Gastroenterologists as surgeons: what they need to know.

摘要

In this issue of Gastrointestinal Endoscopy, Jagannath et al present some of their pioneering work in the area of transgastric surgery, reporting upon the successful endoscopictransvisceral ligation of porcine fallopian tubes. This follows on the heals of their initial reports of transgastric gastrojejunostomy and peritoneoscopy with liver biopsy. This work is exciting and innovative, opening a whole new arena of possibilities for minimally invasive therapy. Indeed, from other parts of the world, we hear anecdotal reports of such procedures as transgastric appendectomy having been performed in human subjects. The possibilities for future developments tantalize the imagination, yet the questions to be answered are legion.In the past decade, minimally invasive approaches to therapy have developed in almost every specialty. In most cases, these have brought great patient benefit. Some have developed through careful scientific study, while others have emerged from mere ideas. The use of an intragastric balloon for the treatment of morbid obesity was prophetic and ahead of its time. Initial clinical experience was marred by complications that may have been avoided with careful preclinical trials. Though laparoscopic cholecystectomy has clearly become the standard for excision of the gallbladder, its explosive development was driven more by market forces than by science.