Digestive endoscopy in five decades

Abstract

-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.

Exotic meets suave: the micro dynamics of homophily in the Cambridge cluster

“…While the homophilous model seems to work for the Cambridge cluster, in contrast to evidence of heterogeneity of Indians and Chinese in Silicon Valley, we question the long-term viability of such a model in the light of the importance of the Brazil, Russia, India, China, South Africa countries and the changing demographic profile of universities which increasingly admit students of diverse origins. Interestingly, research indicates that there is little change in terms of the gender and ethnic composition in social networks in the Cambridge cluster (Cotton and Kirk, 2012; Myint et al , 2005), thus further reinforcing the findings from our study about the homophilous model in the Cambridge cluster. This may, in some instances, be due to immigration policies, which place restrictions on those who are outside the European Economic Area (SQW, 2011).…”

“…In Silicon Valley, the paths of Asian professionals were mostly through higher education, and they used ethnic networks built by co-ethnics to strategically augment their enterprise and capital (Shih, 2006). However, anecdotal and visual evidence, and research investigating entrepreneurial activity in Cambridge based on social capital highlighted the lack of diversity (Myint et al , 2005; Cotton and Kirk, 2012) that was influential in Silicon Valley (Motoyama, 2003; Saxenian, 2000, 2000, 2002b). In fact, policies to encourage cluster formation are crucial for promoting economic development and enhancing innovation (Obadic, 2013) as is an actor-network perspective, for entrepreneurs can create various kinds of relationships in exploiting entrepreneurial opportunity (Salamzadeh and Roshandel Arbatani, 2020).…”

Schwindende Fachgrenzen zwischen Viszeralchirurgie und interventioneller Endoskopie

“…[2] und deutete die zunehmende Zuordnung zur Gastroenterologie an. Dem steigenden Einsatz endoskopischer Verfahren durch engagierte Endoskopiker wurde sowohl in den Mutterdisziplinen der Gastroenterologie als auch der Chirurgie mit Skepsis und Ablehnung begegnet [5]. Obwohl in der Folgezeit die Endoskopie sowohl von Chirurgen als auch Internisten betrieben wurde, verlor die Endoskopie in den meisten chirurgischen Kliniken an Bedeutung und wurde von den Gastroenterologen übernommen und weiterentwickelt [12].…”

ERCP in Postsurgical Patients

“…Cotton [ 1 ] published an overview of 30 years' experience with ERCP, and describes that the use of side-viewing endoscopes for cannulation of native papilla is an effi cient technique for radiologic imaging and treatment. In the "modern" biliary era, Freeman and Guda [ 2 , 3 ] reported a treatment success rate of 95 % in patients with normal anatomy and native papillary anatomy, and many high volume centers can surpass even this high bar in terms of success.…”