Impact of flexible endoscopy in the evaluation of digestive anastomosis

Flexible endoscopy plays a fundamental role in the clinical monitoring of surgical digestive anastomosis. Endoscopic examination is essential for the recognition and for the description of the type of anastomosis (end to end, end to side, side to side), providing both an accurate evaluation of the new digestive anatomy and the early detection of any postsurgical complications or recurrence. Close monitoring of the surgically treated disease, both neoplastic and nonneoplastic, can be realized by an accurate and scheduled follow-up which should consider all the imaging modalities nowadays available in the clinical practice, such as radiology and endoscopic ultrasonography. On the other hand, prompt detection of any pathologic pattern of the anastomosis (stenosis, dehiscence, fistula, recurrence) is the key factor for the choice of any further and appropriate treatment. Our chapter is aimed at defining the key factors of an accurate endoscopic evaluation of surgical anastomosis and at discussing the clinical criteria for an accurate follow-up.