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 24 May 2022

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Career Summary

Peter Cotton is Professor of Medicine, and Director of the Digestive Disease Center, at the Medical University of South Carolina in Charleston.

He was born and educated in England, where his father was a rural family physician. He graduated in 1963 from Cambridge University and St. Thomas Hospital Medical School (London). During a year of bench research as part of his GI training, he came across a paper describing the first fiberoptic gastroscope with a biopsy capability. The instrument was acquired, and a career was born. He developed the Endoscopy Laboratory at St. Thomas’ Hospital whilst still officially in training, and wrote many of the first European papers on the use of endoscopy in the investigation of dyspepsia, bleeding and other contexts.

After a 6 month spell in Iran (during which he introduced endoscopy to the Middle East), he went to Japan to see pioneer Kazuei Ogoshi cannulating the pancreatic duct, a huge breakthrough at a time before there were any abdominal scans. Believing the Japanese name for the procedure to be rather cumbersome, he coined the term Endoscopic Retrograde Cholangio Pancreatography, which has stuck. He brought ERCP back to England in 1971, and his first paper on the subject was published in January 1972.

In 1973 he was appointed to the faculty of the Middlesex Hospital and Medical School (London), where he worked closely with Surgical and Radiology colleagues to develop and evaluate the rapidly growing portfolio of endoscopic procedures. He initiated the first randomized controlled trials of laser therapy for bleeding, and other trials comparing endoscopic, radiologic and surgical approaches to biliary obstruction. There was strong emphasis on teaching, which attracted postgraduates from all over the world. He pioneered live endoscopy teaching workshops in 1975, and opened a video-conferencing center in 1982. With colleagues in London he developed the first computer-based endoscopy reporting system, and maintains a strong interest in the slow march towards paperless GI and endoscopic practice

Dr. Cotton left England in 1986 to become Professor of Medicine and Chief of Endoscopy at Duke University in North Carolina. He developed a state of the art endoscopy center. He maintained his interests in teaching (mainly through live video courses), new techniques, and careful outcome evaluation. He moved to Charleston, South Carolina in 1994 to initiate the Digestive Disease Center.

The mission of the Digestive Disease Center is to provide multidisciplinary patient-friendly, cost-effective patient care, and to pursue the research and teaching necessary to enhance it. Approximately 40 full-time faculty from Gastroenterology, Surgery, Radiology, Oncology and other specialties work together. Dr Cotton has maintained his enthusiasm for teaching postgraduates, especially in ERCP, and many from overseas. He continues to practice consultative gastroenterology, focusing on pancreatic and biliary problems, and personally performs about 400 complex ERCP procedures each year.

Dr. Cotton has been active in many National and International organizations, and has given invited lectures and demonstrations in almost 50 countries. He helped to form the British Society for Digestive Endoscopy, became its President, and served the British Society of Gastroenterology as its vice president and treasurer. He was secretary of the European Society for Gastrointestinal Endoscopy, and president of the Pancreatic Society of Great Britain. He was elected Fellow of the Royal College of Physicians (London) in 1978, Fellow of the Royal College of Physicians and Surgeons (Glasgow) in 1997, and Fellow of the Royal College of Surgeons (London) in 2002. He has honorary memberships of the British Society of Gastroenterology, the Hong Kong Society for Digestive Endoscopy, and the South African Gastroenterology Society.

His long association with ASGE began in 1974 when he was invited to give the Roche keynote lecture at DDW. He and his group have made innumerable original presentations at ASGE, and participated as faculty in many postgraduate courses. He was given the 2004 ASGE Rudolph Schindler award for services to Endoscopy.

He has been on the editorial boards of 12 gastroenterology and endoscopy journals, and was the first international editor of Gastrointestinal Endoscopy. His bibliography includes more than 800 publications, including 232 original contributions in peer reviewed journals. He has not been shy to express strong opinions in many editorials. His book, “Practical Gastrointestinal Endoscopy” (co-authored with Christopher Williams ) is a well-known teaching text. Now in its 5th Edition, (with CDRoms), it has been translated into 7 languages. He is involved with the educational website, where he has recently edited an innovative new ebook/annual on Advanced Digestive Endoscopy.

Peter and Marion Cotton live happily in Mount Pleasant and on Dewees Island, South Carolina. Between them in the UK and US they are blessed with 4 grown children and 4 grandchildren. They enjoy family, friends, travel, wildlife and golf.

What made you decide to become a gastroenterologist?
Serendepity. I was destined for Pediatrics when I saw an advertisement for a Medical Registrar (training) position at my alma mater (St. Thomas' Hospital, London) to work with Dr. Brian Creamer. This was General Medicine training, but Brian also had a particular interest in Gastroenterology. More important, he was one of the few faculty members who did any active teaching when I was a medical student at St. Thomas'. He made things seem simple, straightforward and fun. The simple part was particularly attractive, since I had difficulty with exams. Gastroenterology had very few facts attached to it at the time, and there seemed little need to memorize anatomy or understand electrolytes. Furthermore, the practice of gastroenterology was splendidly relaxed, without any on-call or emergency duties - since we were impotent therapeutically (things have changed since then!). I worked mainly on small intestinal lipids in the laboratory during this training with Brian. The only "hands on" interventions in Gastroenterology were liver biopsy and jejuna biopsy. There was a semi-flexible gastroscope in the laboratory, gathering dust. Brian referred to gastroscopy as a useless exercise, only for voyeurs. He affirmed that it might become relevant if an instrument were to be developed with biopsy capability (see later).
Which research paper influenced you the most?
During my training with Brian Creamer, I noted a short paper by people working with Sidney Truelove in Oxford in the British Medical Journal describing the first Olympus side-viewing gastroscope with a biopsy capability. Brian had the vision to encourage a surgical partner and I to get such an instrument. We started using it, without actually ever seeing an endoscopy performed! Very soon it became obvious that the endoscope was a valuable clinical tool, and I seemed to enjoy its use far more than thin-layer chromatography. The development, teaching and evaluation of endoscopic procedures has subsequently provided me with a successful and fun career.
What is the most important fact that you have discovered?
Tough question, both at work and in life. I am a little short on scientific breakthroughs, but I have discovered some well-known truths - not least that friends are more important than possessions, feelings more important than facts, and that there is no substitute for discipline and dedication. "Every thing cometh to he who waiteth, so long as he who waiteth worketh like hell while he waiteth."
What is the biggest mistake that you have made?
Also a tough question - and getting a little personal. Fifteen years after leaving England (with absolutely never any second thoughts about that decision), I do regret not having tried harder to publicize and change the deficiencies in the British Health Service while I was there, not least the destructive effect that private practice has on all academic endeavors. Another regret is not having had the discipline to document my clinical and endoscopic experience more carefully, so as to be able to analyze results and prevent perpetuating therapeutic naivety.
How do you relax?
My relaxation center was destroyed by the British School System, which equates enjoyment with sin. I do like to play golf, but that is more frustrating than most activities, and fishing is even worse.
What is your best place in the world?
After lecturing in 47 countries, the answer is crystal clear - my home in Charleston, SC.
What are your favorite films?
"Shirley Valentine", and "A Fish called Wanda".
What car do you drive?
An aging Chrysler La Baron convertible.
What is your best electronic 'toy'?
A Handspring Visor Palm Pilot.
What book are you reading at the moment?
"The Greatest Player who Never Lived" by J. M. Veron.
Why did you get in involved in
The Internet has enormous potential for collaborative educational networking and clinical research. The experience and resources of Blackwell Science, and the star-studded team which has been assembled, has every chance of becoming one of the premier resources in gastroenterology, hepatology and endoscopy. Christopher Williams and I are determined that our successful book "Practical Gastrointestinal Endoscopy" will be reborn in a much more useful "virtual" format under the umbrella, with all sorts of multimedia fun. The integration of Internet publishing, computers and endoscopy provides an incredible platform for future endoscopic developments, teaching and collaboration.

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Roy Pounder (London)


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