Endoscopy plays an important role in the diagnosis and treatment of digestive diseases. The benefits are maximized when procedures are performed at an optimal level of quality. Technical failures and adverse events are more likely to occur when procedures are performed by inexperienced endoscopists. Professional organizations and manufacturing industry which support and represent endoscopy, and their leaders, have increasingly embraced the quality improvement paradigm that is advancing through medicine. We all need to agree on the metrics of endoscopic performance, to develop the infrastructure to collect and analyze the data, and to use the resulting knowledge to stimulate improvements in practice and benefit the patients.