Globally, esophageal and gastric cancers are rapidly increasing and are the sixth most common cause of cancer-related deaths [1]. Surgery for these cancers, such as oesophagectomy or gastrectomy, remain an important component of the curative treatment pathway for patients [[2], [3], [4]]. Regardless of the surgical approach (i.e., open or minimally invasive), anastomotic leaks remain a devastating complication to patients and sadly common, up to 20 % of patients undergoing oesophagectomy and up to 10 % of patients undergoing gastrectomy [[5], [6], [7]].

Patients suffering from anastomotic leak are associated with prolonged length of stay in hospital, worse short and long-term health related quality of life, and greater in-hospital mortality. These patients are also associated with poor functional recovery and high risk of local recurrence, leading to evidence suggesting poor long-term survival [8]. Given these poor outcomes, there remains substantial research efforts into reducing the incidence and severity of anastomotic leaks [9]. This state of the art review delves into the intricacies of suspected anastomotic leaks, exploring the integration of endoscopic and surgical interventions in the broader context of the multi-modality management of these leaks.