Dellaportas D, Margaris I, Charalampous CM, Gkiafi Z, Pikouli A, Myoteri D, Pararas N, Lykoudis PM, Nastos C, Pikoulis E. Intraoperative endoscopy: A controversial tool or a necessity in modern esophagogastric surgery? World J Gastrointest Surg 2025; 17(12): 111262 [DOI: 10.4240/wjgs.v17.i12.111262]
Corresponding Author of This Article
Panagis M Lykoudis, MD, PhD, 4th Department of Surgery, University Hospital “Attikon”, School of Medicine, National and Kapodistrian University of Athens, 1 Rimini Street, Athens 12462, Attikí, Greece. p.lykoudis@ucl.ac.uk
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Surgery
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Minireviews
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Dec 27, 2025 (publication date) through Dec 25, 2025
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World Journal of Gastrointestinal Surgery
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1948-9366
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Dellaportas D, Margaris I, Charalampous CM, Gkiafi Z, Pikouli A, Myoteri D, Pararas N, Lykoudis PM, Nastos C, Pikoulis E. Intraoperative endoscopy: A controversial tool or a necessity in modern esophagogastric surgery? World J Gastrointest Surg 2025; 17(12): 111262 [DOI: 10.4240/wjgs.v17.i12.111262]
World J Gastrointest Surg. Dec 27, 2025; 17(12): 111262 Published online Dec 27, 2025. doi: 10.4240/wjgs.v17.i12.111262
Intraoperative endoscopy: A controversial tool or a necessity in modern esophagogastric surgery?
Dionysios Dellaportas, Ioannis Margaris, Charalampos M Charalampous, Zoi Gkiafi, Anastasia Pikouli, Despoina Myoteri, Nikolaos Pararas, Panagis M Lykoudis, Constantinos Nastos, Emmanuel Pikoulis
Dionysios Dellaportas, Anastasia Pikouli, Nikolaos Pararas, Constantinos Nastos, Emmanuel Pikoulis, 3rd Department of Surgery, University Hospital “Attikon”, School of Medicine, National and Kapodistrian University of Athens, Athens 12462, Attikí, Greece
Ioannis Margaris, Charalampos M Charalampous, Zoi Gkiafi, Panagis M Lykoudis, 4th Department of Surgery, University Hospital “Attikon”, School of Medicine, National and Kapodistrian University of Athens, Athens 12462, Attikí, Greece
Despoina Myoteri, Department of Pathology, Aretaieion University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens 11528, Attikí, Greece
Panagis M Lykoudis, Division of Surgery and Interventional Science, University College London, London WC1E 6BT, United Kingdom
Author contributions: Dellaportas D, Pikouli A, Myoteri D, Pararas N, Lykoudis PM, Nastos C and Pikoulis E made critical revisions related to important intellectual content of the manuscript; Dellaportas D, Lykoudis PM, and Pikoulis E conceptualized and designed the study; Margaris I, Charalampous CM and Gkiafi Z conducted the literature review, acquired the data and drafted the article; Pikouli A and Myoteri D did the interpretation of data; Pararas N and Nastos C did the analysis of data. All authors have read and approved the final manuscript for publication.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Panagis M Lykoudis, MD, PhD, 4th Department of Surgery, University Hospital “Attikon”, School of Medicine, National and Kapodistrian University of Athens, 1 Rimini Street, Athens 12462, Attikí, Greece. p.lykoudis@ucl.ac.uk
Received: June 26, 2025 Revised: July 22, 2025 Accepted: October 11, 2025 Published online: December 27, 2025 Processing time: 181 Days and 10.5 Hours
Abstract
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.
Core Tip: Endoscopy is indispensable for the evaluation of foregut conditions, supporting the formulation of a tailored plan for each surgical candidate. It provides live detailed visualization of tumor margins while it also enhances staging accuracy and risk stratification. Moreover, its utility in the management of postoperative complications in the hands of the operating surgeon is of paramount importance. Fellowships in upper gastrointestinal surgery underline the role of intraoperative endoscopy and scientific surgical societies are in alignment with the above views.
