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 digestive foregut and distal 25 cm of the large bowel, fiberoptic endoscopy extended these limits considerably, which resulted in a greater volume of biopsies submitted to the pathology laboratory. Furthermore, this technique is 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 videoscope rather than the fiberscope. With the added advantage of direct visualization, flexible endoscopy has eclipsed barium radiology as the premier investigative modality for GI diseases. Although upper GI endoscopy and colonoscopy account for the majority of biopsy material, there are other flexible endoscopic techniques, including endoscopic retrograde cholangiopancreatography and enterostomy. Flexible endoscopy has not only impacted the diagnosis of important disease entities (eg, reflux esophagitis, H. pylori gastritis, celiac disease and GI polyps and neoplasia), but it has also become a key component of surveillance protocols for dysplasia in 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 investigation include increased use of endoluminal ultrasound and trans-bowel fine needle aspiration. Biopsy material will be submitted with more frequency for genetic molecular studies such as tumor development and progression and identification of infections agents; the priorities for handling biopsy material may have to be re-examined. Gastrointestinal (GI) biopsies constitute a substantial proportion of the surgical pathology load in most tertiary care medical centers. Based on topographic site of origin, the GI tract is the single largest component of the biopsy service in this institution. This relates in part to the high frequency 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 application of this technique. To gain a better appreciation of the impact of the changes in endoscopic techniques on gastrointestinal pathology, it is pertinent to examine the historical perspective from which the technology arose.