Reply to Lee et al.

Abstract

Dear Sir,We are grateful to Lee et al. for their comments on our article [1] and for highlighting the importance of endoscopists' experience and competence in order to achieve a higher success rate with a low rate of complications. Whatever procedure is discussed in modern medicine, and specifically in surgery, it has been obvious that the results differ depending upon the individual surgeon. Therefore population-based data are of utmost importance and will confirm whether or not new technology will be implemented in a proper way. Previous studies have emanated from specialized referral centers and it has not been well understood until now to what extent the success rates and rate of complications reported were valid in other clinical settings. The only way to explore this very important issue is of course the exploration and validation of the different end points. Without defining the end points and analysing the results of an endoscopic or surgical procedure, preferably in a population-based setting, it is not possible to detect whether a procedure is being adequately performed. A comparison can be made with rectal cancer surgery. It has been claimed the surgical technique is difficult, demanding, and has to be performed in a specific way, but without monitoring of the results, the outcome of rectal cancer surgery can never be evaluated. End points such as postoperative mortality and morbidity, as well as cancer-related end points such as local recurrence and cancer-specific survival, are knowledge which is essential for evaluation of the final outcome [2] [3]. When proper monitoring is undertaken, the surgical community becomes aware of the results and can act to improve upon them.