What happened to the British Endoscopy Society 40 years ago?

What happened to the British Endoscopy Society 40 years ago?

Many gastroenterologists practicing today may not know that there was once a British Society for Digestive Endoscopy (BSDE). It folded in 1980.

What was it, why, and what happened to it?

The flexible endoscopy revolution started in the late 60s and blossomed in the 70s. Before that happened, the British Society of Gastroenterology (BSG) had a small select membership with strict entry criteria that excluded many of the young people who were embracing the new technology. None of the established staff/consultants/professors were interested. I ran an endoscopy service in the “gut hut” at St Thomas’s Hospital for 3 years while still a trainee “registrar”.

St Thomas’s Hospital, London

We were all on a steep learning curve (there were no experienced teachers and no textbooks), while trying to cope with the rapidly increasing demands for procedures and indeed teaching what little we knew. We were struggling to get equipment, staff and space at a time when NHS resources were scarce. My first two scopes were bought with charity funds. At the same time, many established Gastroenterologists questioned our passion for this new technology and the resulting activities. There was a disconnect between old and young, academic and practical. Some teachers in particular resented the fact that their trainees were heading for endoscopy labs rather than their basic science labs. Sir Christopher Booth, then president of BSG, said “Will gastroenterologists become purely technicians”. And my good friend Solly Marks, grandfather of gastroenterology in South Africa, was kind enough to say “Peter, remember the whole patient, not just the hole in the patient”.

Having said that, it was one academic leader who had the idea of getting the budding “endoscopists” together. Sidney Truelove was the chief at Oxford, with a long history of important clinical research in ulcerative colitis. His group published the first British paper about flexible endoscopy, in the BMJ in 1968.

It was reading that article that sparked my own interest, and changed my career trajectory. I was then attempting to do some basic research on small bowel lipids in the “gut hut” at St Thomas’s. It was becoming plain to me and my mentor, Brian Creamer, that I would never make a scientist. Brian persuaded the Hospital Trustees to provide the funds to buy a gastroscope, and let me loose.

Sydney Truelove and a disciple, Klaus Schiller of Chertsey, organized a meeting of fellow endoscopy enthusiasts in London in 1970. That led to the formation of the BSDE on the fringes of the annual BSG meeting in 1971, not without considerable backlash from the establishment. Sydney was the first President and Klaus was the tireless secretary. The initial committee members were: Alan Read, Geoffrey Chandler, Denis Gibbs, Alan Dean, Paul Salmon, Duncan Colin-Jones, Christopher Williams, John Lennard Jones, and myself. Unlike the BSG we welcomed endoscopy nurses and techs as members, and even some corporate leaders.

The goal was pragmatic, how to manage the accelerating service and teaching needs. There were no “endoscopy units” and very few defined “endoscopy nurses”. Many of us worked initially with one endoscope, in ward side rooms with any passing assistant. I will not mention disinfection. We ran meetings, developed training materials (“slide tape lectures”) and wrote pious editorials, not least to our NHS masters.

I remember one sentence in that 1973 document (since I wrote it). “It is no longer appropriate to attempt to function with current resources, but essential to press for the resources we need to provide the needed services”.

The main annual BSDE meetings were held alongside those of the BSG, and gradually attracted more participants and indeed members than the BSG (leaders of which were not amused). It became clear to me that the situation was not sustainable, and we had to find a better way to collaborate. I felt (and still feel) that endoscopy is only a part of the great discipline of gastroenterology, and not a separate specialty, and that our professional organization should represent that relationship.

Thus, in 1980, I chaired a meeting of representatives of BSDE and BSG (with Chris Booth as President), which recommended a merger. The format was approved almost unanimously at the BSDE meeting in 1980 and reported in Gut.

The BSDE identity and title were lost; all members (except corporates) became members of the BSG. The BSDE President (me) became “Vice-President Endoscopy” of the BSG. The pattern was copied subsequently to embrace many other specialty sections.

This arrangement seemed to me to be logical and appropriate, and indeed still does, but it stands out somewhat as an anomaly. Most countries still have independent Endoscopy societies, sometimes more than one, and I am not aware of any others that have been folded. My adopted country now has five societies, all of which provide platforms for endoscopy presentations and publications, and issue thoughtful guidelines. They are the ASGE (for committed endoscopists), ACG (for practicing gastroenterologists), AGA (for academics), SAGES (for surgical endoscopists), and SGNA (for nurses and associates). They all have thousands of members, rafts of officers and substantial funds.

Is this continuing fragmentation good or bad? Those in favor say that a society with a tight focus can progress its agenda better alone, but I worry that the inevitable disagreements (however subtle) may confuse the payers (federal and insurance agencies in USA) and indeed empower them to cherry pick their targets. The various societies do collaborate to a certain extent (often as determined by the transient Presidents), but I can’t help feeling that the gastroenterology community would be better served if it could speak with one voice. Probably naïve….maybe everything has gotten too big.

Fun looking back. Scoping in the gut hut with Sue Wright (Nightingale nurse), Sue Wallace (lab tech) and John Beales (Radiologist)…only 40 years ago.

All part of life’s rich tapestry…..

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