Digestive endoscopy in five decades.

The world of gastroenterology changed forever when flexible endoscopes became available in the 1960s. Diagnostic and therapeutic techniques proliferated and entered the mainstream of medicine, not without some controversy. Success resulted in a huge service demand, with the need to train more endoscopists and to organise large endoscopy units and teams of staff. The British health service struggled with insufficient numbers of consultants, other staff and resources, and British endoscopy fell behind that of most other developed countries. This situation is now being addressed aggressively, with many local and national initiatives aimed at improving access and choice, and at promoting and documenting quality. Many more consultants are needed and some should be relieved of their internal medicine commitment to focus on their specialist skills. New instruments and procedures are stretching the diagnostic boundaries and changing the interface with sister disciplines like radiology, surgery and pathology. The old distinctions, particularly between gastroenterology and surgery, are increasingly irrelevant and unhelpful. The future is bright for gastroenterology and for endoscopy, but unpredictable. In this fast-changing world it will be essential to remain flexible, with our goals firmly focused on the best interests of our patients.