Advancement in endoscopy and its usage in Pakistan for therapeutic and diagnostic purposes

Endoscopy has a long history of over 200 years. From the first simple tube endoscope to the modern world’s latest technology, the endoscope has helped a lot in the medical profession in diagnosing and treating a wide range of conditions. The history of the endoscope began with the invention of a German physician named Phillip Bozzini in 18061. It was at that time called the Lichtleiter, and it was used to visualize internal organs. It consists of an eyepiece, a container for candlelight, and a mirror that reflected the candlelight through a tube. It was further pursued by Antonin Jean Desormeaux, a French physician, called the “father of endoscopy.” He was the first to use the term “endoscopy.” He improved the instrument by focusing light and switching to a gasoline lamp, which burnt alcohol and turpentine for more excellent illumination. It was considered “state of art” and was used for the inspection of the bladder, rectum, and pharynx. Image transmission using flexible quartz fiber was introduced in the late 1920s, but it was not until 1954 that Hopkins built a model of a flexible fiber imaging device. From that time till now, this instrument is under advancement2. Endoscopy has changed the approach to treating disease. Diseases that previously could not even be diagnosed are now treated with the help of this. Diseases of the gastrointestinal tract like Barrett esophagus, carcinoma of the esophagus, peptic ulcer disease, carcinoma of the stomach, small intestine, and colon can be diagnosed through endoscopy3. Carcinomas of the gastrointestinal tract, which could never be diagnosed in early stages, are now being easily diagnosed by endoscopy. Pakistan is yet far behind the developed countries in this regard and facilities are confined mostly to big cities. With the advancement in the medical field, endoscopy has now many types, which are mostly according to the area they visualize. Major types include a colonoscopy for the colon, cystoscopy for bladder examination, bronchoscopy for lungs, enteroscopy for the small intestine, hysteroscopy for visualizing the uterus, laryngoscopy for the larynx, and laparoscopy for visualization of the abdomen and pelvis and many others4. The type of endoscopy which should be performed depends on the patient’s condition, signs, and symptoms of the disease5. Like any other technology, endoscope in improving at a great pace, and newer-generation endoscope uses high-defining imaging to create images in incredible detail. The latest type of endoscopy includes “capsule endoscopy,” in which the patient swallows a small pill with a camera inside the capsule, which moves inside the alimentary canal without any discomfort, and takes hundreds of images as it passes through it. Emdoscopic Retrograde Cholangio Pancreaticography is now used for diagnoses and treatment of diseases of the bile and pancreatic duct5. Chromoendoscopy, in which a special dye is used helps in better visualization. Endoscopic mucosal resection is used to remove cancerous tissue in the digestive tract. Endoscopic ultrasound,6 narrow-band imaging, uses a filter that differentiates mucosa from the vessel in the digestive tract7. These advancements play a key role in modern medical and surgical practice in saving the life of patients. The common clinical practice is to perform endoscopy on patients with alarm symptoms or those with an age over 45. Alarm symptoms include dyspepsia, gastrointestinal bleeding, dysphagia, odynophagia, and a family history of gastrointestinal malignancies. Younger patients without alarm symptoms can be treated empirically, and endoscopy is done when symptoms fail to resolve8. Endoscopy also has complications that may be intraoperative or postoperative. Hemorrhages and perforations are the most common intraoperative complications. Postoperative complications include fever, chest pain, shortness of breath, bloody black dark stool, severe persistent abdominal pain, and vomiting9. Due to a lack of knowledge, people in Pakistan have created myths about this procedure. Most of them think that their condition will worsen from this procedure. Through proper campaigns and government involvement, these problems can be solved. Doctors must spread awareness of endoscopic diagnostic approaches and how they will be better for patient prognosis. Government should equip backward areas in Pakistan with this instrument so people could have easy access to it10. Pakistan has to cover a long journey in the medical field to match developed countries. Due to economic conditions, the food and water supply are not efficient, which is the main cause of digestive tract infections. Also, other risk factors which lead them to this disease are not known by the people of Pakistan. All these conditions increase the patient load in hospitals and only through awareness campaigns and government involvement these issues can be solved. In this situation, these endoscopic approaches will make diagnosis more specific, and instead of giving symptomatic treatment, diseases can be diagnosed and efficiently treated which will lead to a better prognosis. Ethical approval Not Applicable. Sources of funding No funding was received. Author contribution All authors contributed equally. Conflicts of interest disclosures The authors declare that they have no financial conflict of interest with regard to the content of this report. Research registration unique identifying number (UIN) Not Applicable. Guarantor First author.