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Operative endoscopy today.

Operative endoscopy permits therapeutic measures to be carried out that spare the patient major surgery. In its narrower sense, operative endoscopy was "inaugurated" with total biopsy of polyps. A complication occasionally seen with polyp-ectomies, namely haemorrhage, provided the impetus for developing endoscopic haemostasis using the laser beam and the electro-hydro probe. The possibility of cannulating the papilla of Vater and carrying out ERCP permitted the endoscopist not only to visualize concrements in the common bile duct, presenting as filling defects in the contrast material column-but also, when in a prepapillary location, to feel them with the tip of the catheter. The prepapillary concrement was, as it were, a sort of provocation for the diagnostic endoscopist. His response was to construct a simple papillotome, with the aid of which the roof of the papilla of Vater could be slit. In general, after papillotomy bile duct stones pass spontaneously, or can be extracted. In principle it is possible to destroy stones which cannot pass by employing pressure waves in the common bile duct induced by spark discharge in a liquid medium, or to reduce them in size by means of locally introduced dissolving agents. A relatively new branch of operative endoscopy involves interventions that might be described as prosthetic endoscopy. This includes the passing of plastic tubes down an oesophagus constricted by tumor growth, and the introduction of drainage tubes into the biliary system. Foreign body extraction, concerned primarily with swallowed objects located in the stomach, is an older but still very useful possibility of operative endoscopy.