Ever-changing endoscopic treatment for early gastric cancer: yesterday-today-tomorrow.

Endoscopic resection has been an optimal treatment for selected patients with early gastric cancer (EGC) based on advances in endoscopic instruments and techniques. As endoscopic submucosal dissection (ESD) has been widely used for treatment of EGC along with expanding ESD indication, concerns have been asked to achieve curative resection for EGC while guaranteeing precise prediction of lymph node metastasis (LNM). Recently, new techniques including ESD or endoscopic full-thickness resection combined with sentinel node navigation enable minimal tumor resection and a laparoscopic lymphadenectomy in cases of EGC with high risk of LNM. This review covers the development and challenges of endoscopic treatment for EGC. Moreover, a new microscopic imaging and endoscopic techniques for precise endoscopic diagnosis and minimally invasive treatment of EGC are introduced.

[Rudolf Schindler and the gastroscopy]. / Rudolf Schindler und die Gastroskopie.

Rudolf Schindler (1888 - 1968) accelerated the spread of gastroscopy in various ways. Together with the technical expert Georg Wolf he developed in 1932 the semiflexible gastroscope, which for about 25 years was the standard gastroscope worldwide before the onset of the fiberscopic era. With his previously constructed rigid gastroscope he became the founder of routine gastroscopy. His Lehrbuch und Atlas der Gastroskopie made him the leading endoscopic authority. He founded the ambulant gastroenterological-endoscopic practice. He was the first to describe and differentiate gastritis. In 1941 he founded the American Gastroscopic Club, he was its first president and the first editor of the journal of this society. For about 40 years he practiced gastroscopy every day with his wife Gabriele. Last but not least, Schindler was a leading authority, which attracted a steadily increasing number of pupils. Schindler was born and grew up in Berlin. He made most of his innovations in Munich between 1920 and 1934. An arrest by the Nazis of two months duration in 1934 drove him away from Germany. In the next decade he made Chicago the Mekka of gastroscopy. In 1943 he moved to California, From 1958 through to 1950 he worked in Belo Horizonte, Brasil. He spent his last years again in Munich. Schindler, possibly the best known digestive endoscopist and an innovative artistical personality, received worldwide high acceptance.

The Sydney System for classification of gastritis 20 years ago.

The roots of research into gastritis go back into the early decades of the 20th century. Modern aspects of its classification and knowledge of its biological course and consequences were relatively well known even at the time that Helicobcter pylori was discovered by Robin Warren and Barry Marshall in 1982. This discovery, however, significantly changed the field, establishing that the commonest form of gastritis is simply an infectious disease, a finding that raised enormous interest in the subject amongst gastroenterologists, microbiologists, pathologists and basic researchers. However, many of these "new" players in the field often had a limited knowledge of the morphological aspects of gastric inflammations and chronic gastritis. As a consequence in the late 1980's a Working Party was set up to review the biology and natural course of chronic gastritis, to propose a new classification for gastritis, and to provide simple guidelines for reporting the pathology of gastritis in endoscopic biopsies in an attempt to bring uniformity to the subject and facilitate comparative studies in what was to be an era of high research activity. These guidelines, The Sydney System: A New Classification of Gastritis was presented to the World Congress of Gastroenterology in Sydney in 1990, and was later published as six papers in the Journal of Gastroenterology and Hepatology. Now, twenty years on, this review looks back on the birth of Sydney System and why it is still important and successful.

From the sword to Schindler: a saga of gastroscopy.

Gastroscopy is an art as well as a science. The art is getting the instrument down; the science is the instrument itself. Rudolf Schindler was a master of both and is properly called "The Father Of Gastroscopy". He can also be called a renaissance man, so varied were his interests. Sword-swallowing played a minor but interesting role in the development of gastroscopy. It is still alive and well.

[Introduction of cold light to endoscopy]. / Die Einführung des Kaltlichts in die Endoskopie.

It is the aim of the paper to describe how, 40 years ago, optic glass fibers were developed, and what has been K. Storz's contribution to the new technology. In 1951 the term "Cold Light" was used the first time for illumination of a French type film- and photoendoscope. In 1957 the gastroenterologist B. Hirschowitz at Ann Arbor, U.S.A. succeeded making glass fibers of high light-guiding properties. In 1961 the Cystoscope Makers Inc (ACMI) at New York using these fibers brought the first flexible gastroscope on the market, still equipped with a conventional electric lamp. But in 1960, the year before, the physicist's of ACMI, J. H. Hett and L. Curtiss built the first cold light endoscope using glass fibers for both light and images conduction. In the following years ACMI equipped all of his endoscopes with this new type of illumination. Not before 1963 did K. Storz and the other German manufacturers produce their first cold light cystoscopes. Not possessing the know-how of glass fiber manufacturing, they had to get their fibers from abroad. K. Storz transmitted the term "cold light", which before had been the label of his French-type endoscopes, to the new glass fiber illumination. He constructed an excellent light source for fiber illumination without having light cables of his own fabrication. That is why his name is intimately connected with cold light illumination. But, nevertheless, the invention of the new glass fiber illumination must be credited to B. Hirschowitz and the physicists of ACMI in the U.S.A.

Johann Anton von Mikulicz-Radecki (1850-1905)--a pioneer of gastroscopy and modern surgery: his credit to urology.

The author presents the life and achievements of Johann von Mikulicz-Radecki and his contribution to European and world surgery. Mikulicz was born in Czernowitz, then a part of the Austro-Hungarian Empire. He was educated in numerous Austrian schools and graduated at Vienna University in 1875. In 1880 he became surgeon and lecturer (Docent) in the famous Billroth's School of surgery in Vienna. His scientific and clinical activity as assistant in Vienna and full professor in Cracow, Koenigsberg and Breslau resulted in 232 publications. He described many at that time novel surgical methods. He constructed the esophagogastroscope, scoliometer, peritoneal clamp and many other surgical devices. He organized the first in the world aseptical operation theatre in Breslau. He adopted hand disinfection, cotton and rubber gloves, mask, cup and general and local anaesthesia. Besides his many contributions to general, gastrointestinal and thoracic surgery Mikulicz devoted himself also to urological surgery. He performed ureterointestinal anastomosis and the first ileocystoplasty on a patient suffering from extrophy of the bladder. He died prematurely at the age of 55 in Breslau.

[Rudolf Schindler (1888--1968)--"father" of gastroscopy]. / Rudolf Schindler (1888 - 1968).

Rudolf Schindler was born in Berlin and achieved his international reputation with the textbook "Lehrbuch und Atlas der Gastroskopie", written in Munich. This was the first book containing excellent endoscopic pictures. He was the first to report on more than four hundred gastroscopies performed without complications. 1928 to 1932, he developed the first semi-flexible gastroscope together with the technical designer Georg Wolf from Berlin. This became the lasting standard for about twenty-five years. In 1934, Schindler emigrated to Chicago after being released as a Nazi prisoner. In 1937, he was awarded the gold medal for his research on gastritis by the American Medical Association. He became the leading person among American gastroscopists for many years and, in 1941, the first president of the American Gastroscopic Club. After 1943 he moved to California to work and live. He also received awards from the American Societies for Gastroscopy and Gastrointestinal Endoscopy in 1953 and 1962. He spent his last years in Munich. His honorary titles of father, architect or super salesman of gastroscopy describe the spectrum of his personality. He was an endoscopist with outstanding technical and diagnostic skills and knew particularly how to deal with patients, how to develop endoscopes as well as being a highly qualified teacher, author and scientist. He also had many hobbies, in particular playing and conducting music perfectly.

Historical perspectives on the treatment of gastroesophageal reflux disease.

The current vogue in the historical evolution of the management of the problem of reflux is represented by augmentation procedures for the lower esophageal sphincter. Rather than employ a transperitoneal approach, these are directed at the sphincter by the transesophageal route and include stitching, collagen injection and radio-frequency-induced fibrosis. It is however probable that these techniques will suffer all the drawbacks of any mechanical intervention but somewhat decrease the morbidity of open, albeit minimally invasive surgery. Similarly, a specific pharmacotherapeutic probe targeting the lower esophageal sphincter, while long fantasized, remains to be identified.

The history and future of implantation therapy for gastroesophageal reflux disease.

The initial development of endoscopic implantation techniques for the treatment of gastroesophageal reflux disease in the 1980s helped set the stage for current implantation techniques and studies, which now include more than 500 patients. The relative simplicity of these techniques adds to their attraction. Ultimately, multiple factors, including therapeutic efficacy durability, safety, simplicity, and cost-effectiveness, will determine clinical application of these techniques. This article focuses on transoral endoscopic implantation, although surgical, transcutaneous, and other endoscopic routes have been used as well.

Percutaneous endoscopic gastrostomy-20 years later: a historical perspective.

BACKGROUND/PURPOSE: Percutaneous endoscopic gastrostomy (PEG), initially developed for children with inability to swallow, had its first presentation at the annual meeting of the American Pediatric Surgical Association in Florida in 1980. Based on the novel concept of the sutureless approximation of a hollow viscus to the abdominal wall, this minimally invasive procedure has become the standard for direct gastric access worldwide. This report is a brief retrospective about the evolution of PEG and the expanded applications of the surgical concept on which it is based. METHODS: Information related to PEG was obtained from personal records, a focused literature search, and data from various registries and the industry. RESULTS: The search identified 836 peer-reviewed publications directly related to PEG. The original Journal of Pediatric Surgery article has received 483 bibliographic citations. The procedure has had a profound impact on nutritional management, particularly among adult patients. Over 216,000 PEGs are performed annually in the United States. Twelve major manufacturers produce PEG or PEG-related enteral access devices. Select expanded applications of PEG and its principle include indications beyond feeding, use in high-risk patients, percutaneous jejunostomy, percutaneous cecostomy, correction of gastrostomy leakage and gastric volvulus, multiple PEG portals for intragastric interventions, and laparoscopically assisted gastrostomies. CONCLUSIONS: Over 20 years, percutaneous endoscopic gastrostomy has experienced exponential growth. Improved guidelines and technical refinements have added to its safety. The concept on which it is based has created a ripple effect and led to numerous applications beyond gastric access for feeding. In an era when so many of our procedures are adopted from "adult" general surgery, it is worthwhile to have an historical perspective on PEG, a technique that originated in pediatric surgery.