[The gastroenterological center].

Because of the possibility of direct optical and bioptical approach, endoscopy and surgery are related from the very beginning. Endoscopy developed and practiced mainly by gastroenterologically orientated internists, has already permanently influenced surgical procedure, because of advances in the diagnostic field such as early recognition of carcinoma, emergency endoscopy in cases of bleeding and the retrograde presentation of the biliary and pancreatic system. In a certain sense, the development of operative endoscopy with polypectomy, papillotomy and the elimination of sources of bleeding by the use of laser light, indicates that the dividing line between conservative and operative medicine has become blurred. This factor gives rise to reflection concerning the division of roles between internal medicine and surgery in the endoscopic field and probably also in a broader sense. Whether this classical split between conservative and operative medicine will maintain itself in the future is uncertain. It is possible that an organ related medicine will develop, determined by methods which will demand from the future physician a greater knowledge and ability within a narrower field. A conclusive statement on this point however, cannot be made today. Much depends on the local relationships and it would no doubt be a mistake to hope too much for any planning.