videos and webpage will allow knowledge to be disseminated widely. Most, if not all, of the world experts in pediatric endoscopy have contributed and we are truly grateful. We would like to thank the publishers, without whose guidance and help this would have been impossible.
This journey would not have been possible without the love and support of our families.
Mike:
thanks to Kay, my wife, and Ella, Jess and Flo, my wondrous daughters who put up with their old dad – especially editing the chapters when on holiday!
George:
many thanks to Irina, my beloved wife and muse, and my two precious artists: my daughter Zhenya and granddaughter Nikka who continue to bring beauty to the world.
Thank you and hopefully those of you who are training now will be contributors in future editions and we will pass on the baton to you in due course. Remember – do no harm and have fun. It is the best specialty you can imagine.
Mike and George
2 History of pediatric gastrointestinal endoscopy
Samy Cadranel, Jean‐François Mougenot, and Douglas S. Fishman
Rigid endoscopy as the proof of concept: invisible could be visible: the first step toward exploration of the esophagus and the proximal stomach.
Semiflexible endoscopy as the next step toward correct diagnosis of gastric pathology beyond the gastric body and development of endoscopic target biopsy.
Fiberoptic flexible gastrointestinal endoscopy as the foundation of modern diagnostic and therapeutic pediatric gastrointestinal endoscopy – more recently, videochip at the tip.
During the last half century, two achievements can be considered as major advances in the field of gastroenterology: the adaptation of fiberoptics to gastrointestinal endoscopy, and, as a consequence, the discovery of Helicobacter pylori [1,2]. Indeed, the role of H. pylori would not have been suspected without the pathologic and microbiologic study of biopsy material obtained with the endoscope. Attempts to inspect in vivo the internal cavities of the human body are probably as ancient as medicine itself. The challenge was to find a safe source of light that would not generate heat that could damage tissues.
The precursors
As early as the end of the 18th century, the Lichtleier, an ancestor of the modern proctoscope, paved the way with a system of lenses illuminated by candlelight. The name “endoscope” was coined as early as 1853 by A.J. Desormeaux for an instrument used in urology [3] while the first “gastroscope” was developed in Erlangen by A. Kussmaul [4]. These instruments were hampered by the fact that they could not direct enough light to the targeted site. With the invention of the electric bulb, a better insight became possible, but these instruments could not be used for prolonged periods of time because of the heat generated by the light bulb.
In 1881, Mikulicz performed the first gastroscopy in a human being using a rigid instrument of 65 cm long and 14 mm diameter [5]. This angulated instrument compensated for the anatomical angulations of the human esophagus and was equipped with a water circulation system to cool the light bulb and channels for the light source and to introduce air.
In 1932, the first semiflexible gastroscope was developed by instrument maker and technician George Wolf and gastroenterologist Rudolf Schindler who is widely rated as “the father of gastroscopy.” This instrument allowed a greater range for examination, facilitating diagnosis and endoscopic treatments.
We cannot leave the discussion of semiflexible gastroscopy without mentioning one of the most decorated American gastroenterologists, Walter L. Palmer, who brought a new level of understanding to the diagnosis and treatment of digestive diseases, particularly peptic ulcer, gastrointestinal cancer, and ulcerative colitis. In 1934, he facilitated the release of Dr. Schindler from a Nazi concentration camp where he was held because of his part‐Jewish blood. Eventually, Dr Schindler immigrated to the US. In 1941 he founded the Gastroscopic Club, now the American Society for Gastrointestinal Endoscopy, and became its first president.
The fiberscope
The development of fiberoptics led to the birth of modern gastrointestinal endoscopy.
In the hybrid semiflexible gastroscope built by the German instrument maker Storz in 1966, lenses were used for visualization while the electric light bulb was replaced by optical fibers made of either glass or plastic. Plastic fibers were more flexible and durable than glass; however, glass optical fibers could be manufactured with diameters smaller than their plastic counterparts, and the quality of light transmission was superior in glass optical fibers. The next improvements in fiberoptic technology were due to optical engineers who considered the possibility of fiberoptics transmitting not only light but also images. In 1954, two articles were published in the same issue of Nature, a brief note by van Heel on the “transport of images” and an extensive article on a flexible fiberscope by Harold Hopkins of London and his co‐worker Narinder Singh Kapany [6]. Thanks to the collaboration between Basil Hirschowitz and the physicist Larry Curtiss who succeeded (with the aid of Corning Glass) in producing high‐quality fiberoptics, clinical application of fiberoptics to gastrointestinal endoscopy became possible and was reported in Gastroenterology in 1958 [7].
Prototype fiberscopes were made by American Cystoscope Makers (ACMI) in 1960 and a commercial model was produced in 1961 with the first color images published in the Lancet [8]. Because of the high prevalence of gastric cancer in Japan, the Machida Company developed fiberendoscopy and soon the technicians at Olympus, led by the engineer Kawahara, produced many fine models of high optical quality with side‐ and front‐viewing capabilities [9].
Following the adaptation of fiberoptics for medical instruments, endoscopy of the GI tract became a routine diagnostic and therapeutic tool in many gastroenterology units throughout the world. In the early 1970s, the curiosity of a few pediatric gastroenterologists and surgeons was stimulated by the growing interest in endoscopy and its diagnostic success in adult gastroenterology. At that time, gastrointestinal endoscopy in children was performed with the standard adult gastroscopes, bronchoscopes and prototypes of pediatric fiberscopes which were available in a few pediatric hospitals in Europe, United States and Japan [9–14].
During the middle and late 1970s, several publications demonstrated the safety, diagnostic and therapeutic value of pediatric GI endoscopy, contributing to our knowledge of many GI diseases in infants and children [15–23]. Although the literature was not readily accessible, similar skills were developing in Eastern Europe and Russia [24–27]. Less than 10 years after its introduction in pediatric gastroenterology, endoscopy was the subject of several books in Spanish, German, and English [28–30]. By middle and late 2000s, an extensive knowledge of pediatric GI endoscopy was summarized in additional books [31–23].
Today, training in pediatric gastroenterology is not complete without acquiring competence in diagnostic upper gastrointestinal endoscopy and colonoscopy and basic therapeutic endoscopic GI procedures [34]. Diagnostic endoscopy has become a routine part of pediatric gastroenterology, combining the advantage of direct visual observation of the GI tract with target mucosal biopsy and therapeutic procedures.
The
