Purpose: To assess the advantage of using intraoperative endoscopic guidance during sleeve gastrectomy   and its efficiency to decrease various complications.   Methods:  This was a retrospective study at Ain shams specialized hospital and Cure hospital. Patients who had sleeve gastrectomy with intra-operative endoscopic  guidance were included in this study.   Results: From September 2017 to February 2019, 226 patients had LSG as a definitive bariatric procedure. All the procedures were done with intra-operative endoscopic guidance. Seventy nine  percent were female with a mean age of 39.7±14 years (range 23–49 years) and a mean body mass index of 48.6±14 kg/m2 (range 41–59 kg/m2 ). Two cases showed intraoperative leak that was managed intraoperatively by over suturing and omental patch. One case showed mild twisting at the incisura angularies that was managed intraoperatively by fixing the twisted angle to the retroperitoneum. Marked internal bleeding from the staple line was seen in two cases; which necessitated endoscopic clip insertion in one case and epinephrine injection for the other. The average length of the hospital stay was 1.8 days post operatively. The post-operative  leakage was 0% and no cases had obstructive symptoms.   Conclusion: Sleeve gastrectomy surgery with endoscopic guidance is very important not only to calibrate the size of the gastric pouch instead of the bougie, but also to prevent various complications as gastric obstruction or bleeding or even fatal complications as gastric leak