Endoscopy is an important method of examination that allows the doctor to see body cavities and organs. It is also used in planning operations and minimally invasive procedures.
The term endoscopy is understood to mean the internal illumination and inspection of hollow organs and body cavities with the aid of an endoscope. Endoscopy is used in the areas of diagnosis, surgical planning, therapy and aftercare.
What is an endoscope?
An endoscope is a tubular instrument, which, depending on the examination purpose, has a diameter of a few millimeters to almost two centimeters. At the top, it is equipped with a light source and optical devices, so that at the other end of the tube, the doctor can look directly at the examined region. Mostly today, however, images of a small video camera are transferred to a monitor. These provide excellent picture quality.
Depending on the examination area, rigid, flexible or capsule endoscopes are used.
A rigid endoscope is used to examine easily accessible areas such as the rectum or the ear, nose and throat area.
Flexible endoscopes can be guided through the organs in a targeted and anatomical way. They are used, for example, to examine the colon, trachea and lungs. Through the tube, other instruments can be introduced, for example, for the metered injection of air, so that the organ expands, for the removal of tissue or the injection of drugs. Flexible endoscopes are used to perform minimally invasive surgery.
Capsule endoscopy: What are the differences?
A capsule endoscopy is a young form of endoscopy, which is used in the small intestine. The capsule is the size of a film-coated tablet, inside which there is a small camera that moves through the digestive tract. This examination does not have to take place under medical supervision.
During this time, the camera takes two pictures per second, which it sends to a receiver attached to the body. The pictures are recorded and evaluated later. The battery lasts six to eight hours. During this time, the video capsule has reached the colon and is excreted naturally.
Meanwhile, even working on smart capsules. Unlike previous capsule endoscopes, these VECTOR capsules are intended to be actively controlled by the physician and have legs similar to a beetle to move in the stomach and intestine. For detecting disease spots, the VECTOR capsules receive optical sensors that can analyze the tissue and thus improve the early detection. The treatment of early tumor forms will also be possible with the VECTOR capsules since they can remove diseased tissue or destroy it in the body with grippers and surgical instruments.
Preparation and procedure of endoscopy
The preparation and the course of an endoscopy differ according to the examination objective and region and should be explained in detail by the medical staff.
In general, the person to be examined should appear sober for endoscopy. If the endoscopy is done through the mouth, removable dentures and piercings in this area must be removed. Maybe the glasses should be stored.
For examinations of the excretory organs, the bladder and intestine must first be emptied. If you have a gastroscopy, do not eat or drink anything for at least six hours. Depending on the scope of the examination and the condition of the person to be examined, local anesthesia or general anesthesia is performed for endoscopy.
What happens during the investigation?
The endoscope is inserted through natural orifices or a skin incision. A skin incision is necessary if the abdominal cavity, chest cavity or joints are endoscopic. Important findings can be recorded in color or printed, thus enabling optimal comparison before and after treatment. Flexible endoscopes have a working channel through which ancillary equipment can be inserted. Additional devices are gripper, sling, injection needle or forceps, with which foreign bodies can be removed, polyps removed or tissue samples were taken.
Fields of application of endoscopy
Endoscopy offers a variety of examination options in different body regions.
In diagnostics, endoscopy has decisive advantages over other examination methods, such as the imaging technique: pathological changes can be viewed directly and it is possible to differentiate between functional disorders and tissue changes reliably. The exact extent of the change can be determined and targeted tissue removal is possible directly during the examination. In diagnosis, endoscopy is used, among other things, for the early detection of carcinomas, for the targeted placement of X-ray contrast media or the assessment of the extent and severity of an internal injury.
Endoscopic operation planning: Direct examination and removal of diseased tissue enables targeted therapy and surgical planning. This is advantageous, above all, for the assessment of the position and extent of a tumor.
Endoscopic operations are characterized by the need for little or no intervention on the outside of the body to reach the site where surgery is to be performed.
The type of surgery used is called “minimally invasive.” As an alternative to the term “minimally invasive surgery” (MIC), the colloquial terms “surgery through the keyhole” or “keyhole surgery” are often used for endoscopic surgery. Common areas of application are, for example, the treatment of a hernia, the removal of the cecum, or an intervertebral disk operation.
As a result, hardly any scars remain, even the stay in the hospital is shorter. Even long stays in the hospital can be avoided so often. Some endoscopic surgeries, such as arthroscopy (articulation) of the ankle joint or the shoulder, can even be performed on an outpatient basis and without general anesthesia.
Endoscopic surgery is used in many different areas. Gastrointestinal tract problems that can be resolved by endoscopic surgery include heartburn, diverticulosis, intestinal polyps, and gastrointestinal bleeding. Operation using laparoscopy is often used to treat a hernia, gallstones, or an inflamed cecum. But even in cosmetic lipoplasty or in the treatment of severe obesity ( obesity ) often endoscopic operations are performed.
Other keyhole surgery applications include intervertebral disc herniation, neurosurgical procedures, cardiac surgery such as bypass surgery, and bladder dysfunction and carpal tunnel syndrome
Aftercare: In tumor follow-up, endoscopy, in addition to ultrasound and computed tomography, is an indispensable method of examination to detect possible recurrences or new changes in good time. Endoscopy is a great advantage compared to imaging methods, as it shows very clearly the difference between scar tissue and tumor tissue.
|Endoscopy technical term||means|
|choledochoscopy||Reflection of the duodenum and bile ducts|
|colonoscopy||Colonoscopy (large intestine)|
|thoracoscopy||Reflection of the thoracic cavity|
|laparoscopy||Belly reflection (a reflection of the abdominal cavity)|
|nephroscopy||Reflection of the renal pelvis|
|ureteroscopy||Reflection of the ureter|
|ductoscopy||Mirroring the milk ducts|
|ERCP||Gastroscopy combined with X-ray|
|Mediastinoscopy||Reflection of the mucous membranes of the hollow organs|
|Autofluorescence endoscopy||Reflection of the ribcage|
|panendoscopy||Reflection of complete ENT area plus larynx, trachea, pharynx, esophagus|
When ophthalmoscopy, the fundus photography, no endoscope is inserted, the doctor looks at the organ through the dilated pupil.
Standard examination without risk
Endoscopy is a standard procedure that often replaces significant surgery. It is hardly painful but is usually perceived as unpleasant. Complications are rare in endoscopy. There may be irritation or injury to the mucous membranes through the endoscope.
In principle, all other imaging procedures are an alternative to endoscopy for diagnosis and depending on the examination object. For example, computed tomography, ultrasound and MRI(magnetic resonance imaging, also called “nuclear spin”) are also used as methods of investigation in the case of a tumor suspected and for the assessment of the surrounding tissue. For therapeutic procedures, surgery is another option. These are, however, more extensive and burdensome for the person concerned.
In 1950 the first endoscopic pictures were taken
The first medical endoscopy was a gastroscopy, the physician and researcher Adolf Kussmaul 1868 performed on a sword swallower. With an iron pipe and a candle, he tried to illuminate the stomach. A failed attempt but laid the foundation for endoscopy. Initially, the examinations were carried out with rigid instruments. In 1932, semi-flexible and 1957 flexible endoscopes were introduced, which were also equipped with glass fiber for light transmission.
First endoscopic images were produced in 1950 with a gastrocamera. For this purpose, a tube with a camera at the tip was inserted over the throat into the stomach. The stomach was inflated, illuminated and photographed.
Since then, endoscopy has continued to evolve. Decisive advances are endoscopes with instrument channel, disinfectable fiberscopes and video endoscopy.