Previous authors have questioned the value of an "open-access" upper gastrointestinal endoscopy service, its increased usage and its low useful diagnostic yield. We have analysed the results of 8270 consecutive endoscopies that were performed in one private outpatient gastrointestinal clinic from 1977 to 1984. Of these, 1409 endoscopies were performed as part of an open-access service for referring doctors. The remainder were performed after referral for a gastrointestinal consultation. No deaths or major complications occurred in either group. A steady increase in referrals to both groups was noted over the years, with an increasing proportion of normal results. A positive endoscopic finding was found significantly more frequently in the open-access group (61%) compared with those patients that were referred for a gastrointestinal consultation (52.6%). Individual endoscopists varied significantly in their tendency to report mucosal inflammatory lesions. We believe that outpatient open-access endoscopy that is performed by experienced clinicians with trained staff and appropriate facilities is a safe and acceptable alternative to barium meal examinations.