasound and made it possible to detect tumors of the bladder, foreign bodies in its cavity, remove and extract them through natural routes.
With the help of cystoscopy, one can assess the efficiency of the kidneys, determine the localization of the disease process, and identify pathologies of the ureters and bladder. Modern technologies make it possible to combine the process of cystoscopy with taking a biopsy and placing a catheter in the urinary tract.
Endoscopic examination of the abdominal cavity
Laparoscopy is an endoscopic examination of the organs of the abdominal cavity and small pelvis. Laparoscopy is one of the few endoscopic techniques that involves invasive intervention due to the need to create a special hole in the area under study. The diameter of the hole through which the laparoscope is inserted is 0.5-1.5 cm, so the procedure can be classified as low-traumatic.
A laparoscope is a telescopic tube with an optical system or video camera to which an illumination cable is attached. Modern laparoscopes are equipped with digital matrices, which allows you to get high-quality images in high resolution. During the procedure, the abdominal cavity is filled with carbon dioxide to facilitate inspection.
The scope of laparoscopy is not limited to the diagnosis of diseases. The range of surgical procedures performed using a laparoscope is very wide: from simple removal of polyps to complex surgical interventions. Laparoscopy has had a strong influence on the development of modern surgery as miniature surgical instruments are inserted with a laparoscope through a small puncture.
The use of laparoscopy in surgery has many advantages: low trauma, shortening of the patient's recovery and hospital stay, no need for suturing, and a decrease in the risk of postoperative complications.
A video capsule endoscope is a miniature electronic device that allows you to examine the gastrointestinal tract along its entire length and record the detected changes with high accuracy in the form of digitized images. To date, capsule endoscopy is the safest and most informative method for examining hard-to-reach parts of the small intestine.
The 10x25 mm video capsule is equipped with a battery and a video camera that makes up to 3 frames per second and transmits the image to a special device - the receiver. All that is required of the patient is to swallow the capsule under the supervision of an endoscopist. Sensors are attached to the abdomen, which transmit an image to a receiver worn by the patient.
Indications for video capsule examination:
- ulcers, tumors, acute bleeding in the small intestine;
- suspected Crohn's disease;
- the need to diagnose polyps and celiac disease;
- pathology of the small intestine;
- pain in the region of the small intestine, the origin of which cannot be established in any other way.
Capsule endoscopy also requires preparation and is performed on an empty stomach, 3-4 hours after the capsule enters the intestine, the patient needs to eat. The duration of the examination is 10-12 hours, during which the patient is in the hospital. The capsule is excreted from the body naturally.
Contraindications to video capsule examination are intestinal stenoses, strictures and diverticula, dysphagia, epilepsy, and acute intestinal obstruction. The procedure is not recommended for pregnant women and patients with installed pacemakers.
Advantages and disadvantages of the method
Endoscopy has a number of advantages that favorably distinguish it from the background of research methods requiring surgical intervention. Modern endoscopes make it possible to detect and treat various diseases at an early stage, so endoscopy is practiced in such areas of medicine as gastroenterology, pulmonology, urology, gynecology and surgery.
Positive aspects of endoscopic diagnostics:
- low invasiveness, relative safety and painlessness of the procedure;
- high examination accuracy, high resolution digital imaging;
- early detection of tumors, ulcers, inflammations, polyps and other neoplasms;
- compatibility with biopsy, drug administration and surgical procedures of varying complexity;
- the ability to observe in real time and save information on electronic media for later analysis.
The negative aspects of endoscopy include the need for preparation for the examination and the limited scope of the method.
Endoscopes can only be used to examine hollow organs and internal cavities. During the examination without anesthesia and after its completion, the patient feels severe discomfort.
Performing an endoscopy is a process that requires appropriate qualifications from a specialist, because careless insertion of an endoscope is fraught with injuries and complications.
Laparoscopy and thoracoscopy require surgery. Before endoscopic examination, consultation with a specialist is required.
- Anishchuk A. A. – Endoscopy. View from inside; Medical news agency. - Moscow, 2008. - 240 p.
- de-Francis R., Lewis B. S., Mishkin D. S. – Capsule endoscopy in plain language; Practical Medicine. - Moscow, 2012. - 128 p.