Introduction: Intraoperative esophagogastroduodenoscopy (IOG) is a diagnostic and therapeutic method for a variety of special conditions in upper gastrointestinal (UGI) pathology. The indication remains individual due to insufficient evidence and limited training of surgeons in digestive endoscopy.
Aim: To evaluate the indications, benefits and risks of IOG.
Material and methods: A single-center retrospective study of 110 consecutive IOGs in 104 patients was performed. The preoperative plan, the timing of IOG, preoperative evaluation, intraoperative finding, localization of the pathology, type of the procedure, change of expected therapy and complications were assessed.
Results: The cohort comprised 29 esophageal tumors, 5 tumors of the cardia, 36 gastric tumors, gastrointestinal bleeding (8), esophageal diverticula (3), perforations (3), GERD (5), mediastinal pathology (3), fistula (4), assessment of nutrition (10), duodenal adenoma (2), ulcer disease, esophageal stenosis and gastric volvulus. The indication for IOG was established preoperatively in 79% and intraoperatively in 21%. The lesion was localized in 96.4%. The therapy was altered to a wider resection (11), smaller resection (5), localization and surgical therapy of bleeding (8) or allowed minimally invasive surgery (25). A total of 3 postoperative complications included gastric perforation and positivity of resection line (following EMR/ESD) and recurrent bleeding. The 30-day mortality reached 3.6% without a specific cause in IOG.
Conclusions: The IOG is a complementary method in the diagnosis and treatment of UGI pathology. It enables minimally invasive finalization of the procedures and individualization of the therapy.
Keywords: gastric and esophageal tumors; intraoperative upper endoscopy; laparoscopic endoscopic cooperative surgery.
Pretherapeutic evaluation of patients with upper gastrointestinal tract cancer using endoscopic and laparoscopic ultrasonography.Dan Med J. 2012 Dec;59(12):B4568. Dan Med J. 2012. PMID: 23290296 Review.
A study of the safety and clinical efficacy of esophagogastroduodenoscopy after esophageal, gastric, or duodenal surgery in 60 patients.Am J Gastroenterol. 1995 Aug;90(8):1268-72. Am J Gastroenterol. 1995. PMID: 7639228 Clinical Trial.
Endoscopic submucosal dissection for foregut neuroendocrine tumors: an initial study.World J Gastroenterol. 2012 Oct 28;18(40):5799-806. doi: 10.3748/wjg.v18.i40.5799. World J Gastroenterol. 2012. PMID: 23155323 Free PMC article.
Cooperative laparoscopic endoscopic and hybrid laparoscopic surgery for upper gastrointestinal tumors: Current status.World J Gastroenterol. 2015 Nov 21;21(43):12482-97. doi: 10.3748/wjg.v21.i43.12482. World J Gastroenterol. 2015. PMID: 26604655 Free PMC article. Review.
The society for gastrointestinal intervention. Are we, as an organization of disparate disciplines, cooperative or competitive?Gut Liver. 2010 Sep;4 Suppl 1(Suppl 1):S1-8. doi: 10.5009/gnl.2010.4.S1.S1. Epub 2010 Sep 10. Gut Liver. 2010. PMID: 21103287 Free PMC article.
- Davenport KP, Mollen KP, Rothenberg SS, et al. Experience with endoscopy and endoscopy-assisted management of pediatric surgical problems: results and lessons. Dis Esophagus. 2013;26:37–43. - PubMed
- Mittendorf EA, Brandt CP. Utility of intraoperative endoscopy: implications for surgical education. Surg Endosc. 2002;16:703–6. - PubMed
- Beger HG, Schwarz A, Bergmann U. Progress in gastrointestinal tract surgery: the impact of gastrointestinal endoscopy. Surg Endosc. 2003;17:342–50. - PubMed
- Hazey JW, Dunkin BJ, Melvin WS. Changing attitudes toward endolumenal therapy. Surg Endosc. 2007;21:445–8. - PubMed
- Luigiano C, Ferrera F, Morace C, et al. Endoscopic tattooing of gastrointestinal and pancreatic lesions. Adv Ther. 2012;29:864–73. - PubMed