Toward the creation of a pancreatobiliary endoscopic environment that anticipates the times

In 30 years, the world's population will increase to 10 billion, mostly in Africa. Not in 30 years, but soon, the world should be able to provide remote endoscopic treatment to patients in another country virtually from Japan. Furthermore, Japan is an aging society, with 1/3 of Tokyo's population being elderly, and the GDP has dropped from 3rd to 7th or 8th place in the world, so lower costs and greater efficiency are desirable. 55 years have passed since the ERCP was developed, but the basic concept has not changed. Today, pancreatobiliary endoscopes are held in the hand for treatment, but perhaps 30 years from now, the concept of endoscopy itself will have changed. We believe that diagnosis will not be made by endoscopy, but by sitting in a special device that scans the entire body and identifies the site of the disease. Local treatment is considered to remain. Micro-robots may invade the bile duct through the papilla on their own, and endoscopists may operate them with a controller to ablate tumors and crush lithotripsy. Education must also be renewed using AI and virtual technology. Training models have been developed, but they are not always available at all endoscopy centers. We should use virtual training centers to become more confident in ERCP before performing it on patients.