Читать книгу Practical Pediatric Gastrointestinal Endoscopy - Группа авторов - Страница 18

The development of fiberoptics led to the birth of modern gastrointestinal endoscopy.

In the hybrid semiflexible gastroscope built by the German instrument maker Storz in 1966, lenses were used for visualization while the electric light bulb was replaced by optical fibers made of either glass or plastic. Plastic fibers were more flexible and durable than glass; however, glass optical fibers could be manufactured with diameters smaller than their plastic counterparts, and the quality of light transmission was superior in glass optical fibers. The next improvements in fiberoptic technology were due to optical engineers who considered the possibility of fiberoptics transmitting not only light but also images. In 1954, two articles were published in the same issue of Nature, a brief note by van Heel on the “transport of images” and an extensive article on a flexible fiberscope by Harold Hopkins of London and his co‐worker Narinder Singh Kapany [6]. Thanks to the collaboration between Basil Hirschowitz and the physicist Larry Curtiss who succeeded (with the aid of Corning Glass) in producing high‐quality fiberoptics, clinical application of fiberoptics to gastrointestinal endoscopy became possible and was reported in Gastroenterology in 1958 [7].

Prototype fiberscopes were made by American Cystoscope Makers (ACMI) in 1960 and a commercial model was produced in 1961 with the first color images published in the Lancet [8]. Because of the high prevalence of gastric cancer in Japan, the Machida Company developed fiberendoscopy and soon the technicians at Olympus, led by the engineer Kawahara, produced many fine models of high optical quality with side‐ and front‐viewing capabilities [9].

Following the adaptation of fiberoptics for medical instruments, endoscopy of the GI tract became a routine diagnostic and therapeutic tool in many gastroenterology units throughout the world. In the early 1970s, the curiosity of a few pediatric gastroenterologists and surgeons was stimulated by the growing interest in endoscopy and its diagnostic success in adult gastroenterology. At that time, gastrointestinal endoscopy in children was performed with the standard adult gastroscopes, bronchoscopes and prototypes of pediatric fiberscopes which were available in a few pediatric hospitals in Europe, United States and Japan [9–14].

During the middle and late 1970s, several publications demonstrated the safety, diagnostic and therapeutic value of pediatric GI endoscopy, contributing to our knowledge of many GI diseases in infants and children [15–23]. Although the literature was not readily accessible, similar skills were developing in Eastern Europe and Russia [24–27]. Less than 10 years after its introduction in pediatric gastroenterology, endoscopy was the subject of several books in Spanish, German, and English [28–30]. By middle and late 2000s, an extensive knowledge of pediatric GI endoscopy was summarized in additional books [31–23].

Today, training in pediatric gastroenterology is not complete without acquiring competence in diagnostic upper gastrointestinal endoscopy and colonoscopy and basic therapeutic endoscopic GI procedures [34]. Diagnostic endoscopy has become a routine part of pediatric gastroenterology, combining the advantage of direct visual observation of the GI tract with target mucosal biopsy and therapeutic procedures.

The arsenal of accessory instruments has been diversified and very much improved whether dealing with foreign body extraction, diathermic loops for polypectomy, sclerotherapy needles and bands (silicon or latex) for variceal eradication, dilation bougies and pneumatic balloons, hemostatic clipping devices and electro‐ and photocoagulation devices for hemorrhagic lesions, and gastrostomy kits. The reliable use of these tools needs constant maintenance by skilled staff and good training to guarantee a safe procedure.