HAELTH / Common Remedies: Endoscopy

'LET'S HAVE a look at it,' says the doctor when someone complains about a painful foot or a sore throat. Most of our important and troublesome organs are, however, hidden from view and cannot be inspected directly - or could not until fairly recently, with the development of endoscopy: this is the use of viewing tubes to penetrate the dark interior of the body, and it has now replaced much intuitive diagnosis.

Endoscopy began in a simple way 100 years ago with the circus sword-swallower. Watching him at work, doctors reasoned that a viewing tube could be constructed that might make it possible to examine the interior of the stomach. Early instruments were cumbersome and clumsy and their lighting systems were primitive; in the early years of this century short, rigid tubes were developed for inspection of the interior of the bladder and the lower bowel, and various designs of gastroscope were tried to allow the surgeon to peer into the stomach. But what could be seen was dimly lit and the view was severely restricted by the rigid construction of the tube.

Attempts were made to develop flexible gastroscopes, but these were frustrated until the technological breakthrough of fibre optics in the 1960s. Once light and images could be transmitted along a bundle of flexible fibres, within a few years a whole new branch of medical expertise evolved as viewing tubes - endoscopes - were developed not only for the stomach but also for virtually every hollow part of the body.

Endoscopes in current use are of two main types: flexible instruments are used to inspect the interior of the lungs, the oesophagus, the stomach and the duodenum, and the whole length of the large bowel; shorter, rigid tubes are used for the bladder (cystoscopy), the joints (arthroscopy), and the abdominal cavity (laparoscopy). Someone having an endoscopic examination of the stomach or the bowel does not require a general anaesthetic. A mild sedative is usually given but the procedure is not painful, only uncomfortable, and it is safe.

Endoscopy has also changed surgical techniques. The laparoscope was modified by gynaecologists to allow them to carry out minor operations on the ovaries and Fallopian tubes without having to make a surgical incision. In the 1980s another technological revolution occurred as laparoscopes were fitted with small video-cameras, giving the surgeon a clearer view of the interior and so making more intricate operations possible. Laparoscopic surgery is technically challenging for the operator (and in countries other than Britain in which practising on animals is legal, surgeons acquire the necessary skills on pigs); but it has many advantages for the patient. A conventional operation to remove the gall bladder requires an incision beneath the ribs big enough for the surgeon's hands to get in, and the patient needs seven to ten days in hospital to recover and several weeks' convalescence. A laparoscopic cholecystectomy takes the surgeon a little longer, but it is done through a couple of holes in the skin each the thickness of a finger, and the patient will feel fine within two to three days. This hi-tech, minimal trauma surgery is a long way from the sword-swallower.