Obituary: Dr William I Wolff - Revolutionised the diagnosis and treatment of certain cancers by developing the colonoscopy

DDr William I Wolff, who with a colleague revolutionised the diagnosis and treatment of colon cancer by developing the colonoscopy as the procedure is practiced today, died at his home in Manhattan. He was 94.

Working with Dr Hirmi Shinya at Beth Israel Medical Center in Manhattan in the 1960s, Wolff was at the forefront of a worldwide research effort to develop ways to probe the full length of the colon using a tube with electronic sensors. Their most significant advance was the development of a device that could remove a polyp immediately during a colonoscopy, eliminating the need for a second procedure.

Their protocol – using one doctor for the procedure instead of two, for example – became the universal standard, and articles they published about their thousands of successes confirmed the safety and efficacy of colonoscopies.

Though often dreaded by patients as much as a root canal, the procedure, if done in time, can eliminate more than 60 per cent of large-intestine growths. In the United States, more than 1.6 million colonoscopies are performed every year, mostly as a recommended preventive procedure for adults beginning in middle age.

More than 50,000 Americans die from cancer of the colon and rectum each year, making it the second-deadliest cancer in the United States, after lung cancer.

The colonoscope, the snakelike instrument used in the procedure, solved a longstanding problem: it could negotiate the sharp first turn of the large intestine.

That allowed it to examine the full five feet of the organ, its fibres lighting the colon’s walls and carrying the reflected image back to the other end of the colonoscope, where it could be viewed by a doctor. Previous procedures could penetrate only about 10 inches before being blocked.

Wolff and Shinya, working with the Olympus Optical Company, made a further, groundbreaking advance when, using a design by Shinya, in 1969 they introduced a wire loop snare to cauterise a polyp as soon as it was found, making a second procedure unnecessary.

Dr Francis Moore, a leading surgeon, called this “a quantum advance in abdominal surgery”.

Wolff and Shinya first described their surgical procedure in The New England Journal of Medicine; in 1999 the journal Seminars in Colon & Rectal Surgery called it one of the 20th century’s dozen landmark articles in the field.

Colonoscopy expanded through the 1970s and gained wide public exposure when the process was used several times to remove polyps from President Ronald Reagan in the mid-1980s. Many news articles mentioned Wolff and Shinya as the pioneers.

The colonoscope prompted a radical shift in medical thinking. Earlier, most doctors believed that bowel polyps rarely if ever turned into cancer.

Today’s prevailing belief is that most, if not all, cancers of the colon arise from polyps.

The colonoscope is an endoscope, as instruments used to examine the body’s interior are known. Endoscopes were being used increasingly in the 1960s to probe downward from the mouth or nose. Wolff was already doing this as head of surgery at Beth Israel.

At a conference in Denmark in 1966, he became fascinated with a new fibre-optic endoscope.

He then teamed up with Shinya, who had just completed his surgical residency at Beth Israel, to find out if the device could be used to study the entirety of the large intestine.

“We now confess that we were not at all entranced with the prospect of pushing a stiff tube through a thin-walled convoluted colon,” he wrote.

“The spectre of malpractice suits loomed large, should a mishap occur.”

So his team experimented with a softer, more flexible endoscope. In June 1969, they performed one of the first colonoscopies. Three months later, using the electrosurgical polypectomy snare designed by Shinya, they used the procedure to remove polyps.

They held back from publishing until they had done a minimum of 100 successful procedures. Wolff’s subsequent articles, all in top journals, “pre-empted” the field, Irvin M Modlin wrote in his 2000 book, A Brief History of Endoscopy.

William Irwin Wolff was born in Manhattan in 1916, and moved to the Bronx at the age of two. He earned a bachelor’s degree and fencing trophies at New York University and a medical degree from the University of Maryland.

He did an internship and residency at Bellevue Hospital in Manhattan, then served as an Army medical officer during the Second World War in Europe, accumulating vast surgical experience. After being discharged as a major, he worked in surgery at veterans hospitals, specialising in thoracic surgery.

While at a Pennsylvania hospital, Wolff revived a man who had apparently died while being prepared for a lung operation. He had no pulse or heart sounds for six minutes. Wolff opened his abdomen and massaged his heart until it beat. It was one of the first times a clinically dead person was resuscitated. Wolff wrote about it for The Journal of the American Medical Association, and the news media covered it widely.

Wolff delighted in veering from conventionality. During one complex surgery, he noticed that a student nurse was straining to see what was going on. So he summoned her closer to watch, and even encouraged her to touch the patient’s heart. In another case, a patient from Chinatown could pay only with homemade dumplings, and that was fine with him.

Wolff’s first marriage, to Lillian Myrick, ended in divorce. His second wife, the former Rita Smith, died in 2007. He is survived by his sons, Richard, David, Alan, Mitchell and George; his daughters, Deborah Wolff Dumovic, Lisa Wolff, Rebecca Wolff and Barbara Wolff Redmond; and 16 grandchildren.