| The list of milestones in the history of therapeutic endoscopy contains more than 30 inventions and innovations. POEM introduced by Inoue in 2011 was not the last invention. In the next decade, we are expecting further so-called third-space new technologies to come. It took a decade after the introduction of the fibergastroscope by Hirshowitz until the first polypectomy in the colon was performed by Niwa, although Turell, a surgeon in New York has already 1949 introduced the first electrosurgical snare. “Necessity is the mother of invention“. This saying becomes true in case of emergency, particularly in the elderly and high surgical risk patients. No wonder the first therapeutic procedures were foreign body removal, removal of impacted biliary stone and bleeding control. Endoscopic papillotomy, first performed in 1974 by Kawai and Nakajima in Japan, Demling and Classen in Germany, was for removal of impacted stone. I performed my first EPT using a home-made sphincterotome. In 1975, with my first home-made injection catheter I successfully controlled a bleeding from a gastric ulcer using the sice-viewing gastroscope. At that time, barium swallow was still the diagnostic tool of choice. Endoscopic removal of early cancer in the gastrointestinal tract was first performed in the stomach by Henke and Ottenjann in Germany in 1973. It took more than one decade until endoscopists in Japan, one of the countries high incidence of gastric cancer, started to remove early gastric cancer. At the end of the 20th century, en-bloc EMR was recommended only for well-differenciated mucosal cancer not larger than 2 cm in diameter. The frontier between endoscopic and surgical treatment started to shift in favor of EMR. It was a tremendous merit of Gotoda and co-workers from the National Cancer Center Hospital Tokyo, who analysed retrospectively the lymph node metastasis in more than 5000 surgically treated cases with early gastric cancer. Based on this comprehensive finding, endoscopic removal is considered justified also for lesions larger than 2 cm in diameter and with submucosal infiltration. Consequently, ESD has replaced EMR. In 1978, I did the first biliary stent placement using hte side-viewing gastroscope. Conclusion: Invention, creating something completely new, is nowsadays relatively difficult. Innovation, modifying available methods is needed to improve results, to simplify the technique and to reduce complication. These have to be kept in mind, otherwise any trial of modification will appear as a subjective exhibitionism. |
