Recommendations of the ESGE Workshop on Ethical-Legal Issues Concerning Live Demonstrations in Digestive Endoscopy

Introduction

Live-endoscopy courses have become very popular over the last 20 years. Although local live demonstrations had been given for many years by the pioneers in their own centers, the first live-endoscopy courses with participation of foreign faculty members took place in Europe, in December 1981 (Claude Liguory, in Paris) and in June 1983 (Michel Cremer, in Brussels). At that time, these courses were organized in very difficult conditions, not only from a technical point of view (using fiberscopes, with limited transmission capabilities), but also because diagnostic and therapeutic endoscopies were much less developed than they are at present, and especially because the availability of teams including gastroenterologists, radiologists, and anesthesiologists was very limited in this field. The enthusiasm for live-endoscopy courses spread throughout Europe and has rapidly crossed the oceans.

In the late 1980 s and early 1990 s, these courses reached a high level of popularity and have been organized even more frequently at national and local levels. The major teaching advantages of these courses in comparison with videotapes or lectures are that they provide the audience with the opportunity to watch experts working in real time, not only demonstrating the best procedure but also, in some instances, having difficulties. Live demonstrations offer the possibility of showing how experts solve these difficulties as well as indicating the limits of endoscopy. However, alongside these obvious advantages, live-endoscopy courses must be considered with caution, given that procedures are demonstrated on patients who should be offered at least similar treatment to what they could expect if treated or examined routinely.

With the development of video endoscopy in the late 1980s, the success of live demonstrations has been tremendously boosted. This form of teaching is now incorporated into many local, national, and international conferences. The demonstrations currently fall into three different categories:

a relatively small number of international live-endoscopy courses which are organized by professional technical staffs and physicians at units where this type of function has been carried out for several years; many smaller-sized national courses, where foreign clinicians are invited to give demonstrations at centers where such procedures are not done routinely; and finally the local courses, where only one expert is invited, with a small number of attendees, to carry out specific procedures with or without live transmission.

There is also a fourth type of course, when teaching with video demonstrations is done by an expert or a group of experts in their own unit, without the participation of other faculty members. In this case, the patient is treated in routine facilities by the usual endoscopist, and these courses are not considered in the current evaluation.

References

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• 3 Carr-Locke D L, Gostout C J, Van Dam J A. A guideline for live endoscopy courses: an ASGE White Paper.  Gastrointest Endosc. 2001;  53 685-688