No doubt the same caveats apply to other techniques, including surgery, but that should not prevent us from putting our own house in order. Another specific point is that it makes no sense to teach only the diagnostic aspects of a particular procedure. It is unfair to the patient and possibly dangerous to perform diagnostic ERCP in the context of known or suspected biliary obstiruction without being able to provide immediate treatment. Although traditional apprenticeship will remain the cornerstone of teaching, we must develop methods to speed up the process and perhaps also to help us select appropriate trainees. It is not surprising that some surgeons are concerned when their gastroenterology colleagues grow threatening new muscles, and it is unhelpful when endoscopists treat surgeons simply as items of equipment to keep in the closet in case they may be required when things get difficult.
Therapeutic endoscopy is simply a new way of performing surgery.
Collaboration is of the essence. Finally, if we can establish by objective evaluation which of these techniques are undoubtedly beneficial, we have a duty not only to teach them effectively but also to ensure that the services are provided effectively and universally. I cannot foresee what will happen in the 1990s. Maybe developments in pharmacology or molecular biology will render some of our current techniques obsolete. Let's hope so, but the message will stay the same.