The impact of endoscopic technology on gastrointestinal pathology

Since its introduction in the 1950s, fiberoptic endoscopy has dramatically altered the scope and practice of gastrointestinal (GI) pathology. Whereas examination by rigid instruments was generally restricted to the proximal d igestive foregut and distal 25 cm of the large bowel, fiberoptic endoscopy extended these limits considerably which resulted in a greater volume of bi opsies submitted to the pathology laboratory. Furthermore, this technique i s associated with a lesser degree of patient discomfort and a lower risk of complications compared to rigid or semiflexible endoscopy. In established endoscopy units, flexible endoscopy is performed increasingly with the vide oscope rather than the fiberscope. With the added advantage of direct visua lization, flexible endoscopy has eclipsed barium radiology as the premier i nvestigative modality for GI diseases. Although upper Gi endoscopy and colonoscopy account for the majority of bio psy material, there are other flexible endoscopic techniques, including end oscopic retrograde cholangiopancreatography and enterostomy. Flexible endos copy has not only impacted the diagnosis of important disease entities (eg, reflux esophagitis, II. pylori gastritis, celiac disease and GI polyps and neoplasia), but it has also become a key component of surveillance protoco ls for dysplasia ill Barrett's esophagus and idiopathic inflammatory bowel disease. Predicting major trends that may emerge from GI flexible endoscopy in the future is somewhat difficult, but promising new avenues of investig ation include increased use of Endoluminal ultrasound and trans-bowel fine needle aspiration. Biopsy material will be submitted with more frequency fo r genetic molecular studies such as tumor development and progression and i dentification of infectious agents; the priorities for handling biopsy mate rial may have to be re-examined. Gastrointestinal (GI) biopsies constitute a substantial proportion of the s urgical pathology load in most tertiary care medical centers. Based on topo graphic site of origin, the GI tract is the single largest component of die biopsy service in this institution. This relates in part to the high frequ ency of patients' complaints referable to the digestive tract and is also a result of the advances in GI endoscopy that have led to more widespread ap plication of this technique.(1-3) To gain a better appreciation of the impa ct of the changes in endoscopic techniques on gastrointestinal pathology, i t is pertinent to examine the historical perspective from which the technol ogy arose.