Purpose: A prospective and retrospective work to study and evaluate the endoscopic role in management of G.I.T problems, in comparison to surgical one .

Patients & Methods: In the period from Mars 1995 to October 2015, a random sample of patients were enrolled from general surgery department, and gastro-intestinal endoscopy units in Sohag University Hospitals, and Assuit University Hospitals and managed accordingly using endoscopy and endoscopic therapeutic approaches that was feasible in these tertiary level centers, with available experienced teamwork of University staff, associated doctors, and assistants from graduates and nurses.

Results: Endoscopy was very successful as an initial treatment of all those cases as being less invasive, low morbidity and mortality, competitive to surgery in treatment many G.I.T problems as post cholecystectomy problems in which endoscopy was successful in treatment of missed stone (88%), mild to moderate biliary leakage (82%), and biliary stricture (74%). Its success increased by addition of percutaneous techniques in 4%, 2.8% & 8.3% for missed stone, leakage, and stricture respectively. But endoscopy was somewhat complementary to surgery in major leakage, and massive stricture, and surgery was resold to in 15%, and 17% of cases.

Surgery remain as the treatment of choice in complex problems, and endoscopy play a complementary role in such cases of transection, ligation, combined problems of stones, stricture, and leakage (< 40%), compared to 60% for surgery.

The learning curve seems influential in both endoscopy and surgery. The cumulative experience increase the success rate of endoscopy from initial 50% to 95% nowadays, also surgery improved with decreased morbidity and mortality as complications encountered was seen in initial experience and decreased with time.         

Conclusion: Endoscopy was competitive to surgery in simple problems and advised to be the initial treatment choice, but complementary in major leak, ligation, transection, and complex problems, where surgery plays the main role in treatment with its invasiveness, high morbidity and morbidity. Cumulative experience influence endoscopic and surgical treatment of such problems and it is mandatory with other facility and equipment for management of such challenging cases