The role of biopsy in fiberoptic esophagogastroscopy

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DESIGN and technical advances have recently provided the endoscopist with sophisticated instruments that permit safe and relatively complete inspection of the entire esophagus and stomach. Fiberoptic systems for illumination and image transmission allow the manufacture of an extremely flexible instrument, which can be tolerated by the patient long enough for an unhurried examination to be conducted. The directable tip makes it possible for the endoscopist to guide the instrument along tortuous channels, or to turn it retrograde in the stomach for views of the fornix and cardia. Provision has been made for aspiration, inflation with air, washing the objective lens, and photography. A small-diameter biopsy forceps can be passed down the aspiration channel of the instrument.

These useful features have evolved over a number of years, beginning with the development of the lens type of gastroscope by Rudolph Schindler in the late 1930s and followed by the Benedict operating gastroscope in 1948, the Wood biopsy tube in 1950, the Hirschowitz fiberoptic gastroscope in 1958, the Japanese gastrocamera in 1958, and culminating in the Japanese Olympus EF esophagoscope in 1968, and the American Cystoscope Makers, Inc., Model 89 esophagogastroscope in 1969. An instrument is now available which can be used for the examination of the esophagus and the stomach with relative completeness, visually, photographically, and by biopsy. The advantage of histologic confirmation of lesions seen endoscopically has always been obvious, but the overwhelming difficulties in obtaining a specimen from a precisely selected point discouraged most endoscopists from making the effort. The . . .



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