Endoscopy

Endoscopy is a diagnostic and therapeutic technique using special devices that allow obtaining visual information about the condition of hollow organs and natural cavities of the human body. In most cases, the endoscope is inserted through natural pathways (into the stomach – through the mouth, into the large intestine – through the rectum, into the uterus – through the vagina, etc.). Less often, the study of cavities is carried out through punctures or small incisions. Endoscopy is used to obtain data on the state of the gastrointestinal tract, respiratory system, urinary tract, female genital organs, the inner surface of the joints, thoracic and abdominal cavities.

History of endoscopy

The history of endoscopic diagnostics began at the end of the XVIII century, when the German scientist Bozzini invented a device that can be considered the first endoscope. The device was designed to study the uterus, colon and nasal cavity. Bozzini used a candle as a light source. Because of possible burns, the scientist was afraid to use an endoscope on humans and conducted research on animals. The scientist’s invention was apprehensively perceived by contemporaries. The Vienna Faculty of Medicine punished the researcher “for curiosity”, and interest in technology faded for a while.

In 1826, Segales improved the Bozzini device, and a year later Fischer demonstrated to colleagues a similar device of his own design. Despite the recognition of the merits of Bozzini and Fischer in the development of endoscopy, the ancestor of the technique is considered to be the French doctor Desormu, who in 1853 designed an endoscope with a system of lenses and mirrors and used it to study the genitourinary system. The second half of the XIX century was marked by the rapid development of endoscopy. European specialists invented a number of devices for various purposes, but due to the lack of safe light sources, the use of endoscopy was limited.

The situation changed after the invention of the incandescent lamp. The devices were reduced in size and rapidly improved. At the beginning of the XX century, the first operations using an endoscope were performed. In the 30s of the XX century, the first semi-flexible endoscopes appeared, and in the 50s – flexible endoscopes. The use of advanced devices has expanded the capabilities of specialists in the study of the cavities of the human body. The study has become simpler, safer and painless. High information content and affordable prices for endoscopy allowed this technique to take its rightful place in the list of modern diagnostic studies and to displace traditional surgery in the treatment of a number of pathological processes.

Principles of conducting

In the diagnostic process, an endoscope is used – an optical device, the main part of which is a metal tube with a lens at one end and a camera at the other. There is a fiber optic system inside the tube. A light cable and an air or liquid supply system are connected to the device. The endoscope is inserted into a natural opening or a small incision above the examined cavity. Air or saline solution is fed into the cavity – this allows you to provide the best conditions for visual inspection and increase the information content of the study.

The image from the camera is transmitted to the monitor screen. During an endoscopy, the doctor can change the position of the lens by examining various areas of the cavity. If necessary, photographing and video recording is performed. According to the indications, a biopsy, removal of polyps or foreign bodies, stopping bleeding, administration of medications, etc. can be performed. At the end of the procedure, the endoscope is removed. If the study was carried out through a natural opening, additional therapeutic measures are not required. If the endoscopy was performed through a puncture created with the help of a trocar, stitches are applied to the wound and closed with an aseptic bandage.

Types of research

Taking into account the goals, endoscopy can be therapeutic, diagnostic and diagnostic, taking into account the timing of the procedure – emergency, planned, urgent or delayed. There are dozens of varieties of diagnostic endoscopies that can be combined into several large groups:

• Endoscopic examination of the gastrointestinal tract. They include esophagoscopy, gastroscopy, colonoscopy, rectoromanoscopy, choledochoscopy, diagnostic laparoscopy and a number of other endoscopies. Most studies are carried out through natural openings, diagnostic laparoscopy – through a puncture, choledochoscopy – through a surgical incision.
• Endoscopic examination of female genital organs. They include hysteroscopy and diagnostic laparoscopy. Histroscopy is performed through the genital tract, diagnostic laparoscopy – through punctures of the anterior abdominal wall.
• Endoscopic examination of the respiratory system and thoracic cavity. They include bronchoscopy, mediastinoscopy and diagnostic thoracoscopy. Bronchoscopy is performed through natural openings (nasal passages or oropharynx), mediastinoscopy and diagnostic thoracoscopy – through punctures of the chest.
• Endoscopic examination of the urinary tract. These include nephroscopy, ureteroscopy, cystoscopy and urethroscopy. Nephroscopy can be performed through a natural opening (the device is inserted through the urethra, bladder and ureter), a puncture in the lumbar region or a surgical incision. The rest of the studies are performed through natural openings.
• Endoscopic examination of joints (arthroscopy). Performed on large and medium joints, always performed through a puncture.

Endoscopy can be conventional, using a coloring agent (chromocystoscopy, chromoscopy of the esophagus, stomach and colon) or with a biopsy.

Indications

The purpose of endoscopy may be to make a diagnosis if a traumatic injury, a chronic disease or an emergency condition that has arisen as a result of pathological changes in one or another organ is suspected. Endoscopy is prescribed to clarify the diagnosis and conduct differential diagnosis in cases where other studies do not allow to unambiguously establish the nature of the existing pathology. In addition, the study is used to determine the tactics of treatment and in the process of dynamic observation.

Gastrointestinal endoscopy is prescribed to assess the condition of the mucous membrane of hollow organs (esophagus, stomach, intestines, biliary tract). The technique allows us to reliably confirm the presence of inflammatory processes, ulcers, venous dilation, benign and malignant tumors. Indications for endoscopy are digestive disorders (dysphagia, dyspepsia, nausea, vomiting, constipation, diarrhea, flatulence, feeling of incomplete bowel emptying), suspicion of gastric or intestinal bleeding, intestinal obstruction and perforation of the hollow organ, as well as suspicion of bleeding into the abdominal cavity during injuries.

Endoscopy in gynecology is used in the process of examining the vaginal part of the cervix and the uterine cavity. Hysteroscopy is used to identify the causes of infertility in women, uterine bleeding and miscarriage. The study is prescribed if intrauterine adhesions, fibroids, polyps, erosions, endometriosis, cancer, inflammatory diseases and other pathological conditions accompanied by changes in the mucous membrane are suspected. During colposcopy, special samples with coloring solutions can be used – this allows you to identify mucosal defects that are not visible during normal examination.

Endoscopy in pulmonology is widely used in the diagnosis of diseases of the lungs, bronchi, pleura and mediastinum. Bronchoscopy is used to identify neoplasms, inflammatory processes, the source of bleeding and abnormalities of bronchial development. During endoscopy, sputum can be collected and a tissue sample taken for subsequent histological or cytological examination. Thoracoscopy is performed with an increase in intra-thoracic lymph nodes, suspicion of diffuse and focal processes in the lungs, pneumothorax of unclear etiology, recurrent pleurisy and other lesions of the respiratory system.

Urinary tract endoscopy is used to assess the condition of the urethra, bladder, kidneys and ureters. The method allows to identify benign and malignant neoplasms, developmental anomalies, concretions and inflammatory processes. Endoscopy is mainly used at the stage of clarifying the diagnosis and differential diagnosis with insufficient information content of other techniques. It is prescribed for pain, urinary disorders, hematuria, recurrent inflammation, the presence of fistulas, etc. In the process of endoscopy, coloring solutions can be used, as well as sampling for cytological or histological examination.

Arthroscopy is a highly informative endoscopic method of joint examination. It is usually used at the final stage of the examination. Allows you to assess the condition of the articular ends of the bones, the hyaline cartilage covering them, the capsule, ligaments and the synovial membrane of the joint. It is prescribed for pain of unclear genesis, hemarthrosis, recurrent synovitis, traumatic injuries and degenerative-dystrophic diseases of the joints.

Contraindications

General contraindications to planned endoscopy are violations of the patency of hollow organs caused by pathological changes in this anatomical zone (with cicatricial strictures, compression by pathologically altered nearby organs, changes in anatomical relationships with injuries, etc.), acute disorders of coronary and cerebral circulation, cardiac and respiratory failure of stage III, agony and unconsciousness (except for situations when the patient is under anesthesia).

The general serious condition of the patient, blood clotting disorders, mental disorders, exacerbation of chronic diseases (decompensation of diabetes mellitus, renal and heart failure), general acute infections and local inflammatory processes in the area of natural openings or suspected surgical incisions are also considered as contraindications to elective endoscopy.

Along with general, there are specific contraindications for certain types of elective endoscopy. For example, hysteroscopy is not performed during menstruation, gastroscopy is contraindicated for abdominal aortic aneurysm, etc. In urgent conditions, the agonal condition of the patient is considered an absolute contraindication to endoscopy, in other cases, the possibility and necessity of the study are determined individually.

Preparation for endoscopy

Depending on the type of examination and the revealed somatic pathology, before the procedure begins, the patient may be referred for a general examination (general blood test, biochemical urine analysis, coagulogram, ECG, chest X-ray) and for consultations with various specialists (cardiologist, nephrologist, endocrinologist, etc.). Before conducting a subcutaneous examination, an anesthesiologist and the therapist.

The training plan depends on the organ under study. Before endoscopy of the bronchi and upper gastrointestinal tract, you should refrain from taking water and food for 8-12 hours. Before colonoscopy, it is necessary to clean the intestines using laxatives or enemas. Before cystoscopy, you need to empty the bladder. Before hysteroscopy, you should undergo a gynecological examination, shave your pubic hair, empty your intestines and bladder.

The doctor tells the patient about the specifics of the procedure and the rules of behavior during the study. During endoscopy of the bronchi and upper gastrointestinal tract, the patient is asked to remove dentures. The patient is asked to lie down on a table or a special chair in a supine or sideways position. Medications are administered for anesthesia, reducing the level of mucosal secretion, eliminating pathological reflexes and normalizing the psychoemotional state of the patient. At the end of the endoscopy, the specialist gives recommendations on further behavior, prepares a conclusion, passes it to the attending physician or gives it to the patient.