Museum Exhibit Closed as of February 27, 2009

"GI JOURNEY" COMBINES MEDICAL HISTORY WITH MODERN ADVANCES
(Click on image to enlarge)

The National Museum of Health and Medicine of the Armed Forces Institute of Pathology (AFIP) has opened "Research Matters: A GI Journey," an exhibit that details the history of endoscopy and new technological advances in the field. It will run indefinitely.

Endoscopic examinations allow physicians to see inside the human body and are useful in detecting abnormal growths, lesions, and other pathological conditions. A number of body sites can be examined endoscopically, including respiratory, urinary, and gynecological. Gastroenterologists are physicians who use endoscopes to view the body's digestive system through exterior openings.

As the exhibit notes, endoscopes (endo-inside; scope-to see) have been used for nearly 2,000 years, although the designs of the instruments and their level of sophistication have changed dramatically since Roman times. The application of fiber-optic technology to endoscopes has allowed these instruments to bend along anatomical pathways rather than be rigid instruments.

"This exhibit is unique," said Leslie Sobin, M.D., chief of AFIP's Division of Gastrointestinal Pathology and director of Scientific Publications. "It takes the mystery out of the process, while, at the same time, documents the historical development of medical technology."

Sobin's experience with cancer is extensive. He also serves as the associate editor of the AFIP Atlas of Tumor Pathology, chairman of the TNM/Prognostic Factors Project of the International Union Against Cancer, head of the World Health Organization (WHO) Collaborating Center on International Histological Classification of Tumors, and member of the WHO Expert Advisory Panel on Cancer. In addition, he is a professor of pathology at the Uniformed Services University of the Health Sciences and an adjunct professor of pathology at Georgetown University Medical College.

The exhibit features 10 traditional endoscopes from several different time periods, spanning from AD 0 to AD 2003. Included in the display are cystoscopes, vaginal speculums, gastrocameras, otoscopes, rigid gastroscopes, nasal speculums, sigmoidoscopes, and rectal dilators. The artifacts were borrowed from the museum's more than 12,000 historical medical objects.

The exhibit also includes several photographs and diagrams of the inner-workings of the new M2A "pill endoscope," as well as a video that illustrates endoscopic examination and endoscopic biopsy procedures.

The traditional tools on display are considered somewhat limited, because they only allow physicians to see the esophagus, stomach, upper section of the small intestine, and the large intestine. The entire digestive or gastrointestinal (GI) tract has historically been difficult to observe because it runs from the mouth to the anus and is more than 30 feet long.

New technology, however, makes observation of the entire tract possible. The M2A Capsule, the newest and most advanced endoscopic instrument displayed in the exhibit, allows physicians to see parts of the small intestine that older conventional methods do not.

Although it is the size of a pill and weighs less than 4 grams, the M2A consists of a light, camera, power source, and transmitter. The capsule-encased camera records two photographs per second for up to 8 hours, until it is excreted. Up to 50,000 images can be recorded on the pack worn by the patient, which are then downloaded onto a computer and analyzed by physicians.

Given Imaging, Ltd., a diagnostics company based in Israel, patented M2A in 1999. Since the FDA cleared the M2A for use in 2001, the company has sold almost 22,000 capsules. Given Imaging, Ltd. donated a capsule to the museum in March 2003.

According to Given Imaging, the M2A differs from traditional endoscopic instruments because it is "painless, convenient, and less invasive" than other methods and because it utilizes the most recent advances in nanotechnology. Moreover, this endoscopic technique can be combined with radiology and ultrasonography for more detailed images of the gastrointestinal tract.

"This exhibit does several things," said Jim Connor, Ph.D., the museum's assistant director for collections. "First, it highlights the pathology aspect of the AFIP. Second, it identifies interesting elements of a collection that we have not been able to show in the past. Finally, it shows people that issues like colon cancer must be addressed and that early detection is extremely important, using tools like endoscopes and the M2A capsule."

AFIP pathologists continue to research the possible uses and advantages provided by advancements in endoscopic technology. In fact, much of this research is already recognized internationally. One of AFIP's most successful post-graduate courses focuses on the diagnosis of gastrointestinal endoscopic biopsies. A widely read AFIP publication is the "Atlas of Gastrointestinal Endoscopy and Endoscopic Biopsies." Photographs from this atlas are the source of much of the current exhibit's illustrations.