A minority have also been trained in diagnostic and therapeutic procedures that include endoscopic retrograde cholangiopancreatography (ERCP), endoscopic ultrasound (EUS) and endoscopic resection of gastrointestinal neoplasms. Gastric acid studies are rarely performed, barium studies have become uncommon and, apart from endoscopy,

there are a variety of other investigation options that include ultrasonography (US), computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET). The modern gastroenterologist also has access to an expanding array of new drugs that include proton pump inhibitors, anti-viral agents, monoclonal antibodies and various chemotherapeutic drugs. Despite these impressive advances, concerns have been raised

that the average gastroenterologist is now ‘drowning’ in endoscopy, Acalabrutinib datasheet particularly screening colonoscopy.1 For example, a survey in the USA in 2001 showed that 55% of gastroenterologists spent more than half their working time doing endoscopic procedures (sometimes more than 50 procedures per week). Obviously, this is good for maintenance of income but, in many settings, there are negative effects on teaching and research. In addition, the gastroenterology workforce is ageing in the USA and perhaps elsewhere, again with negative effects on research, innovation and the adoption of new technology. Although attempts to visualize and explore various body orifices date back to Egyptian and Greco-Roman times, the first successful click here rigid gastroscopy was reported in a sword swallower in 1868.2 However, endoscopy was restricted to a small number of enthusiasts until 1932 when Schindler and Wolf manufactured a semiflexible gastroscope in Germany. Subsequently, Schindler migrated to the USA, promoted the safety and efficacy of gastroscopy and was subsequently recognized as the ‘father of gastroscopy’.3 Other semiflexible endoscopes were also developed MCE although, prior to 1965,

they were only used by a relatively small number of individuals. The revolution that led to the widespread use of endoscopes occurred in the 1950s and 1960s when Dr Basil Hirschowitz and others used the principles of fiberoptics to develop the ‘fiberscope’.3 Early models had side-viewing lenses and there were problems with overheating of the tip of the endoscope by the distal light source and with breakage of glass fibers that resulted in small black dots in the visual field. The latter problem was never successfully overcome but subsequent advances led to development of endoscopes that were end-viewing, longer and had four-way flexible tips. By 1970, endoscopes could be readily passed into the duodenum and the era of ‘panendoscopy’ had arrived. The availability of side-viewing endoscopes raised the possibility of cannulation of the ampulla of Vater.