Often tempting to request endoscopy

Dear Sir, - I would like to comment on Gerald Wells's letter in last week's Chronicle on endoscopy rates.

Though it is some years since I practised, requesting endoscopies in various specialities was often tempting and sometimes useful.

Investigating possible disease is an art, as well as a science, with the potential for satisfying your own curiosity rather than helping the patient.

As endoscopies are invasive, non-invasive tests such as radiography are often used fi rst.

It is when these are unavailable for some reason that clinicians often resort to them.

Moreover, the ability to actually see what is going on can be almost irresistible, especially if it includes the possibility of treatment at the same time.

It is probably where endoscopies are used to "exclude" disease that has been made unlikely by previous non-invasive tests that savings can be most easily made. - Yours faithfully,

(DR) PETER HIRST

Middlewich.