From Big Medical Encyclopedia

ENDOSCOPY (Greek endon inside - f-skopeo to consider, investigate) — a method of visual examination of hollow bodies and cavities of an organism by means of the optical devices supplied with the lighting device (endoscopes). If necessary E. it is combined with an aim biopsy (see) and the subsequent morfol. a research of the received material, and also with radiological and ultrasonic investigation. The results received at E., can be documented by means of photography (see the Photo in medicine), filmings and video filming (see Kinoendoskopiya). Development of endoscopic methods, improvement of the endoscopic equipment and their widespread introduction in practice are important for improvement of early diagnosis of pretumor diseases and tumors of various localization at early stages of their development.

In the history of development of a method it is possible to allocate conditionally the period of use of the rigid and bending lens endoscopes and the period of use of flexible endoscopes with a fiber optics. The rigid and bending lens endoscopes began to apply in 19 century to survey of a mucous membrane of a rectum and a stomach. Technical imperfection of these endoscopes caused considerable difficulties during the work with them, and the researches conducted with their help were fraught with danger of emergence at sick heavy complications, up to an injury of a wall of body. The possibility of development of complications during the research was caused also by the fact that the filament lamp located on the working end of the endoscope was a light source.

Wide perspectives of development E. opened thanks to in endoscopes of a fiber optics. About the first experience the wedge, uses of the flexible endoscope with a fiber optics (fiberscope) intended for an endoscopic research of a stomach and a duodenum (fibroskopiya) reported in 1958 Mr. Girshovitts (V. J. Hirschowitz). Implementation of fiberscopes in broad practice became possible after development by the industry of optical fiber glass (see) that allowed to take out lighting system out of limits of the endoscope. At the same time transfer of light is carried out on the fiber light guide providing sufficient illumination of an observed object without heating of fabrics — «cold light» (see Light sources).

Flexibility of fiber light guides and ability pkh to transfer the image I light on the bent way made the fiberscope elastic and easy in management that allowed to reduce danger of a research, to reduce to a minimum the unpleasant feelings arising at the patient during introduction of the device and during the research. Use of a fiber optics caused qualitatively new level of development of the applied methods E long ago. — bronkhoskopiya (see), gastroscopies (see), holedokhoskopiya (see), etc., and also led to development and deployment of new methods E., a wedge, implementation to-rykh it is impossible without use of devices with fiber light guides — angioskopiya (see), hysteroscopies (see), duodeno-skopiya (see), kolonoskopiya (see) etc. Became the fiber optical and lighting rule to equip also rigid endoscopes that allowed to make the endoscopic research conducted with their help, safer for the patient. It is especially important since in a number of areas a wedge, medicine, napr, in urology, proctologies, and also at nek-ry endoscopic researches, napr, laparoscopies, mediastinoskopiya, torakoskopiya, an arthroscopy, rigid endoscopes continue to use with success, especially during the performance of operational endoscopic interventions.

The greatest distribution E. received in gastroenterology; in a crust, time are most widely applied an ezofagoskopiya (see), gastroscopy (see), a duodenoskopiya (see), an intestinoskopiya (see), a kolonosko-piya (see), a rektoromanoskopiya (see), a holedokhoskopiya (see), a laparoscopy (see Peritoneoskopiya) and new beginners to be implemented into a wedge, practice methods — a pankreatokholangio-skopiya (see Holedokhoskopiya) and a fistu-loskopiya. At diagnosis and treatment of diseases of bodies of respiratory system such endoscopic methods as a laringoskopiya (see), a bronkhoskopiya (see), a torakoskopiya (see), a me-diastinoskopiya are widely applied (see). Other methods E. allow to conduct informative researches or separate systems, napr, urinary — a nefroskopiya (see), a tsistoskopiya (see), an uretroskopiya (see), neurologic — a ventrikuloskopiya (see), a miyeloskopiya, or nek-ry bodies, napr, a uterus — hysteroscopy (see), an arthroscopy (see Joints), vessels — an angioskopiya (see), cardial cavities — a kardio-skopiya, etc.

Nek-ry endoscopic methods G success apply a wedge, medicine in various areas. So, the pe-ritoneoskopiya is used not only in gastroenterol. to practice, but also in gynecology for the purpose of specification of the diagnosis acute ginekol. diseases, such as a salpingitis, torsion of a leg of an oothecoma, an extrauterine pregnancy, and their differential diagnosis with acute surgical diseases of abdominal organs.

Improvement of the equipment and methods E., and also professional development of the personnel conducting a research allowed in a crust, time to plan two main directions of development of a method — diagnostic and medical. Allocation of these directions is rather conditional since endoscopic methods always include an element of diagnosis available patol. process, and then carrying out to lay down. manipulations. Development medical, in particular operational, AA. allowed to expand considerably possibilities of a method and in some cases to avoid the most difficult surgeries interfaced to risk for life of the patient, napr, esophagotomies (see), &gastrotmiya (see), a transduodenal papillosfink-terotomiya (see Faterov of pacifiers).

Thanks to the increased diagnostic opportunities of endoscopy it turned in a number of sections a wedge, medicine from auxiliary into the leading diagnostic method. Great opportunities modern E. significantly expanded indications and sharply narrowed contraindications to a wedge, to use of its methods.

Carrying out a planned endoscopic research is shown for specification of character patol. the process suspected or established by means of other methods a wedge inspections of the patient, and receiving material for morfol. researches. Besides, E. allows to differentiate diseases of the inflammatory and tumoral nature, and also to exclude authentically patol. process, to-ry was suspected during the carrying out all-clinical inspection. Emergency E. apply as means of urgent diagnosis and therapy at acute complications at patients with hron. diseases, being in critical condition when it is impossible to conduct an ordinary research and furthermore an operative measure.

A contraindication to performance E. disturbances of anatomic passability of the hollow bodies which are subject to a research, the expressed disturbances of coagulant system of blood (because of danger of developing of bleeding), and also such disturbances of activity of cardiovascular and respiratory systems, at to-rykh are E. can bring to life-threatening sick to effects. Besides, the possibility of carrying out an endoscopic research is defined by qualification of the doctor who is carrying out a research and technological level of the endoscopic equipment, the cut it has.

Training of patients for endoscopy depends on research objectives and a condition of the patient. Planned E. make later a wedge, inspections and psychological training of the patient, at a cut explain it a research problem and acquaint with ground rules of behavior during endoscopy. At emergency E. it is possible to carry out only psychological training of the patient, and also to specify the main details of the anamnesis of a disease and life, to define contraindications to a research or prescription of medicines.

Medicamentous training of the patient first of all is aimed at providing optimal conditions for implementation of an endoscopic research and consists in removal of psychoemotional tension of the patient, performing anesthesia during manipulations, decrease in secretory activity of mucous membranes, the prevention of emergence various patol. reflexes. Combinations of various medicines vary depending on research objectives, a condition of the patient and his psychological readiness for carrying out a research.

Technology of carrying out E. is defined by anatomo-topographical features of the studied body or a cavity, model of the used endoscope (rigid or flexible), a condition of the patient and research objectives. Endoscopes enter usually through natural foramens. Thus conduct almost all endoscopic researches in pulmonol., gastroenterol., ginekol. and Urals. to practice. During the carrying out such endoscopic researches as a torakoskopiya, the medias-tinoskopiya, a peritoneoskopiya, a holedokhoskopiya create an opening for introduction of the endoscope special troakara, to-rye enter through thickness of fabrics.

A recent trend in E. use of flexible endoscopes for a research of internal and outside fistulas — the fistuloskopiya> described in 1980 by D. Fedorov V. P. Strekalovsky is. Fistu-loskopiya is applied as an independent type of a research or in combination with a kolonoskopiya. Is obligatory rentgenol. control during the research, at Krom both the fistular course, and body contrast, from to-rogo it

proceeds. When all fistula does not manage to be examined because of narrowing of its course, its separate branches (the selection fis-tulografiya) contrast. In the presence of internal fistulas fistuloskop enter under control of other endoscope (colonoscope). Indications for a fistulo-skopiya are outside intestinal fistulas with a diameter not less than 3 mm; the internal intestinal fistulas which are located at distance to 20 — 25 cm from an anus; high extent of narrowing of a gleam of a gut when by means of endoscopes of other designs it is not possible to examine narrowing and overlying departments of a gut. There are also messages on a fistuloskopiya and holangioskopiya at outside bilious fistulas; at the same time, except a holedokhoskop, rigid endoscopes — the cystoscope, the thoracoscope can be used.

The combination E gains ground. with rentgenol. by methods of a research. So, e.g., retrograde contrasting of bilious and pancreatic channels at a duodenoskopiya (see) allows to diagnose diseases of a pancreas and to find out the reason of jaundice. Besides, this method gives the chance to avoid the unjustified operative measures dangerous to the patient, at parenchymatous jaundice. A combination of a pe-ritoneoskopiya with puncture care a tsistokholangioskopiya, tsistoskopiya with urography (see), for hysteroscopies with a gisterosalpingografiya (see Metrosaljpingografiya), bronkhoskopiya with the isolated bronchography (see) separate shares and segments of a lung allow to disclose fullestly the nature of a disease and to establish localization and extent patol. process that it is extremely important for definition of need of an operative measure or carrying out endoscopic to lay down. actions.

Recently methods of a research are developed, in to-rykh the combination E is used. with ultrasonic methods that facilitates diagnosis of the band educations close to the studied body, and detection of concrements in bilious or uric ways. The ultrasonic probe probe entered via the handling channel of the endoscope allows to determine also density of fabric, the sizes patol. educations i.e. to receive the data extremely important for diagnosis of tumoral process. As the sensor by means of the endoscope is located in close proximity to the studied object, the accuracy of ultrasonic investigation increases and hindrances, possible are eliminated during the carrying out a research with a usual way.

In recent years was widely adopted in a wedge, practice medical E. It includes such methods as removal of polipovidny tumors, local administration of medicines, a section of cicatricial stenoses, a stop of internal bleeding, extraction of stones and foreign bodys (see), drainage of belly and pleural cavities, imposing of outside fistulas on hollow bodies, etc. Unlike X-ray endovascular surgery (see) at E. the stop of bleedings and operative measures are carried out directly under direct vision.

Via endoscopes perform various surgeries by means of electrosurgical and cryosurgical methods (see the Electrosurgery, the Cryosurgery), carry out photocoagulation by laser radiation (see the Laser), sclerosing therapy, bougieurage (see), dilatation, and also conservative manipulations — irrigations, injections, applications, sanitation.

Use of methods medical E. in a complex with other conservative actions allows to improve results of treatment of patients, to refuse traumatic operative measures or to reduce their risk. It is of particular importance during the rendering to lay down. the help to patients of advanced and senile age, at to-rykh, as a rule, there are associated diseases. To lay down. the manipulations which are carried out via the endoscope do not break an integrity of body that, in turn, excludes further its deformation or dysfunction.

Endoscopic diagnosis can be complicated owing to the local reasons (the expressed deformation of the studied body, existence of commissures) or the general serious condition of the patient. Various complications E. can be connected with preparation or carrying out a research; they arise in the studied body or other systems of an organism, depend on the basic or associated disease and are shown during the research or a nek-swarm a time later. Most often complications are connected or with anesthesia (individual intolerance of medicines), or directly with disturbance of the technique of an endoscopic research. Non-compliance with obligatory methods of endoscopy can lead to an injury of body up to its perforation. Other complications are less often possible: bleeding

after a biopsy, traumatization of varicose veins, aspiration of gastric contents during the emergency research, etc.

The endoscopic pictures received by means of various methods of an endoscopic research see on the color inserts published in articles: Amnioskopiya, t. 1, Art. 393; Gastroscopy, t. 5, Art. 40, 48; Hysteroscopy, t. 6, Art. 224; Duodenoskopiya, t. 7, Art. 500; Kolonoskopiya, t. 11, Art. 160; Tumours, t. 17, Art. 368; Peritoneoskopiya, t. 19, Art. 49; Joints, t. 24, Art. 368; Torakoskopiya, t. 25, Art. 176; Uretroskopiya, t. 26, Art. 208; Holedokho-skopiya, t. 27, Art. 112; Tsistoskopiya, t. 27, Art. 112.

Endoscopes. Modern medical endoscopes — difficult optical-mechanical devices. They are supplied with various nozzles, and also tools and cannulas for carrying out a biopsy, extraction of foreign bodys, electrothermic coagulation, administration of medicinal substances and dyes, transfer of laser radiation, etc.

Depending on appointment distinguish viewing, biopsy and operational endoscopes. There are endoscopes intended for adults and for children. Depending on a design of a working part endoscopes divide on rigid, to-rye keep the form during all research, and flexible, capable to change a configuration of a working part depending on a form of bodies. In rigid endoscopes optical system, as a rule, lens, light is transmitted from a source through a fiber light guide. Recently began to release rigid endoscopes with rod-shaped optics, i.e. with such optical elements, axial length to-rykh in 8 — 10 times more, than their cross sectional dimension. It allows to increase at preservation of all other parameters of the endoscope almost three times a svetosila of optical system.

In flexible fiber endoscopes (fiberscopes) the optical system is essentially arranged as well as lens, but for transfer of the image given by a lens instead of the lens wrapped systems use a flexible fiber light guide with regularly laid fibers (the arrangement of fibers at one end face shall correspond precisely to an arrangement of fibers at other end face). Light from a source is transferred on a fiber light guide with irregularly located fibers. In such fiber-optical andcastrate the image it turns out raster. Flexible endoscopes have the managed working end, a bend angle to-rogo depends on purpose of the device.

A variety of functional purposes of endoscopes defines distinction in their device. E.g., ezofagogastroduodenoskop with a side arrangement of optical system on the end of the endoscope facilitates a research and manipulations on a fa-terovy nipple (a big nipple of a duodenum, T.), ezofa-gogastroskop with a face arrangement of optical system allows to conduct a research and medical interventions in a gleam of a gullet and stomach. There are fiberscopes with various optical increase (see Endomicroscopy) allowing to reveal changes of a mucous membrane, which are not defined at usual sighting.

In recent years the original endoscope is developed for a research of bilious ways and a pancreat duct — pankreato-ho by l of an angioskopiya. This device consists of two endoscopes — so-called maternal and affiliated. On the additional channel of the maternal fiberscope (similar to a duode-noskop) carry out the tool of the smaller size — «affiliated», with the help to-rogo later endoscopic papillotomiya or through the expanded mouth of a faterov of a nipple survey of the general bilious channel and pancreat duct is carried out. Flexible two-channel endoscopes were widely used. Existence of two tool channels gives the chance at the same time to use various endoscopic tools (for capture of the studied education, a biopsy and coagulation) that considerably facilitates performing surgeries.

Endoscopes subject sterilizations in vapors of the substances possessing bactericidal action (e.g., in ethylene oxide, vapors of formalin); rigid endoscopes can be sterilized in solutions of antiseptic agents (e.g., ant to - you or alcohol). Sterilization by autoclaving — but for light guides, optical tubes and plastic cannulas such way of sterilization we do not accept a universal way for the surgical instruments used in endoscopy since at the same time they collapse.

After carrying out a research the endoscope shall be washed carefully out and cleared. The tool channel of the endoscope is brushed special then wash out and dried up compressed air by means of special devices. All gates and valves of accessory instruments sort, wash out and carefully dry up before assembly. Store endoscopes in special cases or on tables in situation, at Krom deformation of working parts of the device and their accidental damage is excluded.

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L. K. Sokolov, A. D. Timoshin;

V. P. Busygin, N. S. Issopova (tekhn.).