One of the pioneers of modern colonoscopy, William Wolff, MD, has died at the age of 94.
Wolff and Hiromi Shinya, MD, working at New York City's Beth Israel Medical Center in the late 1960s, were among the first to use a flexible fiberoptic endoscope to probe the full length of the colon.
At that time, Wolff and Shinya wrote, they had extensive experience – more than 1,000 procedures -- using endoscopes to examine the stomach and esophagus. It was a "logical extension," they wrote, to use a similar – but specially-built – instrument to probe from the other end of the gastrointestinal tract.
Between June 1969 and June 1972, they reported in the New England Journal of Medicine (N Engl J Med 1973; 288: 329-332), they had performed more than 1,600 diagnostic procedures using the colonoscope "without morbidity or mortality."
Their most significant advance was a device designed by Shinya – a wire loop snare-cautery that enabled physicians to remove a polyp immediately, making a second procedure unnecessary.
By June, 1972, they reported, they had removed 303 polyps from 218 patients using the device in one or more procedures per patient including, in three cases, five polyps in one session. The main complication was bleeding, but that was rare and easily controlled.
Interestingly, sedation – now a commonplace – was rarely used. "Apprehensive patients may require mild sedation," they wrote. "Most are given none and require none if time is taken to discuss the examination with them."
The procedure, though often dreaded, is now routine: more than 1.6 million colonoscopies are performed in the U.S. annually, for the most part as preventive care. Colonoscopy is recommended by the American Cancer Society for adults over 50 as a way to find and – if necessary – remove polyps, which are now seen as precursors of colon cancer.
The process pioneered by Wolff and Shinya has been shown to reduce the risk of colon cancer, according to Henry Bodenheimer Jr., MD, chair of medicine at Beth Israel.
Bodenheimer told MedPage Today he had the chance to meet Wolff and discuss those early developments a few years ago, shortly after he arrived at the hospital to take charge of the endoscopy program.
"He was incredibly enthusiastic about relaying the history of Beth Israel and endoscopy," Bodenheimer said, adding it was "insightful and motivating" to meet Wolff.
"He had envisioned a way to do surgery in what we would now call a minimally invasive way, and he did it before anyone else," Bodenheimer said.
Extending endoscopy to the colon may have been a logical step, he noted, but it required the development of new tools, including a flexible device that could navigate the twists and turns of the colon.
It also took the insight to realize that there could be clinical advantages to exploring the gastrointestinal tract from below as well as from above.
Wolff was born in Manhattan on Oct. 24, 1916, according to the New York Times. He earned his bachelor's degree at New York University and got his MD at the University of Maryland. After internship and residency at Bellevue Hospital in Manhattan, Wolff served in Europe as an army surgeon during World War II.
After the war, he worked as a surgeon at veterans' hospitals in New York and Butler, Pa.
At Beth Israel, he was director of surgery from 1970 to 1977.
Wolff died Aug. 20, leaving nine children and 15 grandchildren. A cause of death was not reported.