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Colonoscopy

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Colonic Diseases

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Abstract

There have been several steps in the evolution of the modern colonoscope from the Hirschowitz fiberoptic gastroscope. The tortuosity, variable anatomy, and acute angulation of the colon precluded successfully tolerated flexible fiberoptic colonic endoscopy until the design of an improved tip control and an insertion sheath that produced increased stiffness when torqued. Using silicon rubber casts of the rectum and sigmoid colon, Dr. Bergein Overholt optimized a prototype flexible sigmoidoscope. His initial clinical series of 40 patients was published in 1968 (1). In parallel, Japanese investigators also designed longer gastrointestinal endoscopes with improved controls. By the early 1970s, patient colonoscopy series were being reported from several centers (2–4). Image optical clarity, light source technology, and endoscope handling improved in an incremental manner until 1983 when Welch-Allyn announced that they had installed a charged-coupled device (CCD) video camera within an endoscope.The video optics of a modern colonoscope now has a 120–130° wide angle view and an approx 30-fold magnification. Present tip controls allow for 180° up-down deflection and right-left controls of 160–180°. The insertion tube diameters vary between 11.3–12.8 mm, and instrumentation—suction tube channels vary between 2.7–4.2 mm. Double-channel colonoscopes are now available. Some models have variable stiffness in the shaft of the colonoscope. The tip irrigation systems have permitted better lens clearing. The modern colonoscope provides an excellent platform to travel the length of the colon and has permitted multiple advances in lesion recognition and treatment of specific colonic diseases. It has permitted access for electrocautery polypectomy, for Argon plasma cautery and laser photoablation of lesions. With an injection of India ink, specific sites in the colon can be located at the time of a repeat endoscopy or surgery. Inoperable strictures may be treated with laser ablation or by the placement of permanent stents. Colonoscopy in the setting of acute lower gastrointestinal hemorrhage is now the standard of care. Colonoscopy has been used to treat colonic pseudo-obstruction. Newer techniques of imagining, particularly with magnified video colonoscopy, vital dye staining of colonic mucosa, autofluorescence, and endoscopic optical coherence tomography may all evolve to provide ways of evaluating areas of bowel for dysplastic change.

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Authors
  1. Donald G. Seibert
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  1. Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, WI, USA

    Timothy R. Koch MD

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Seibert, D.G. (2003). Colonoscopy. In: Koch, T.R. (eds) Colonic Diseases. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-59259-314-9_16

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