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Evolution of surgery to endoscopy.

‘Progress lies not in enhancing what is, but in advancing toward what will be’ Khalil Gibran The last decade has seen an uptick of endoscopic procedures for digestive conditions which were once treated only surgically. This is exemplified in two excellent reviews in this edition of Current Opinion: Endoscopic Techniques for treating Gastroesophageal Reflux (pp. 288–294) and Endoscopic Techniques for Full Thickness Intestinal Biopsy (pp. 295–300). Both reviews highlight, in particular, the use of timehonored surgical principles to create robust endoscopic approaches to these diseases. This evolution is also happening with bariatric surgery which was recently reviewed in Current Opinion [1]. A further example is palliation of malignant intestinal or biliary obstruction. No longer do endoscopists need to place endoscopic stents for palliation, which are technically difficult and suffer from tumor overgrowth, but they are now able to perform endoscopic bypass as would previously be done surgically [2]. Myotomies for achalasia and other motility disorders are transitioning from surgical to endoscopic approaches [3]. Why is this happening now? Recent advances in technology have generated endoscopic tools to create surgical-like solutions. Transoral Incisionless Fundoplication mirroring laparoscopic surgical fundoplication and Endoscopic Sleeve Gastroplasty mimicking laparoscopic sleeve gastrectomy are expected to be durable while less invasive. Emerging long-term data are now supportive of this notion. Although this forecasts good news for patients (less invasive procedures with quicker recovery) and healthcare systems (lower costs), it does create challenges for advanced endoscopic training. Training in advanced endoscopy now offers a bewildering array of opportunities for the incoming trainee. The basic menu of advanced endoscopy training