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Page 2 of 3 Rey. Mini-invasive Surg 2021;5:21 https://dx.doi.org/10.20517/2574-1225.2021.14

because it is no less acceptable for patient safety. SMIS, large ESD, full-thickness resection, and stenting
procedures can reunify physicians and surgeons in the same crucial but narrow field even if they have
different backgrounds.

Consequently, we should organize common training to qualify endoscopists who carry out SMIS and all
advanced therapeutic procedures. They should have access to high-level qualification as provided by
Research Institute against Digestive Cancer (IRCAD) to avoid malpractice due to inadequate training.
When we started ERCP in the 1970s, it was on our own as we did not have a teacher; we were innovators.
This is not acceptable in the 21st century. However, common high-level diagnosis endoscopy without
minute teaching should not be a pathway for poor surgical colleagues to perform poor diagnosis
procedures. With high-resolution endoscopes, imaging-enhanced endoscopy, daily use of classifications for
characterization, and diagnosis endoscopy also require a skillful experience and should not be considered as
an accessory to a limited surgical practice. For our patient safety, the best is both trained and skillful
(surgeons or physicians) endoscopists for high-level therapeutic endoscopy and trained and skillful
physicians or surgeons for diagnosis endoscopy.

This new concept needs resources: diagnosis endoscopy requires fewer resources than high-level therapeutic
endoscopy, which needs multiple expensive devices. In endoscopy units, nearly all diagnostic endoscopic
procedures are carried out in clinics, while, for advanced therapeutic procedures, patients usually have to
stay some hours to days in the hospital.

In this special issue focused on biliary and pancreatic diseases, we review all possibilities of advanced
diagnosis or therapeutic procedures described by world experts based on clinical practice for the best
management of our patients. High-quality endoscopy is mandatory due to its importance in global
healthcare.

DECLARATIONS
Authors’ contributions
The author contributed solely to the article.

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflicts of interest
The author declared that there are no conflicts of interest.

Ethical approval and consent to participate
Not applicable.

Consent for publication
Not applicable.

Copyright
© The Author(s) 2021.