Drs Riley and Attwood are to be commended for their recent publication (Gut 2004;53:1–6i). We have difficulty with one recommendation related to dilatation. Under 6.1, it is stated that during oesophageal dilatation the endoscopist should be supported by at least two endoscopy assistants. We agree that this certainly is desirable when complicated strictures are dilated or if one is dealing with an achalasia patient.

However, for dilatation of Schatzki’s rings or simple peptic strictures, one endoscopy assistant generally is sufficient. At our institution, over the years numerous dilatations have been done with only one assistant and without any adverse consequences.

As written, your guidelines seem to indicate that the standard of care would be to have two endoscopy assistants present and I think this is both unrealistic and unwarranted.