History of colonoscopy and technological advances: a narrative review

Background and Objective: Colonoscopy is an ever-growing procedure, being the primary diagnostic and therapeutic modality to manage lower gastrointestinal pathologies. It has a decades-old history with significant successive endoscopic innovations that eventually led to the development of the current colonoscope, as we know it today. Methods: We reviewed multiple databases in non-systemic fashion using PubMed, Embase and Cochrane library to shed light on historic timeline of advancements and groundbreaking landmark achievements currently underway. Key Content and Findings: Initially starting off as a rudimentary rigid, device that utilized candles as a light source, the primitive colonoscope was adapted to a semi-rigid framework to allow better maneuverability. Improved lenses allowed better viewing quality and the development of video capabilities with the capability of performing both diagnostic and therapeutic interventions transformed the colonoscope completely into a modern interventional device. Its utility started gaining attention in the late 90s when multiple guidelines were published, supporting its impact on survival for colorectal screening. Over the years, the therapeutic component of colonoscopy has evolved further allowing it to be used as a treatment modality for several lower gastrointestinal pathologies including control of lower gastrointestinal bleeds, management of large bowel perforation, foreign body removal and dilatation of colonic stenosis. With improving technological advances, success rates of colonoscopic interventions continue to rise and new therapeutic modalities underway further enhancing their role. Multiple developments are underway including use of artificial intelligence (AI) with as endocuff vision, amplify EYE and G-EYE among others that hold great promise for the future of colonoscopy. Conclusions: With our review, we hope to further the understanding clinicians about the colonoscope and help contribute towards its further developments.