Gastrointestinal endoscopy continues to evolve and has seen a steady increase in demand, complexity, and innovation in what it is possible to do with an endoscope. It is now the undoubted investigation of choice for the GI tract, although there is no room for complacency. Parallel improvements in imaging capabilities such as MRCP and CT colonography are now impacting on the “diagnostic” endoscopy workload, and much of the current emphasis is on advancing endoluminal, transluminal, and hybrid therapeutic techniques. The ongoing adoption of national bowel cancer screening programs has driven up standards for endoscopists across the board. Increasing recognition of the importance of identifying even small, subtle premalignant dysplastic lesions and the ability to provide complex therapeutic intervention in both the upper and lower GI tract has made the learning process even more lengthy and difficult for those new to the field. Accordingly, the “fundamentals” no longer refers solely to basic or simple procedures, if indeed it ever did.
In this era of increasing complexity of endoscopy and increasing attention to quality performance, the fundamental skills that constitute the foundation of all endoscopic practice have never been more important to master. In line with the last edition, we have limited this book to the most common diagnostic and therapeutic “upper” and “lower” GI procedures, reserving more advanced techniques such as ERCP and EUS for others to cover. What is new to this edition is acknowledgement of the enormous impact of the Internet and electronic “e-learning.” This edition is supported by a selection of online multimedia images and clips, which are signposted in the text and referenced at the end of each chapter. To allow for greater use of mobile platforms, each chapter has been reconfigured into a more easily digestible “bite-sized” chunk with its own key learning points and searchable keywords. Multiple-choice questions (MCQs) are also available online to allow self-assessment and consolidate learning. We also formally acknowledge with this edition what has been common parlance for years—that this book is “Cotton and Williams′” fundamentals of gastrointestinal endoscopy, sharing personal opinions, tips, and tricks gained over many years. Although this is the last edition in which these two pioneering authors will actively participate, this textbook will remain a practical guide squarely based on their practice and principles. It has been our privilege to work with them to produce this edition, and we are honored to have been asked to sustain this important effort in the future.