Image transmission opens up all the potential of 'telemedicine'. The simplicity of electronic databases and the increasing interest in 'outcomes research' provide the tools and an environment in which we can evaluate our procedures in a meaningful way. What we do nowadays is so complex that we cannot possibly keep track without accurate and detailed recordings, including representative images stored from every examination. Without documentation there is no measurement. Comparisons of endoscopic treatments with surgery and interventional radiology are not possible unless we develop a common database, and particularly a method for recording realistic risk factors.
Some endoscopy procedures are undoubtedly worthwhile.
Others need to be tested. At that time, budgets were fixed annually in the UK, and there was pressure to do fewer procedures, or at least to prioritize stringently. Doctors and institutions both had a vested interest in maximizing endoscopic activity. There was less scrutiny of indications, and more opportunity for abuse. Gastroenterologists and endoscopy units proliferated.