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Abstract

I appreciate the letter by Drs Lin and Barthel and I applaud their efforts in establishing the first Section of Endoscopic Oncology in the United States. Their work certainly does bridge the gap between endoscopy and oncology. The creation of a 1-year Advanced Endoscopic Oncology Fellowship is a laudable example of the second tier subspecialization training program I believe will be necessary in the short term if gastroenterologists are to take on a more meaningful role in the multidisciplinary management of GI oncology patients. I would like to remind Drs Lin and Barthel, however, that our scope of practice as gastroenterologists is not limited to endoscopy. Full engagement in GI oncology also will require that at least some future gastroenterologists master topics such as cancer epidemiology, risk assessment, genetics, chemoprevention, and even medical therapeutics. Advanced training for gastroenterologists in oncology may focus on advanced endoscopy for some trainees, but for others the focus may be on some of these other topic areas. With an improved understanding of the molecular progression of GI neoplasia, and the rapid growth of targeted therapeutics, I see an inevitable blurring of the lines between the chemoprevention and the medical treatment of early GI cancers. With proper multidisciplinary training, I see no reason that future gastroenterologists should be barred from the delivery of medical therapy to GI cancer patients because some might term it “chemotherapy.” Medical oncology and gastroenterology are going to remain distinct subspecialties, and I think it is unlikely that gastroenterologists, regardless of specialized training, will assume en masse a primary role in the delivery of systemic therapy to patients with widely metastatic GI cancer, but at the same time, I think the field of gastroenterology should prepare its trainees to be fully engaged in the prevention and treatment of early cancers, even if this entails the use of medicines, rather than, or in addition to, endoscopy. Endoscopic Oncology: Bridging the Gap Between Gastroenterology and OncologyGastroenterologyVol. 137Issue 2PreviewWe read with great interest the article by Dr Terdiman regarding oncology training and the subspecialization of gastroenterology.1 We agree that gastroenterologists play an important role in the care of gastrointestinal cancer patients; however, we respectfully disagree with Dr Terdiman with regard to expanding the role of the gastroenterologist to include the administration of chemotherapeutic agents. Gastroenterologists already have a central role in the prevention of gastrointestinal malignancies, and now with rapid advances in endoscopic technology, gastroenterologists have assumed an increasing role in the procedural treatment of gastrointestinal malignancies and palliation of their late complications. Full-Text PDF