Endoscopic drainage treatment of pancreatic pseudocysts.

BACKGROUND/AIMS: This study presents the experience of its authors with endoscopic drainage treatment of pancreatic pseudocysts. The first part of the study offers a literature overview of the basic knowledge of pancreatic pseudocysts. The authors gradually deal with the individual types of pancreatic pseudocysts, the clinical picture, complications and diagnostics. Within the bounds of differential diagnostics the authors stress mainly the necessity of differentiating pancreatic pseudocysts from cystic tumors and benign cysts. Special attention is dedicated to various modalities of pancreatic pseudocyst treatment. The second part of the study presents the authors' own results of the endoscopic drainage treatment of pancreatic pseudocysts. METHODOLOGY: Results of endoscopic drainage treatment of pancreatic pseudocysts, which is one of significant possibilities of treatment of these conditions, are presented. RESULTS: This method was used to treat 33 patients (24 men and 9 women) from September 2007 to March 2009. Endoscopic drainage of pancreatic pseudocysts was performed 4 times transduodenally a 29 times transgastrically, namely in 6 cases under endosonographic guidance and in 27 cases by a duodenoscope after endosonographic targeting. CONCLUSIONS: The authors conclude that endoscopic drainage is an effective method of pancreatic pseudocyst treatment.

Single balloon enteroscopy for endoscopic retrograde cholangiography in patients with Roux-en-Y hepaticojejuno anastomosis.

AIM: To evaluate single balloon enteroscopy in diagnostic and therapeutic endoscopic retrograde cholangiography (ERC) in patients with Roux-en-Y hepaticojejunoanastomosis (HJA). METHODS: The study took place from January 2009 to December 2011 and we retrospectively assessed 15 patients with Roux-en-Y HJA who had signs of biliary obstruction. In total, 23 ERC procedures were performed in these patients and a single balloon videoenteroscope (Olympus SIF Q 180) was used in all of the cases. A transparent overtube was drawn over the videoenteroscope and it freely moved on the working part of the enteroscope. Its distal end was equipped with a silicone balloon that was inflated by air from an external pump at a pressure of ≤ 5.4 kPa. The technical limitations or rather the parameters of the single balloon enteroscope (working length - 200 cm, diameter of the working channel - 2.8 mm, absence of Albarran bridge) showed the need for special endoscopic instrumentation. RESULTS: Cannulation success was reached in diagnostic ERC in 12 of 15 patients. ERC findings were normal in 1 of 12 patients. ERC in the remaining 11 patients showed some pathological changes. One of these (cystic bile duct dilation) was subsequently resolved surgically. Endoscopic treatment was initialized in the remaining 10 patients (5 with HJA stenosis, 2 with choledocholithiasis, and 3 with both). This treatment was successful in 9 of 10 patients. The endoscopic therapeutic procedures included: balloon dilatation of HJA stenosis - 11 times (7 patients); choledocholitiasis extraction - five times (5 patients); biliary plastic stent placement - six times (4 patients); and removal of biliary stents placed by us - six times (4 patients). The mean time of performing a single ERC was 72 min. The longest procedure took 110 min and the shortest took 34 min. This shows that it is necessary to allow for more time in individual procedures. Furthermore, these procedures require the presence of an anesthesiologist. We did not observe any complications in these 15 patients. CONCLUSION: This method is more demanding than standard endoscopic retrograde cholangiopancreatography due to altered postsurgical anatomy. However, it is effective, safe, and widens the possibilities of resolving biliary pathology.

Unusual Multiorgan Immunoglobulin G4 (IgG4) Inflammation: Autoimmune Pancreatitis, Mikulicz Syndrome, and IgG4 Mastitis.

Autoimmune pancreatitis (AIP) type 1 is commonly associated with simultaneous involvement of extrapancreatic organs. Sclerosing cholangitis, sialadenitis, retroperitoneal fibrosis, Sjögren syndrome, and other extrapancreatic lesions are often observed concurrently with AIP. High levels of immunoglobulin G4 (IgG4) in the blood serum and affected tissues are typical of this diagnostic entity. We describe a case report of a 58-year-old female with findings of AIP (according to Asian criteria), IgG4-positive mastitis, and histologically verified Mikulicz syndrome. The effect of corticoid therapy supported the diagnosis of AIP and simultaneously led to the eradication of recurrent mastitis. To the best of our knowledge, this is the first reported case of concurrent findings of AIP and IgG4 mastitis. Our case report supports the concept of systemic IgG4 syndrome with multisystem involvement. Timely diagnosis and appropriate therapy can be effective in a high percentage of patients.

Endoscopic drainage treatment of pancreatic pseudocysts.

BACKGROUND/AIMS: This study presents the experience of its authors with endoscopic drainage treatment of pancreatic pseudocysts. The first part of the study offers a literature overview of the basic knowledge of pancreatic pseudocysts. The authors gradually deal with the individual types of pancreatic pseudocysts, the clinical picture, complications and diagnostics. Within the bounds of differential diagnostics the authors stress mainly the necessity of differentiating pancreatic pseudocysts from cystic tumors and benign cysts. Special attention is dedicated to various modalities of pancreatic pseudocyst treatment. The second part of the study presents the authors' own results of the endoscopic drainage treatment of pancreatic pseudocysts. METHODOLOGY: Results of endoscopic drainage treatment of pancreatic pseudocysts, which is one of significant possibilities of treatment of these conditions, are presented. RESULTS: This method was used to treat 33 patients (24 men and 9 women) from September 2007 to March 2009. Endoscopic drainage of pancreatic pseudocysts was performed four times transduodenally and 29 times transgastrically, of which 6 cases were under endosonographic guidance and 27 cases by a duodenoscopy after endosonographic targeting. CONCLUSIONS: The authors conclude that endoscopic drainage is an effective method of pancreatic pseudocyst treatment.

Hepatorenal syndrome.

Hepatorenal syndrome (HRS) is defined as a functional renal failure in patients with liver disease with portal hypertension and it constitutes the climax of systemic circulatory changes associated with portal hypertension. This term refers to a precisely specified syndrome featuring in particular morphologically intact kidneys, where regulatory mechanisms have minimised glomerular filtration and maximised tubular resorption and urine concentration, which ultimately results in uraemia. The syndrome occurs almost exclusively in patients with ascites. Type 1 HRS develops as a consequence of a severe reduction of effective circulating volume due to both an extreme splanchnic arterial vasodilatation and a reduction of cardiac output. Type 2 HRS is characterised by a stable or slowly progressive renal failure so that its main clinical consequence is not acute renal failure, but refractory ascites, and its impact on prognosis is less negative. Liver transplantation is the most appropriate therapeutic method, nevertheless, only a few patients can receive it. The most suitable "bridge treatments" or treatment for patients ineligible for a liver transplant include terlipressin plus albumin. Terlipressin is at an initial dose of 0.5-1 mg every 4 h by intravenous bolus to 3 mg every 4 h in cases when there is no response. Renal function recovery can be achieved in less than 50% of patients and a considerable decrease in renal function may reoccur even in patients who have been responding to therapy over the short term. Transjugular intrahepatic portosystemic shunt plays only a marginal role in the treatment of HRS.

Diagnosis and treatment of autoimmune hepatitis.

Autoimmune hepatitis (AIH) is a generally progressive, chronic liver disease of unknown etiology, relatively uncommon, associated with chronic hepatic inflammation. An environmental agent is hypothesized to trigger an immune-mediated attack directed against liver antigens in genetically predisposed individuals. The disease can lead to potentially fatal liver dysfunction. AIH is characterized by female predominance (sex ratio 3.6:1), hypergammaglobulinemia, circulating autoantibodies and association with human leukocyte antigens DR3 or DR4. The diagnosis of AIH is based on the revised descriptive criteria reported by the International Autoimmune Hepatitis Group in 1999. Without appropriate immunosuppressive therapy AIH has a very poor prognosis with 10-year survival rates as low as 10%, but usually very good response to immunosuppression, and survival rates of responders to the treatment are similar to those of healthy counterparts from the same population.

Immunoglobulin G4-related cholangitis: a variant of IgG4-related systemic disease.

IgG4-related sclerosing cholangitis as part of IgG4 systemic-related diseases is commonly associated with autoimmune pancreatitis. Major clinical manifestations of IgG4-related sclerosing diseases are apparent in the organs in which tissue fibrosis with obstructive phlebitis is pathologically induced. IgG4-related sclerosing cholangitis is included within the heterogeneous group of 'sclerosing cholangitis'. Sclerosing cholangitis may be associated with choledocholithiasis, infection or biliary malignancies. Sclerosing cholangitis of unknown etiology is called primary sclerosing cholangitis (PSC). Conservative therapy of PSC is usually unsuccessful, the disease involves extra- and/or intrahepatic biliary tree, and the end point of this disease is liver cirrhosis. Typically, PSC is identified at the age of 30 to 40 years, and the disease is frequently associated with inflammatory bowel diseases. On the other hand, IgG4-related sclerosing cholangitis is not associated with inflammatory bowel diseases. In patients with IgG4-related sclerosing cholangitis, a first symptom can be obstructive jaundice, whereas obstructive jaundice is rarely present in PSC. Clinically, patients with IgG4-related sclerosing cholangitis are older at diagnosis compared to patients with PSC. A typical diagnostic feature of IgG4-related sclerosing cholangitis is elevation of serum immunoglobulin G4. In patients with IgG4-related sclerosing cholangitis, response to steroid therapy is high; in patients with PSC corticosteroid therapy is unsuccessful. Histochemically abundant infiltration of IgG4-positive plasma cells is detected in the biliary duct wall. Histologically, we can identify dense lymphoplasmacytic infiltration of the bile duct wall, transmural fibrosis, lymphoplasmacytic infiltration and fibrosis in the periportal area of the liver - a typically obliterative phlebitis. The biliary epithelium is usually intact in contrast to PSC, where mucosal erosion is often present. Steroids are the first-choice therapy of IgG4-related sclerosing cholangitis. In the literature, cholangiocarcinoma in patients with IgG4- related sclerosing cholangitis was not described, whereas cholangiocarcinoma develops in up to 10-30% of patients with PSC.

Probiotics in hepatology.

The paper provides a basic review of intestinal microflora and its importance in liver diseases. The intestinal microflora has many important functions, above all to maintain the microbial barrier against established as well as potential pathogens. Furthermore, it influences the motility and perfusion of the intestinal wall, stimulates the intestinal immune system and therefore also the so-called common mucosal immune system, reducing bacterial translocation and producing vitamins. Immune homeostasis at mucosal level results from a controlled response to intestinal luminal antigens. In liver cirrhosis, there are many changes in its function, mostly an increase in bacterial overgrowth and translocation. In this review, probiotics and their indications in hepatology are generally discussed. According to recent knowledge, these preparations are indicated in clinical practice only for cases of hepatic encephalopathy. Probiotics are able to decrease the permeability of the intestinal wall, and decrease bacterial translocation and endotoxemia in animal models as well as in clinical studies, which is extremely important in the prevention of complications of liver cirrhosis and infection after liver transplantation. Probiotics could limit oxidative and inflammatory liver damage and, in some situations, improve the histological state, and thus non-alcoholic steatohepatitis could be considered as another possible indication.

Endoscopic variceal band ligation compared with propranolol for prophylaxis of first variceal bleeding.

Administration of nonselective beta-blockers in prophylaxis of first variceal bleeding is not suitable for all patients. Thus, we evaluated endoscopic variceal band ligation (EVBL) in primary prevention of bleeding in patients with cirrhosis and large esophageal varices. A total of 73 consecutive patients with liver cirrhosis and large esophageal varices without a history of gastrointestinal bleeding were randomized to receive either EVBL or propranolol and were followed for up to 18 months. Forty patients underwent EVBL and 33 patients received propranolol. Variceal bleeding occurred in 2 patients in the EVBL (5%) and in 2 patients in the propranolol group (6%, NS). The 18 month actuarial risk for first variceal bleed was 5% in the EVBL (95% CI, 0-12%) and 20% in the propranolol group (95% CI, 0-49%, NS). The actuarial probability of death at 18 months of follow-up was 5% (95% CI, 0-11%) in the EVBL group and 7% (95% CI, 0-17%, NS) in the propranolol arm. In conclusion, EVBL was an effective and safe alternative to propranolol in primary prophylaxis of bleeding in patients with large esophageal varices.

Chronic liver diseases as liver tumor precursors.

Liver cancer is a major global health problem and hepatocellular carcinoma (HCC) accounts for 75% of all liver carcinoma. HCC occurs more often in men than in women and mostly in people 50 to 60 years old. The disease is more common in parts of sub-Saharan Africa and Asia than in North and South America and Europe. Nevertheless its incidence increased over the past 4 decades in some Western countries. Worldwide, liver carcinoma is the 5th most common cancer and 3rd most common cause of cancer mortality (behind only lung and colorectal cancer) with approximately 680,000 annual deaths. Unlike most of the other malignancies, HCC almost entirely develops in the context of inflammation and organ injury and is related to cirrhosis in about 85% of the cases. Among underlying etiologies of liver cirrhosis, most frequent are viral infection and toxic substances, mostly alcohol. The main HCC risk factor in Eastern Asia and Africa is hepatitis B virus infection. Hepatitis C virus infection is the main risk factor in Western countries. Hereditary hemochromatosis is not a very frequent cause of liver cirrhosis, but these patients are at higher risk for HCC compared with other etiologies of cirrhosis. Aflatoxins, cancer-causing substances made by a type of plant mold, can play a role in some countries in Asia and Africa, and can have a synergistic effect with hepatitis B infection.

Spontaneous bacterial peritonitis: a severe complication of liver cirrhosis.

This report presents a survey of current knowledge concerning one of the relatively frequent and severe complications of liver cirrhosis and associated ascites-spontaneous bacterial peritonitis. Epidemiology, aetiology, pathogenesis, clinical manifestation, diagnosis and present possibilities of treatment are discussed.

Double-blind randomized multicenter study comparing the efficacy and safety of 10-day to 5-day terlipressin treatment of bleeding esophageal varices.

BACKGROUND/AIMS: The aim of the study was to compare the efficacy and safety of 5-day terlipressin treatment of bleeding esophageal varices to 10-day treatment period. METHODOLOGY: Of 25 patients with variceal bleeding, 15 were randomized to receive terlipressin for day 1-5 and placebo for day 6-10 (Group A), and 10 to receive terlipressin for day 1-10 (Group B). RESULTS: The bleeding was stopped in 24 patients (96%). Rebleeding till day 42 was observed in 9 (36%) patients (5 in group A, 4 in group B, ns). 2 patients died in group B (due to rebleeding till day 5) and one in group A (rebleeding between day 5-10). Transfusion needs were lower in group B (2.7 +/- 2.6TU compared to 4.13 +/- 5.8 TU in group A, ns). Serious AE leading to treatment discontinuation were observed in 1 patient in group A (peripheral ischemia) and none in B, non-significant AE in 3 patients in group A (hypertension), and in 3 in group B (hypertension, hyponatremia, epiparoxysm). CONCLUSIONS: Prolonged treatment with terlipressin did not prove significant decrease of mortality or bleeding recurrence; lower rebleeding rate after day 5 and tendency towards lower transfusion requirements were observed. Prolonged treatment had no influence on AE rate.

Simultaneous electrochemical monitoring of metabolites related to the xanthine oxidase pathway using a grinded carbon electrode.

Using a mechanically grinded pyrolytic graphite electrode in edge orientation, a sensitive electrochemical method was developed for simultaneous determination of uric acid (UA), xanthine (XAN), hypoxanthine (HYP) (products of purine catabolism in human), allopurinol (ALO), and oxypurinol (OXY) (a drug used in treatment of purine catabolism disorders and its metabolite, respectively). It is demonstrated that differential pulse voltammetry in connection with this electrode can serve as a simple and efficient tool for monitoring transformation of purine catabolites (HYP --> XAN --> UA) catalyzed by xanthine oxidase (XO) as well as inhibition of this pathway by ALO being enzymatically converted to OXY. Our protocol is based on direct electrochemical measurement of oxidation peaks for each of the substances during in vitro reactions in a single detection step by the same electrode system. In addition, we show that the proposed electrochemical technique can be applied to parallel detection of metabolites involved in the XO pathway excreted in urine without any pretreatment of the clinical samples.

The effect of probiotics on gut flora, level of endotoxin and Child-Pugh score in cirrhotic patients: results of a double-blind randomized study.

OBJECTIVE: To determine the effect of Escherichia coli Nissle (Mutaflor, Ardeypharm GmbH, Herdecke, Germany) on the intestinal colonization, level of endotoxin and liver functions in patients with liver cirrhosis. METHODS: Thirty-nine patients with liver cirrhosis diagnosed by means of biopsy and clinical examinations were randomly allocated to treatment with E. coli Nissle or placebo for 42 days. Standard clinical examination, biochemical and hematological examinations, level of endotoxin and microbiological examination of the stool were performed before and after the treatment. RESULTS: In comparing the treatment of E. coli Nissle and placebo, significant improvement of the intestinal colonization (P<0.001) in the E. coli Nissle group was described. We found a trend of significant lowering of the endotoxemia (P=0.07) and improvement of liver functions evaluated by Child-Pugh score (P=0.06). CONCLUSION: E. coli Nissle seems to be effective in the restoration of normal colonic colonization and can probably lower endotoxemia in cirrhotic patients.

The efficacy of terlipressin in comparison with albumin in the prevention of circulatory changes after the paracentesis of tense ascites--a randomized multicentric study.

BACKGROUND/AIMS: Postparacentesis circulatory dysfunction is the most severe complication of ascites paracentesis. The aim of our study was to compare the standard treatment with the administration of a vasoconstrictor terlipressin. METHODOLOGY: Forty-nine patients treated by paracentesis due to tense ascites were randomized for the treatment with albumin (8g/L of removed ascites) or terlipressin (1 mg every four hours for 48 hours). The blood pressure, heart rate, diuresis, electrocardiograph, standard biochemical and hematological parameters, sodium, potassium and nitrogen urinary excretion, aldosterone and renin activity in the blood plasma were monitored for a period of 72 hours. RESULTS: In any parameter of hemodynamic changes, no statistically significant difference was demonstrated between randomized groups, in particular measurements as well as in the development in the course of the first three days after the intervention. The result suggests similar efficacy of the circulatory dysfunction prevention after the paracentesis in both treatment procedures. In both groups, on the first three days, there was a tendency to improve hemodynamics reflected by the renin-angiotensin-aldosteron system activity. In the terlipressin group, this tendency approached statistically significant levels. CONCLUSIONS: The administration of terlipressin in a dose of 1 mg every fourth hour performed for a period of 48 hours was as effective as intravenous albumin in preventing hemodynamic changes in patients with tense ascites treated by paracentesis. The treatment was well tolerated.

Factors participating in the development and mortality of variceal bleeding in portal hypertension--possible effects of the kidney damage and malnutrition.

BACKGROUND/AIMS: Acute bleeding from esophageal varices due to portal hypertension is a frequent and severe complication of liver cirrhosis. The development of esophageal varices as well as their rupture depends on the level of portal pressure; however, a number of other factors may play a negative role in the rise of bleeding and its prognosis. METHODOLOGY: The report presented has compared a set of 46 patients admitted to hospital for acute bleeding with 48 cirrhotics hospitalized for other reasons. RESULTS: Bleeding patients had significantly higher level of nitrogenous substances (urea 14.1 mmol/L vs. 7.78 mmol/L, p < 0.01, creatinine 129.8 micromol/L vs. 106.04 micromol/L; p = 0.09). The disturbed renal function in itself probably does not increase the risk of bleeding, it may be rather considered a certain prognostic index of the portal hypertension degree. Bleeding patients had a lower level of total protein (60.7 g/L vs. 69.9 g/L; p < 0.01) with only slight insignificant decrease of albumin (26.64 g/L vs. 28.51 g/L). Cirrhotic patients are known to suffer from malnutrition and it is possible that malnutrition shares negatively and directly in the rise of bleeding. CONCLUSIONS: A prognostic index of mortality was a more conspicuous disorder of hepatic function (bilirubin 97.4 micromol/L vs. 57.4 micromol/L; p = 0.1; prolonged prothrombin time 1.99 INR vs. 1.56 INR; p = 0.01) and again the disorder of renal function (creatinine 166.7 micromol/L vs. 114.9 micromol/L; p = 0.09). Therefore, the maintenance of good renal function must be a component of complex therapy given to bleeding patients.

Variceal bleeding in portal hypertension: bacterial infection and comparison of efficacy of intravenous and per-oral application of antibiotics--a randomized trial.

OBJECTIVE: To determine the prevalence of bacterial infection in patients admitted to hospital with variceal bleeding in comparison with patients with liver cirrhosis admitted because of another reason. To compare the effect of orally administered antibiotics vs. intravenous antibiotics. METHODS: Bacteriological investigation of blood culture, urine, throat smear, perianal smear and ascites (polymorphonuclear count as well in ascites) was made in 46 cirrhotic patients admitted to hospital with variceal bleeding and 48 cirrhotic patients admitted because of another reason. Bleeders were treated endoscopically (sclerotization) and pharmacologically (terlipressin 1 mg every 4 h for 5 days), and were randomly allocated to the treatment with oral norfloxacin (25 patients) or intravenous ampicillin/sulbactam (21 patients). Early and late mortalities were evaluated. RESULTS: The incidence of infection was high in both groups (63.0% bleeders vs. 54.2% controls), but bleeding patients more often had positive blood culture (17.3% vs. 8.6%) and statistically significantly more positive findings in the throat smears (36.9% vs. 17.3%, P=0.04), which gives the evidence of increased pathological colonization in these patients. No difference in survival was seen in patients with per-oral or intravenous administration of antibiotics. CONCLUSION: Bacterial infection was demonstrated in high percentage in patients with liver cirrhosis admitted to hospital. The administration of antibiotics is indicated in these patients. Intravenous application is probably of the same efficacy as per-oral one.

Recombinant urokinase is safe and effective in restoring patency to occluded central venous access devices: a multiple-center, international trial.

BACKGROUND: The treatment of choice for central venous access device (CVAD) occlusion is intracatheter thrombolysis, which has been reported to reestablish patency in up to 80% of cases. However, these salient results have only been achieved in highly selected CVAD subgroups such as nontunneled devices in adult patients, devices with recent occlusion, and in partially occluded devices through which fluid can still be infused (withdrawal occlusions). Less is known about the success of intracatheter thrombolysis in the broader range of CVAD malfunction encountered in clinical practice, especially in those devices that are totally occluded. OBJECTIVE: This multiple-center, open-label study was performed to test the hypothesis that a new recombinant urokinase (r-UK, urokinase alfa) is safe and effective in reestablishing patency in a large unselected cohort of occluded CVADs. METHODS: Pediatric and adult patients with any type of CVAD occlusion of any duration were treated with 5000 IU/mL intracatheter r-UK. Lumen patency was assessed after 5, 15, and 30 mins; a second dose of r-UK was instilled if the catheter remained occluded after 30 mins. RESULTS: A total of 903 r-UK instillations were performed in 878 patients (age range, 16 days to 96 yrs). Overall, instillation of r-UK successfully restored total catheter patency (all treated lumens) to 75% of CVADs (681 of 902). Patency was restored to at least one occluded lumen in 79% of devices (712 of 902). Patency was restored equally in catheters with total occlusion (76%) as in catheters with only withdrawal occlusion (75%). The median +/- sd time to patency was 15 +/- 20.8 mins (range, 5-203 mins). CONCLUSION: The use of a new r-UK, 5000 IU/mL, is safe and effective for the restoration of patency to occluded CVADs.

Management of acute variceal bleeding.

Portal hypertension as a consequence of liver cirrhosis is responsible for its most common complications: ascites, spontaneous bacterial peritonitis, hepatorenal syndrome, hepatic encephalopathy and the most important one--variceal hemorrhage. Variceal bleeding results in considerable morbidity and mortality. This review covers all areas of importance in the therapy of acute variceal hemorrhage--endoscopic and pharmacological treatment, transjugular intrahepatic portosystemic shunt, surgery and balloon tamponade. Indications and limitations of these therapeutic modalities are widely discussed.

Intestinal obstruction and perforation--the role of the gastroenterologist.

Intestinal obstruction belongs to highly severe conditions in gastroenterology, namely from the viewpoint of quick and correct diagnosis as well as at determining rational and effective therapy. Etiological multifactorial characteristics leading to processes resulting in mechanical or dynamic obstruction of the intestine, often referred to as paralytic ileus, are undoubtedly serious factors influencing the accuracy of diagnosis and therapeutic approach. Digestive endoscopy is a mandatory method in the diagnosis of intestinal obstructions. Diagnostic endoscopy, colonoscopy in the involvement of the large intestine or enteroscopy in the case of incomplete obstruction of the small intestine are the methods indicated in the majority of obstructive intestinal lesions. Besides their diagnostic importance, they also enable an effective therapeutic approach which may immediately follow the diagnostic intervention. Besides endoscopy that--due to the nature of performance--belongs to invasive methods, the diagnosis of obstructive intestinal processes is unthinkable without the use of non-invasive imaging methods. Abdominal ultrasound examination, a widely applied method, provides--under optimal examination conditions--information, e.g., about the width of the intestinal lumen or about the intestinal wall thickness; however, the specificity of investigation is not always sufficient. Both specificity and sensitivity of exploration are increased by a plain X-ray of the abdomen supplementing the ultrasound examination. Better results are achieved when the abdominal cavity is inspected by means of spiral CT examination that is nowadays not fashionable but highly effectively applied in the modification of the so-called CT enteroclysis or CT colonography. The usage of magnetic resonance (e.g. virtual colonography) is similar, but its efficacy is lower than that of CT examination. From a gastroenterologist's perspective, endoscopic examination is the fundamental diagnostic and therapeutic method. However, endoscopic examination is initially limited by the cardiopulmonary state of the patient--in a number of cases, first the cardiopulmonary condition must be stabilized, dysbalance of water and mineral state must be restored, and only then can endoscopic investigation be carried out. The application of enteroscopy in small intestine disorders is only suitable in cases where air must be aspirated from the region of the stomach and mainly small intestine as it happens, for example, in acute intestinal pseudo-obstruction. The success of complex conservative therapy in these states is reached in 80% of the cases. In acute and complete intestinal obstruction, a surgical treatment performed in time is the only method. In these cases, the importance of identification of obstruction and timing of the intervention performance from the viewpoint of the patient's survival is explicitly the principal and life-saving concern. In acute intestinal obstructions developing in patients with malignant affection of the intestine, it is necessary to choose--according to the obstruction location and general state of the patient--either urgently performed surgery or palliative endoscopic intervention which is the reduction of the intestinal lumen of the growing tumor mass and following insertion of a drain. This method also concerns lesions localized in the left half of the abdominal cavity, i.e. in the region of the rectosigmoid and descending part of the colon. Most patients in whom acute intestinal obstruction developed on the basis of malignant disease are risk and polymorbid subjects, and acute surgical intervention may be either impracticable or highly stressing. In such cases it is therefore helpful to insert a drain and to bridge the obstructed area after restoring the cardiopulmonary state including adjustment of the aqueous and mineral environment. Later, the performance of an elective surgical intervention is safer. Another alternative before inserting a drain is the dilatation of the stenotic site by means of a balloon, followed by stenting. Up until today, various types of intestinal drains have been introduced--they have always been self-expanding metallic stents. Just the application of self-expanding stents in patients with malignant intestinal obstruction and the endoscopic possibility of dilatations of benign intestinal obstructions with dilatation balloons are the most significant therapeutic contributions of digestive endoscopy in these states.