Intraoperative endoscopy: A controversial tool or a necessity in modern esophagogastric surgery?

Upper gastrointestinal (UGI) endoscopy has become increasingly popular with the recent advancements in technology and the increase of minimally invasive techniques. UGI endoscopy is indicated for diagnostic, staging, and therapeutic purposes and significantly influences the management of patients with a spectrum of foregut diseases, including esophageal and gastric malignancies, achalasia, and gastroesophageal reflux disease. There is growing evidence that intraoperative UGI endoscopy can be a useful adjunct and a powerful tool to enhance tumor localization, offering a direct evaluation of the surgical reconstruction and identifying potential sources of postoperative complications. However, its widespread utilization has been limited by concerns over cost, accessibility, and sufficient training and expertise. The aim of the current study was to review and elaborate on the available literature while presenting our experience in an academic institution specializing in esophagogastric surgery with intraoperative UGI endoscopy. We focused on the indications, added benefits, and related complications.