History and evolution of esophagogastroduodenoscopy

Abstract

Gastroenterology is a branch of medicine focused on the digestive system and its disorders. Citing from Egyptian papyri, Nunn identified significant knowledge of gastrointestinal diseases among practicing physicians during the periods of the Pharaoh. Irynakhty of the tenth dynasty, c. 2125 B.C., was a court physician specializing in gastroenterology, sleeping, and proctology. Among ancient Greeks, Hippocrates attributed digestion to concoction. Galen's concept of the stomach having four faculties was widely accepted up to modernity in the seventeenth century. One of the numerous instruments used in gastroenterology for diagnosis, is the gastroscope, used in esophagogastroduodenoscopy. Esophagogastroduodenoscopy (EGD) is a diagnostic procedure that allows the physician to diagnose and treat problems in the upper gastrointestinal (UGI) tract. The doctor uses a long, flexible, lighted tube called an endoscope. The endoscope is guided through the patient's mouth and throat, then through the esophagus, stomach, and duodenum (first part of the small intestine). The doctor can examine the inside of these organs and detect abnormalities. The early pioneers faced two obvious albeit formidable problems: the gut is not straight and its dark in there. Kussmaul is generally credited with the first gastroscopy in 1868. Although unrecognised at the time, the illumination problem was solved around 1878 by Thomas Edison, but 25 years elapsed before the incandescent lamp was incorporated into endoscopes. The first approach to the tortuosity of the gut was an instrument with articulated lenses and prisms, as proposed by Hoffmann in 1911. Approximately two decades elapsed before this concept was perfected in the semi‐flexible gastroscope, the work of Wolf, a fabricator of medical instruments, and Schindler, a physician. Image transmission using flexible quartz fibres was conceptualised in the late 1920s but it was not until 1954 that Hopkins built a model of a flexible fibre imaging device. The most significant development in the history of endoscopy then occurred in 1958: the flexible fibreoptic endoscope of Larry Curtiss, then a graduate student in physics, and Basil Hirschowitz, a trainee in gastroenterology. What made this instrument possible was the availability of highly transparent optical quality glass. Over the next 30 years, the fibrescope evolved to a level of technical sophistication that seemed insurmountable. But obsolescence was assured with the invention of the charge coupled device (CCD) in 1969. Ten years later, this technology was incorporated into an endoscope. Because the CCD produced an electronic image, endoscopy suddenly had a wider audience, a television audience. Moreover, the image was digital, and instantaneously an interface between endoscope and computer was established. From 1968 to 1990 there was an explosion of technical achievements that transformed the practice of gastroenterology .These remarkable 22 year period was so formative that I believe it will come to be considered historically as the golden era of gastrointestinal endoscopy. Two things are evident from the history of endoscopy. Firstly, innovation arose from close collaborations between physicians struggling to solve clinical problems and artisan‐engineers: witness (among many) Schindler and Wolf, Hirschowitz and Curtiss. Secondly, progress occurred largely through incorporation of technology from other fields.