Where is endoscopy applied?
Endoscopy of the knee is not so much a reflection of a body cavity or hollow organ, but rather a reflection of a joint – namely the knee joint. Because of this, the endoscopy of the knee is also called arthroscopy, which comes from the Greek and means “to look into the joint” (arthros = joint; skopein = to look). The device specially made for this purpose is accordingly called an “arthroscope”.
The endoscopy is usually performed either under local anesthesia of the corresponding knee or under general anesthesia. After a small incision has been made in the knee area, the rigid, non-moving arthroscope is inserted into the knee joint after the knee joint has been filled with a special fluid (Ringer’s solution) for better visibility later on. The knee joint is subsequently examined and inspected, making it possible to confirm certain suspected diagnoses and possibly – by further insertion of tools – to treat the knee joint during the examination.
Endoscopy of the stomach, also known as “gastroscopy“, is performed with a flexible endoscope, the so-called “gastroscope”. Contrary to what the name suggests, gastroscopy usually involves examining not only the stomach, but also the esophagus and the duodenum immediately adjacent to the stomach. The indication for an endoscopy of the stomach is usually when a suspected disease of the esophagus, stomach or duodenum is suspected and needs to be confirmed, but also to assess the course of an existing disease, to perform a treatment on site or to perform aftercare of a disease.
Among the most common diseases for which gastroscopy is performed are cancers of the esophagus, stomach and duodenum, ulcers and mucous membrane injuries (erosions), bleeding from vessels (arterial or venous), wall perforations and varicose veins in the stomach or esophagus (varices).The gastroscopy is usually performed under mild sedation of the patient, whereby the pharyngeal mucosa is also anaesthetized on the surface. The flexible, movable gastroscope is then introduced via the mouth or nose and then pushed forward through the esophagus further into the stomach. After inspection of the esophagus and stomach, during which tissue samples may also be taken using tools that can be pushed through special endoscope channels, the duodenum is examined before the gastroscope is withdrawn.
During the examination, air is constantly blown in to unfold the oesophagus, stomach and duodenum, allowing better vision. In general, endoscopy of the stomach is very low-risk, however, in very rare cases, infections, intestinal wall perforations or internal bleeding (if uncontrolled vascular injury occurs) may occur. If the large intestine is also to be examined and evaluated, a colonoscopy is also necessary.
The endoscopy of the lung is more precisely a reflection of the “ducts” of the lower respiratory tract, i.e. the trachea and the branches branching off from it (bronchial system). This endoscopic examination of the lung is therefore also called “bronchoscopy”, and the associated device is called a “bronchoscope”. Here too, a distinction can be made between a rigid and a flexible bronchoscopy.
In rigid bronchoscopy, the trachea of an anesthetized patient is examined, evaluated and – if necessary – treated with the appropriate tools using a non-moving bronchoscope. In flexible bronchoscopy, the patient is not completely anesthetized, but only sedated, so that a movable tube system can be used to pass through the trachea into the ramifications of the airways (bronchi), where they can also be examined. In general, bronchoscopy is used to clarify suspected lung diseases, make diagnoses, assess the course of the disease and carry out therapies.
Endoscopy of the nose or nasal cavity, also known as rhinoscopy, is an examination procedure in ear, nose and throat medicine, which allows the physician to gain an insight into the main nasal cavity. A distinction is generally made between anterior, middle and posterior rhinoscopy, in which different structures of the nose are examined. In anterior endoscopy, the lower turbinates and the lower nasal passage are assessed through the nostrils.
However, no endoscope is usually required for this, but is usually performed with a so-called nasal speculum. However, for the middle endoscopy, a rigid or flexible nasal endoscope is inserted into the nose after a superficial anaesthetic of the nasal mucosa, so that a better and more far-reaching assessment of the nasal cavity (the various passages and conchae) is then possible. The posterior endoscopy is performed by means of an angled mirror through the mouth in order to be able to see the rearmost parts of the nasal cavity.
The nasal cavity is usually examined for abnormalities in the mucous membrane (swelling, redness, inflammation), for polyps, benign or malignant other tumors, or for shape variations or an inclination of the nasal septum. Because endoscopy is a so-called “minimally invasive procedure” (= a procedure with minimal tissue injury), there are significantly fewer risks than with a conventional surgical procedure. Endoscopic interventions for diagnostic or therapeutic purposes have the advantage that the patient’s burden is significantly reduced and the healing or recovery progresses faster, thus enabling a shorter stay in hospital and better cosmetic results.
Among the risks or complications that are nevertheless possible – but occur in very small percentages – are infections, internal bleeding, organ perforations and cardiovascular disorders. In order to prevent pathogens from being introduced into the body with the insertion of endoscopes and their tools, in some cases (high-risk patients) an antibiotic can be given in advance. Internal bleeding can occur if blood vessels are injured during the examination, but these can usually be stopped immediately. The same applies to organ punctures, which can be sutured again during the examination with the appropriate tools.
