I'll admit that a lot of this extraluminal stuff is relatively new to me as well as far as who, what, when, and where. At the Mayo in Rochester, there is a GI staff by the name of Christopher Gostout who is evidently at the forefront of developing these new "Radical Endoscopy" or extraluminal techniques. Evidently, the Mayo GI folks have a place where they house pigs which they use to develop these techniques.
There is also an article from a May issue of Internal Medicine News talking about how GI surgeons have been losing turf to Gastroenterologists as the development of new flexible endoscopic techniques takes away more bread and butter from them The article focuses on comments by Jeff Ponsky, a GI surgeon at the Cleveland Clinic (and interestingly, one of the developers of the PEG as we know it today) at a recent SAGES (Society of American Gastrointestinal Endoscopic Surgeons ) saying that surgical residencies need to retool and refocus to train their residents in endoscopy/endoscopic techniques or they will be left behind.
May 15 2004 ? Volume 37 ? Number 10, eInternal Medicine News
http://www2.einternalmedicinenews.c...rchDBfor=art&artType=fullfree&id=aqm040371001
As someone starting my GI training in two weeks, I'm more excited than ever. Also, I'm not at all worried about surgeons encroaching on "our" turf to any significant degree because:
1. We do more (the most) flexible endoscopy and will continue to leverage this procedural skill advantage into developing more flexible endoscopic procedures that we continue to teach primarily to GI trainees -- self fulfilling prophecy and sustaining ourselves, so to speak
2. Surgeons still want to cut, and will still do so to make a living as much as they can. Either you stay proficient and spend time operating, or you become rusty in those skills if you do exclusively endoscopy. It's not possible for one person to be good at all these different types of procedures. Nor can you be in the OR or scoping at the same time. One or the other. Only 24 hours in a day. That kind of thing. Case in point, there are many GIs who don't do any advanced endoscopy and have a very satisfying practice with EGDs, Colons, PEGs, maybe some ERCP (but diagnostic only). They either don't want or don't have enough time in their day to devote to doing specialized advanced procedures, and they make a great living anyway.
3. Surgeons can't bite the hand that feeds them -- if they try to do more endoscopy, they lose referrals from GI docs as punishment.
4. Remember, not every GI doc in practice will be trained or will even want to do these "radical" or interventional procedures. The point is, I suspect these techniques will remain pretty exclusive or in the domain of a relatively few "super-trained" GI endoscopists. There will also be some surgeons who learn such procedures, but that dissemination will be limited by 1-3 above.
I suspect that as these procedures begin to enter into clinical practice, they will do so at primarily academic medical centers where they are first developed, then disseminate slowly into the private world as private GIs who are so inclined learn the procedures and incorporate them into practice. Not to mention, they'd better pay well to do -- presume that many of these novel procedures are very time and skill intensive, so one could do 4-5 colonoscopies in the time it could take to do one of these advanced cases, but does the advanced procedure pay better than 5 colons? This factor may limit how readily private GI docs adopt such procedures, in that if it doesn't pay to do them, forget it.
Just some food for thought.
At any rate, to agree with the above posts, GI is becoming more exciting all the time.
I don't know how it got through the JAMA editorial process. 
