Endoscopy has revolutionized clinical gastroenterology. In 1961 Basil
Hirschowitz published the first flexible endoscopic examination of the
stomach and duodenal bulb. We moved from flexible fiberendoscopes to
current video-endoscopic equip- ment. Current video-endoscopes
incorporate a black and white or color 'chip' at the tip of the
instrument which transforms the visual image into electronic signals.
The size of the pincet is constantly getting smaller, heading for 5 /Lm,
further increasing the resolution. The signals are reassembled into
high-quality color images in a video monitor. Endoscopes are now used to
examine the entire gastrointestinal tract from esophagus to rectum,
including the biliary and pancreatic ductal system. Targeted endoscopic
biopsy offers rapid and precise diagnosis. Endoscopic ultrasonography is
of unsurpassed accuracy in staging gastrointestinal tumors, in assessing
pancreatic and biliary disease, and disorders of the rectum and anal
canal. Moreover, targeted cytological sampling is possible of
abnormalities of the intestinal wall or peri- intestinal lymph node. Yet
despite these glamorous achievements changes are to be expected in the
overall emphasis of diagnostic endoscopy. Magnetic resonance
cholangiopancreatography may very well compete for a substantial
fraction of diagnostic ERCP. Virtual colonoscopy or computed tomographic
colography may well compete with (and take over?) screening/surveillance
colonoscopy.