Tunnel BookReview by Richard Kozarek of the World Gastroenterology Organization for GastroIntestinal Endoscopy, September 2012

Home of Fred the Snake (and Dr. Peter)

Although I have written Forewords and reviewed numerous medical texts for journals in my professional career, it has been more than 50 years since I have done a book report. It is my great pleasure to do just that: a book report on Peter Cotton’s The Tunnel at the End of the Light: My Endoscopic Journey in Six Decades. Remember, a book report revolves around 7 facets of a story: character, plot, setting, theme, point of view, style, and tone.

So here, in no particular order, is my report. The point of view is uniquely first person, although there are enough anecdotes from such luminaries as Tony Axon, Rob Hawes, John Cunningham, and Lars Aabakken to make you realize that this is not an endoscopic Everyman’s journey and that Peter and his colleagues and trainees were living in the ether and creating, not simply living in, the endoscopic practice of the day. Theme? The theme (evolution of endoscopy)—from the gastrocamera in the 1960s to Dr. Cotton’s first endoscopic sphincterotomy in the mid-1970s. Those of you who believe in infallibility will be reassured when you read that his first sphincterotomy was associated with a “zipper phenomenon,” and his third patient went to surgery with a stone basket impacted in the biliary tree. The text includes subsequent endoscopic developments, particularly in ERCP, and concludes with 3 predictions: that endoscopes, if not endoscopists, will become increasingly intelligent; that procedures will increasingly be done by nonphysicians; and, finally, that “none of my predictions will come true … and that some other paradigm shift will deflect our profession in other unexpected directions.”

The style and tone of the book are matter-of-fact, light-hearted, but reflectional, and much of this reflection is based on Peter’s last ERCP performed on Friday, May 13, 2011, as well as having achieved “his biblical span.” Fortunately, the latter is not yet true, and Peter Cotton and his trainees remain a dominant force in endoscopic practice throughout the world today. Joseph Leung, Rob Hawes, John Baillie, and Tony Speer are only a few of his trainees from the Middlesex, as was Todd Baron at Duke and Paul Tarnasky at MUSC, which brings me to setting, which not only encompasses the time in London, Duke, and MUSC, but his own worldwide forays, including the world’s first live endoscopy course. Hong Kong? Repeatedly. India? Gastroenteritis (his lament) notwithstanding. Europe? As a contemporary of Demling, Classen, and Cremer. Iran to treat a Shah. Malaysia to forego endoscopy but still go pig hunting with a prince. Saudi Arabia to remove a stone from a king.

The plot is simple: the evolution of endoscopy at a time when diagnostic radiology and surgical therapy reigned supreme. The story is comprehensive, but is not complete. It evolves from a diagnostic specialty to one that has allowed us to treat bleeding, resect or ablate potentially malignant tissue, dilate luminal obstructions, and treat a variety of pancreaticobiliary diseases. It may evolve further into deeper forays into interventional practice “surgical trajectory”), and Peter gives credit to his surgical colleagues throughout his career. He also reinforces a concept that I heartily support: multidisciplinary care for patients with digestive disorders.

What great fun to read this book. I have known Peter for almost 4 decades—“subscribing” to his multiple editions of Practical Gastrointestinal Endoscopy with Christopher Williams and Annual of Gastrointestinal Endoscopy, edited with Guido Tytgat. However, it is the scope and geography in this book that makes it most readable. After all, having Nagi Reddy as your “endoscopic grandson” and John Cunningham describe the unfathomable game of cricket helps put the last half-century of our endoscopic revolution into perspective, a perspective with a harmonizing face.