Lower gastrointestinal endoscopy: Diagnosis and treatment

Abstract

Video colonoscopy is an evolving procedure that is rapidly developing to meet modern diagnostic and therapeutic demands. Over the past 35 years colonoscopy has evolved from fibreoptic to video and has become the optimal technique for diagnosing, and in many cases treating, mucosal disease. The margins between endoscopy and surgery are becoming increasingly blurred. Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) now play a major role in the management of neoplasia, where surgery was once the gold standard. Colonic stenting is influencing surgical options in obstructing cancer, whilst endoscopic dilatation has become the first-line option for short, benign strictures. Standardising and optimising the colonoscopy technique remains of paramount importance for all diagnostic and therapeutic procedures. Accreditation for bowel cancer screeningderived colonoscopies has now been introduced in the UK and there is an increasing focus on demonstration of quality in colonoscopic practice [47]. To this end, the requirement for both basic and advanced colonoscopy training is being supported by renewed commitment and fresh concepts [59]. The following pages provide an insight into how colonoscopy is influencing the world of colorectal surgery. © 2010 Springer-Verlag Berlin Heidelberg.