Chapter 1 of 4 · Fundamentals
Historical origins
History of Surgeons in Endoscopy: From Fiber Optics to Therapeutic Innovation
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Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
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What the experts said
Modern endoscopy began with Basil Hersowitz in the late 1950s when he integrated flexible fiber-optic technology using fiber-optic cables to produce endoscopic instruments which could go through the mouth or rectum to produce images.
Surgeons and gastroenterologists were involved in endoscopy from the very beginning, with Hersowitz using the technology to examine the upper GI tract first, then the lower.
Gastroenterologists such as Gene Oberholt and Jerry Way were involved in the beginning using the scope to develop diagnostic applications of endoscopy.
Surgeons saw the therapeutic applications of endoscopy and developed procedures including polypectomy using electrocautery (Hiromi Shia and Bill Wolf in New York).
Greg Stigman from Colorado applied the principle of banding hemorrhoids in the rectum to variceal banding in the esophagus.
Michael Godard and Jeff Ponsky applied surgical principles of percutaneous techniques to place feeding tubes using the endoscope to guide the procedure.
In Germany, Nipsa Hendra, a surgeon, developed the first stenting of the bile duct.
Surgeons have been involved in the advances in endoscopy, particularly the therapeutic advances.
Modern bariatric and gastrointestinal surgeons use endoscopy to look at their anastomosis and test their anastomosis after they've done it.
Surgeons use endoscopy to stent leaks or perform therapeutic stenting of strictures.
Endoscopy for surgeons today is a technique they use to augment their surgical procedures.
Not all surgeons perform ERCP.
Surgeons in bariatric surgery use endoscopy daily to assess the results of their surgery, look for leaks, stent leaks, put in drainage tubes, and improve the treatment of their complications.
Endoscopic submucosal dissection can be performed even in the colon to remove T2 tumors and extensive spreading tumors without the need for surgery.
Emory Gorgon at the Cleveland Clinic has a huge experience in endoscopic submucosal dissection.
Pre-malignant and early malignant lesions in the esophagus are being removed endoscopically by both GI and surgery specialists.
Division of the esophageal muscles to treat achalasia can now be performed endoscopically where surgery used to be required.
The purpose of endoscopic techniques is not to remove surgery but to augment it and choose the right procedure for the right patient.
The only place surgeons and gastroenterologists fail is when they fail to work together.
The gastroenterology community is excellent at endoscopic ultrasound, which has led to tremendous therapeutic advances.
The ultimate potential of endoscopic ultrasound won't be reached unless surgeons and gastroenterologists work together.
At the Cleveland Clinic, surgeons and gastroenterologists work together, combining surgical techniques with endoscopic techniques.
In 10 years, the field will have advanced so much that current practices won't be recognizable.
Future endoscopy will include transmural surgery, performing resections of pieces of bowel, removing tumors, and sewing up the lumen endoscopically.
Future procedures will include gastrointestinal anastomosis performed endoscopically or using combined endoscopic and percutaneous techniques.
Complications will be managed endoscopically in the future using ultrasound and endoscopy.
New modalities will be integrated into endoscopy to deal with biliary disease, colonic disease, pancreatic disease, gastric disease, and inflammatory bowel disease.
The integration of surgery and gastroenterology will improve the whole specialty.
The robot refines surgical maneuvers and helps perform procedures better and more exactly.
Jeff Ponsky was initially a critic of the robot in laparoscopic surgery when it first began because it was expensive and he thought it unnecessary.
Robotics must be integrated into everything surgeons do and will be used with flexible endoscopy just as it has been used with colorectal and intestinal surgery.
The American Board of Surgery made endoscopy a requirement for surgical training, which put stress on program directors but is necessary for modern bariatric and gastrointestinal surgeons.