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One often hears about the humble beginnings of some of the largest industries, with early prototypes of personal computers put together in a garage by a group of students, spawning a culture-changing, multibillion dollar global industry. In our field of gastroenterology, we increasingly view research as involving multisite consortia, 8-figure budgets, million dollar instrumentation, and teams of bioinformatics experts and statisticians poring over terabytes of data. The garage or dorm room might have been a great place to start Google, Disney, Facebook, or Amazon, but are certainly not places for serious medical research. Yet, as you read on, this was the setting in which the fiberoptic endoscope, arguably the single greatest diagnostic tool for our profession in the last century, was invented. In this fifth installment of ‘‘Paradigm Shifts in Perspective,’’ Mel Wilcox and I would like to spotlight an invention which singlehandedly transformed gastroenterology into the field that it is—the flexible endoscope. It is difficult to believe that prior to 1960, endoscopy was limited mostly to rigid sigmoidoscopy. On rare occasions, gastroscopy was conducted with a multi-hinged tube that required enormous skill combined with extreme cooperation and discomfort tolerance from its subjects, since one needed to align the oral cavity with the pharynx and esophagus through positioning and contortions that only a sword swallower would appreciate. Yet, many practitioners were adept at this, notably Rudolf Schindler, whose early works grace the first issues of this journal. The history of gastroscopy is relatively recent, extending back only to the nineteenth century [1, 2]. Although many had developed instruments equipped with optics that could be inserted into the body enabling the visualization of structures, it was not until 1881 that Johannes von Mickulicz developed the first working gastroscope, complete with air insufflation and integral light source. Following that advance, many inventors, engineers, and physicians jumped in, each with their own version and modification. The next advance was the semi-flexible endoscope in which one part consisted of multiple hinged segments with a series of lenses or prisms to conduct the light and wires to straighten the tube once inserted. Kelling first introduced this type in 1897, followed by versions designed by Kuttner and Sussman. The advantages to these instruments were that the need for neck hyperextension for insertion was reduced, as was gastric intubation. The wires guiding the instrument’s curvature were controlled by a wheel near the eyepiece, which is basically the same design as is used today to manipulate the endoscope head. It was Rudolf Schindler, however, who standardized and systematized foregut endoscopy, publishing his findings in early editions of the forerunner of this journal, The American Journal of Digestive Diseases and Nutrition, subject to a recent commentary in our January issue [3, 4]. It was J. D. Kaunitz (&) Departments of Medicine and Surgery, West Los Angeles VA Medical Center, UCLA School of Medicine, 11301 Wilshire Blvd, Bldg 114, Room 217E, Los Angeles, CA 90073, USA e-mail: jake@ucla.edu

The Fruits of Fiber: The Invention of the Flexible Fiberoptic Gastroscope