Laparoscopy has been used in clinical practice for a century, and has developed rapidly especially in the last two decades, and now covers basically all abdominal procedures except liver transplantation. At the same time, gastrointestinal endoscopy, which shares a common origin with laparoscopy, has also made great progress in terms of instrumentation accessories and operating techniques, achieving milestones in the diagnosis and treatment of many tubulointerstitial diseases. Although gastrointestinal endoscopy allows unobstructed access to the natural lumen of the body for examination and treatment, lesions located deep in the luminal wall and on the surface are still helpless or even difficult to detect. In recent years, more and more gastroenterologists (some of whom are also gastrointestinal endoscopists) are trying to use laparoscopy in the diagnosis and treatment of gastrointestinal diseases, and the combination of laparoscopy and gastrointestinal endoscopy can be more effective in minimally invasive treatment. This paper reviews the progress of laparoscopy in the diagnosis and treatment of gastroenterology. 1, the diagnostic value of laparoscopy for gastrointestinal diseases 1, unexplained chronic abdominal pain: chronic abdominal pain is one of the most common complaints in gastroenterology, often caused by abdominal adhesions, tumors, chronic appendicitis, pelvic inflammatory disease. Because of its diverse and insidious etiology, some patients cannot be diagnosed after a series of routine examinations, which has become a major problem that has long troubled internal medicine physicians. Fever is incorporated into the concept. In recent years, with the continuous development of serology, imaging and non-invasive techniques of microbiological culture, most patients with unexplained fever can have a definite etiology. However, some patients still need to perform further invasive tests to clarify the etiology, such as direct laparoscopic biopsy, which is of great significance for definitive diagnosis. In patients with fever as the main manifestation, accompanied by abdominal symptoms or signs, the cause cannot be clarified by various imaging, blood biochemistry, tumor markers, pathological biopsy, etc., laparoscopy can help diagnose with high safety. 3, ascites: ascites is one of the common clinical signs of gastroenterology, usually caused by cirrhosis, tuberculosis, tumors and other diseases, some ascites can be clearly diagnosed by medical history, imaging, ascites routine and exfoliative cytology, etc., but some difficult ascites through the above examination still can not be clearly diagnosed, laparoscopic exploration can provide a very effective invasive examination of such patients to confirm the diagnosis ā laparoscopy can find the diameter of the lesion Lesions of 1 to 2 mm in diameter can be detected by laparoscopy, and pathologic biopsies of suspicious tissues can be taken under direct vision to increase the rate of positive pathologic biopsies, which can effectively diagnose difficult ascites. Tuberculous peritonitis is one of the etiologies of difficult ascites, and because of the difficulty in diagnosing this disease, diagnostic anti-tuberculosis treatment is often taken, with regression of ascites and reduction of abdominal pain symptoms as an important basis for retrospective diagnosis of tuberculous peritonitis. However, several studies have also pointed out that because laparoscopic exploration may lead to risks such as bleeding and infection, the indications need to be strictly controlled, especially for elderly patients with comorbidities, and non-invasive examination should be performed as much as possible. showed that secondary infection necrosis and multiple organ dysfunction syndrome are the most important causes of death in acute pancreatitis. Early removal of necrotic infected tissues and adequate drainage of abdominal exudate can effectively block the stepwise amplification of inflammation, reduce the occurrence of serious complications such as systemic inflammatory response and MDDS, and reduce mortality.Tu et al. found that heart rate, respiration, body temperature, and white blood cell count of patients with severe acute pancreatitis significantly improved compared with those before surgery 48 h after laparoscopic debridement and drainage.Tan et al. performed a retrospective study of 76 patients with confirmed infected necrotizing In a retrospective analysis of 76 patients with confirmed infected necrotizing pancreatitis, Tan et al. found that blood loss, postoperative complications, and average hospital stay were significantly reduced in the laparoscopic debridement and drainage group compared with the open surgery group, and early laparoscopic surgery in the pancreatitis group significantly reduced the operative time, blood loss, and intermediate open rate, suggesting that laparoscopic debridement and drainage is a more effective minimally invasive treatment compared with traditional open surgery. At present, the laparoscopic debridement and drainage treatment for severe acute pancreatitis has various procedures, which can be divided into classical laparoscopic access, posterior access laparoscopic surgery, radiation-guided laparoscopic surgery, etc. 2, gastroesophageal reflux disease (GERD): GERD has various clinical manifestations, such as heartburn, acid reflux, chest pain, asthma, etc. Its drug treatment course is long, the symptoms are easy to recur, and some refractory GERD drugs are not effective. In recent years, laparoscopy has gradually been used for the treatment of some patients with confirmed GERD, and it is highly favored because of its minimally invasive, safe and effective features. Anvari et al. randomly divided 180 GERD patients into two groups, treated with laparoscopic surgery and PPI, respectively, and evaluated the efficacy of GERD symptom scale, visual analog scale, and 24-h esophageal pH monitoring after 3 years of treatment, which showed that the efficacy of treatment was similar in both groups, but better symptom control and quality of life were obtained in the laparoscopic treatment group. GERD patients, all treated with laparoscopic fundoplication and esomeprazole for 3 months. By evaluating the follow-up assessment of symptom relief and complications in patients during the 3-month esomeprazole pharmacological cleansing period after the folding procedure, it was found that both esophageal and extraesophageal symptoms were significantly relieved in patients after treatment, while the incidence of dysphagia and flatulence increased in patients after laparoscopic surgery during the pharmacological cleansing period, but did not exceed baseline levels. It is suggested that laparoscopic GERD surgery is one of the effective treatments for GERD, but the complications after laparoscopy should be paid attention to. 3. Combined treatment: As gastroenterologists become more proficient in endoscopic techniques, some minimally invasive endoscopic procedures are gradually carried out and becoming more mature, such as endoscopic giant polyp removal, endoscopic submucosal dissection (ESD), endoscopic submucosal excision (ESE), endoscopic total resection (EFR), transoral endoscopic myotomy (POEM) and so on. These minimally invasive techniques avoid the physical trauma and economic burden associated with traditional open surgery, but their application is somewhat limited due to certain risks. The combination of endoscopy and laparoscopy can give full play to their respective advantages and greatly expand the scope of application of minimally invasive treatment At present, the combination of dual-scope treatment is roughly divided into three categories: ① endoscopic surgery assisted by laparoscopy, i.e. endoscopic treatment under laparoscopic monitoring, which is applicable to the initial stage of endoscopic surgery, can effectively reduce the operational difficulty and the risk of serious complications. ②Endoscopy-assisted laparoscopic surgery, i.e., lesion localization using endoscopy followed by laparoscopic surgery. ③Synchronous combined endoscopic resection and laparoscopic resection techniques are mainly applicable to huge and deeply located tumors, extra-cavity growth type tumors, and intracavity growth type tumors (special sites). ① Colon polyps with difficulty in conventional endoscopic resection: colon polyps with large diameter or special sites are more difficult to be resected by conventional colonoscopy and are prone to complications such as perforation and bleeding. In one study, 146 patients with colorectal polyps underwent combined laparoscopic and colonoscopic surgery, 82% of them underwent local resection, the rest underwent partial colectomy, and 5% underwent both procedures. The results showed that the intraoperative and postoperative complication rates were 1% and 3%, respectively. This suggests that combined bimicroscopy is an effective, safe, and minimally invasive procedure for patients with colon polyps that are difficult to be resected by conventional endoscopy, but should be limited to benign lesions. Kakeji et al. successfully performed laparoscopic resection with the aid of endoscopic localization in 18 patients with preoperative diagnosis of gastrointestinal mesenchymal tumor or suspected mesenchymal tumor with a tumor diameter of <5 cm, indicating that combined bimicroscopic resection is a minimally invasive method that can improve the cure rate of mesenchymal tumors. In conclusion, laparoscopy has the advantages of minimally invasive, direct observation of lesions, targeted biopsy, and dual efficacy in diagnosis and treatment, and has been recognized by most physicians and patients, especially in recent years when laparoscopy has played an increasingly important role in the diagnosis and treatment of gastrointestinal diseases.