Most malignancies of the gastrointestinal tract rise from intraluminal sources. Endoscopic evaluation for diagnosis and treatment of these disease processes is a very accurate and inexpensive method compared with non-endoscopic methods alone. Combined laparoscopic and flexible endoscopic techniques greatly facilitate laparoscopic treatment of a significant number of gastrointestinal tract malignancies that might otherwise require a conventional open approach. The theory of combining the procedures of laparoscopy and endoscopy to identify and treat malignant lesions of the gastrointestinal tract is described as well as the techniques, advantages, and problems encountered. At our institution, the combination of these two fields of technology has resulted in improved patient care with a low complication rate.