Endoscopy Practice and Safety
Editor: Peter B. Cotton ed.
Peter B. Cotton
A (very) brief history of endoscopy
Flexible endoscopy is now a major diagnostic and therapeutic tool in the management of patients with digestive disorders.
It was not always so. The discovery of X-rays just over 100 years ago led quickly to the development of the 'barium meal'. This, and the barium enema, rapidly became the workhorses for the diagnosis of luminal disease. Proctoscopy gave visual
access to the anus and rectum, and rigid esophagoscopes were used by a few intrepid surgeons, at some risk. The preoccupation
of the Japanese with gastric cancer (and their well-known engineering talents) led to the development of gastro- cameras in
the 1950s and 60s, which were used (along with barium radiology) in massive screening programs. 'Semi-flexible' gastroscopes were developed in the mid part of the century, but did not achieve widespread use, because they were cumbersome
and the views were incomplete.
Fiberoptics. The first key landmark in the endoscopy revolution was the commercial development of fiberoptics. Pioneering work in Britain
and USA allowed the development of truly flexible endoscopes, which greatly facilitated esophagoscopy and gastroscopy, and
allowed further exploration of the small intestine and the whole colon.
Video-endoscopy added an important new dimension, since the images could be widely shared.
Biopsy. The addition of a biopsy capability added some scientific respectability to procedures which were initially ignored, even
ridiculed, by the academic establishment.
Therapeutics. The development and dissemination of a large variety of therapeutic procedures catapulted endoscopy into the mainstream
of gastroenterology (and surgery).
Professionalism and quality
The endoscopy success story brought growing pains and increasing responsibilities. What started for many of us 30 or more
years ago as an amusing sideline has now become a huge and complex business. We started with one endoscope in a side-room,
sometimes with the assistance of a passing nurse, understanding little about the complexities of the tools we were testing
or the diseases we were exploring. We had a naïve belief that only good could come from our activities, with little concept of infection control, the complexities of safe
sedation, or how to run an efficient unit.
Now it is universally accepted that high-quality endoscopy demands a sophisticated organization. Patients expect their procedures
to be reasonably successful and comfortable, and the risks to be minimized. Fully trained endoscopists work with expert professional
staff, using optimal equipment, in purpose-designed endoscopy units. We need to understand many things outside gastroenterology,
such as electrosurgery, lasers, computers, image management, pathology, radiology, and ultrasound, as well as infection control
and sedation. Endoscopy unit managers have to be skilled in leadership, business principles, efficiency, and quality improvement.
This e-book resource is intended to provide practical guidance for all those attempting to offer (and teach) quality endoscopy
services. This complements and builds on our popular basic book Practical Gastrointestinal Endoscopy. The 5th edition addresses mainly the fundamentals and includes two CD-Roms, concerning Upper Endoscopy and Colonoscopy.
The material in this Advanced Endoscopy series will be updated regularly, and comments are always welcome. I am delighted
that so many distinguished colleagues have kindly agreed to share their wisdom on these important topics, to help us in our
goal of delivering optimal endoscopic care.
Copyright © Blackwell Publishing, 2003