Imagine a doctor viewing your insides, diagnosing and treating one of numerous possible diseases—without any surgery at all. You do not even need to be unconscious.
The procedure is endoscopy, and it is used to view the esophagus, stomach, intestines, colon and the biliary and pancreatic ducts. An endoscope is a thin, flexible tube with a camera at its tip. The doctor inserts it through your mouth or nose and threads it down the esophagus. The doctor can view the image on a monitor. Some endoscopes have tiny compartments in which instruments pass through to collect samples of tissue for a biopsy or operation. Usually, the procedure only takes about 15-20 minutes.The thought of a tube running down your esophagus may make you feel a little squeamish. But the procedure is accomplished with local anaesthetic—so you are not unconscious, but you still do not feel a thing. “There's no need for recovery time,” says Dr. Walt Hogan, Professor of Medicine and Radiology at the Medical College of Wisconsin in Milwaukee. “Patients can get up and do their shopping.”
In the past, endoscopy was considerably more difficult for both the patient and the doctor. The procedure was originally developed a century ago, but the tubes were straight and unbending. In the early 60s semi-flexible tubes were devised, but they were still fairly rigid. “It was like a sword swallower,” says Dr. Hogan, who has been practicing medicine for over forty years. Doctors had to straighten out the patient's mouth and esophagus so they conformed to the tube, just like a sword swallower does to perform his craft. Now, the tubes are flexible enough to conform to the patient.
There was no camera in the early 60s; the scope had a system of lights and mirrors whereby the picture was reflected up onto the eyepiece. Something as small as mucus on the mirror would obstruct the view, and the doctor could not move the mirror around to see different parts of the organs.
Eventually, the camera was added, researchers perfected the ability to move the tip, and the scopes got skinnier and more flexible. It was only in the mid-eighties, however, that the technology enabled the picture to be broadcast onto a monitor rather than transmitted solely to the eyepiece. That is a boon to the surgeon. “You've got a much better image,” Dr. Hogan says. “It allows a much better view of what's going on.”
Endoscopy is used to diagnose cancers or ulcers, perform a biopsy, stop internal bleeding, remove stones, open closed ducts, and diagnose any number of other conditions affecting the upper gastrointestinal tract.
“When I entered this business we had barely anything besides x-ray to determine what was going on in the gastrointestinal tract,” Dr. Hogan said. “Endoscopy has expanded the ability to diagnose and take care of patients exponentially for the gastroenterologist. ... It has opened diagnosis and treatment in a way that we never could have imagined 30 years ago.”
One thing endoscopy cannot do is examine the small intestine. But a new frontier has recently opened. Given Imaging, an Israel-based diagnostics company, has developed a camera in a pill shaped capsule. (For the MedTech1 article click here.)
The patient swallows the pill in the morning, and continues with his or her daily routine. The pill moves through the intestinal tract, taking thousands of pictures, which are then transmitted to a small receiving device located on the patient's belt. Eight hours after swallowing the pill, the patient returns the receiving device to the hospital, where the pictures are downloaded and examined.
This is obviously easier on the patient than endoscopy, but Dr. Hogan emphasizes that there are many things it cannot do. For example, the physician has no control over the camera, and it could miss important evidence. And, obviously, it cannot take biopsies or inject a contrast medium to diagnose tumors. Nevertheless, it is one more step in the quest to find better and better ways to view the intestinal tract.
Resources
Endoscopy on MedTech1
MedTech1 article about the camera-in-a-pill
Read about laparoscopy, MedTech1's #10 innovation
