It will be fun exploring new areas, but my view is that our primary task in the 1990s is to evaluate what is already available, to discover what is really worthwhile, and then to put our energy into teaching and providing it efficiently. Evaluation means honest, objective reporting of the risks and benefits of procedures and meaningful comparisons with alternative techniques. We have not always been scrupulous about the collection or presentation of data. There has been a tendency to overstate the success rates and to minimize the problems, especially if we mistakenly equate complications with negligence. We can illustrate some of the confusion by looking at endoscopic management of binary problems.
Complications range from the trivial to the fatal.
As far as the patient is concerned, the risks are not confined to those which relate directly to the procedure. There is similar potential for confusion in discussing success rates. A cautious endoscopist who accepts only patients known to have small stones may have a higher apparent success rate than experts at referral centers who deal with more complex patients. Thus, the success rate can be defined only in the context of the types of patients referred and the individual endoscopic center. Once we have defined the real success rates and risks, we can attempt to establish whether endoscopic management is any better than established techniques, such as surgery.