Intraoperative gastroscopy in diagnosis and treatment of tumors of the upper gastrointestinal tract

Introduction: Intraoperative gastroscopy (IOG) and surgery with endoscopic assistance is a selectively used method in diagnosis and treatment of the upper gastrointestinal tract tumors. Our aim is to enlighten the possible advantages and limitations and to set possible indications of the IOG.

Methods: Evaluation of 65 consecutive IOG in 61 patients with upper gastrointestinal tract tumor including early (3) and advanced (5) esophageal cancer, intramural esophageal (15) and gastric (12) tumors, tumors of the cardia (3), polyps (4), early cancer (8) and advanced gastric cancer (5), duodenal adenoma (1), unclear stomach resistance (2) and postoperative gastrointestinal tract bleeding (3). Evaluation included pre- and postoperative diagnosis, strategy of IOG, new findings, endoscopic and surgical therapy and complications.

Results: The endoscopy started preoperatively in 52 (78%) and peroperatively in 13 cases (22%) respectively. This resulted in a sole endoscopy in 16 cases including interventional endoscopic therapy. Lesion was localised in 64 cases, localisation failed in1case. Based on IOE, the type of surgery was generally changed in 2 cases (esophagectomy to gastrectomy), to a wider resection (5) and smaller resection (2). Conversion to open surgery was in 5 cases, minimaly invasive approach was used in 21 cases. During the surgical therapy of bleeding, endoscopy was indicated in 3 patients. No specific intraoperative complications of the endoscopy were observed, postoperatively 1 perforation after endoscopic submucosal dissection and 1 recurrence of the bleeding were observed. 30 day mortality was 0%.

Conclusion: Despite a heterogenic cohort of patients, we distinguish IOE as a meaningful complementary method in interventional treatment of upper gastrointestinal tract tumors. It enables minimally invasive and targeted therapy with individualization of treatment in selected patients. IOE expects a wide cooperation between surgeon and endoscopist and is demanding on technical skills. Further systematic studies are necessary.

No conflict of interest.