In a review, Dr. Michael V. Sivak Jr. of Case Western Reserve University in Cleveland predicted the future of endoscopy by drawing upon the history of the discipline. He noted that advancements in endoscopy may slow or stop. Sivak called 1968 to 1990 the “golden era of gastrointestinal endoscopy” because so many devices and procedures were developed in this period. New endoscopic techniques arose primarily from direct collaborations between clinicians and artisan-engineers. Advances mostly stemmed from incorporating technologies developed for other disciplines, such as the CCD. Around 1980, endoscopy was combined with ultrasonography for the first time. While previous innovations had improved only the visual inspection of the gut, endoscopic ultrasonography employed a new method of diagnosis. Sivak believes that the technology serves as a model for innovation and that future techniques will become more focused, perhaps on a single disease. However, nongastroenterologists have not completely accepted endoscopic ultrasonography because of a relative lack of controlled trials that would illustrate its benefit. The gastroenterological achievements between 1994 and 2004 were fewer in number than in the golden era, and few were advancements in diagnosis and treatment methods. Sivak cited a number of reasons why endoscopic technology may reach a plateau. Endoscopists are becoming older, and fewer new endoscopists are entering the field. Manufacturers of endoscopes and of related devices are becoming larger but decreasing in number. Additionally, endoscopic research has received less federal funding. Sivak blamed the lack of funding on the failure of researchers to design clinical trials that demonstrate the benefit of endoscopic technology. He predicted several things for endoscopy. Nurses will perform routine procedures instead of physicians, reducing the latter’s workloads. Endoscopes will be designed for hands-free operation, enabling more complex therapeutic procedures. A variety of combined laparoscopic-endoscopic procedures will be developed. Sivak also foretold that several biological detection methods may change endoscopy, including optical coherence tomography, laser-induced light scattering technology, light-induced fluorescence microscopy and Raman spectroscopy. In addition, endoscopy may be used with photodynamic therapy. Computer advancements, including better training simulators, will improve endoscopy as well. Ultimately, Sivak believes that traditional diagnostic endoscopy may be replaced by a combination of virtual imaging and capsule endoscopy. (Gut, August 2006, pp. 1061-1064).