Introduction: The covered metal stents were first used for malignant oesophageal stenosis. Since 2007 we have used it 15 times for treatment of oesophageal perforations and post-operative leaks. Methods and patients: When the perforation or leakage was recognised the decision on the ways of therapy was done after consultation with an oesophageal surgeon. The optimal size of retrievable covered metal stent was calculated individually. The stenting was supplemented in most cases with drainage, and with antibiotic treatment in an intensive care unit. The timing of stent removal (in most cases 6 – 10 weeks) was after individual consideration. The indications for stenting were: iatrogenic perforation in corrosive stenosis in 4 cases; Boerhaave's syndrome in 2 cases; postoperative leakage in 6 cases; oesophagus defect after thyroid surgery in 1 case and thoracic empyema with oesophageal fistula in 2 cases. Results: The oesophageal defect was sailed in all 15 cases. One patient died as a result of a non-related disease – severe lung destruction and aspergillosis. Twelve oesophagus defects were healed from 14 patients. In one case, with operated Boerhaave's syndrome, the inveterate fistula persisted. In another case, the septic patient with Boerhaave's syndrome was treated with drains and late stenting. After medical stabilization two (residual) mediastinal abscesses were left; they were not drained by the referring hospital despite our request. After removing the stent we observed 2 fistulae. After subtotal oesophagectomy substernal a gastric tube bypass was performed. Conclusion: Early stenting and drainage is a safe, effective and less invasive treatment of oesophageal perforation and leakage with low mortality.

Introduction: The most frequent complication of ERCP is post- ERCP pancreatitis (PEP), which occurs in 4 – 5% of the average risk patients but can be higher than 10% in high risk groups. Prophylactic pancreatic stent (PPS) insertion is recommended in high risk patient to prevent PEP. Inspite of PPS insertion PEP will develop is some cases. The aim of our study was to evaluate the complications of PPS insertion and to look for possible risk factors. Patients and methods: PPS insertion was carried out in 115 patients with increased risk for PEP between May 2009 and March 2015 in our tertiary referral center. The indication, finding of ERCP, detailed procedural data, pre- and postprocedural laboratory data, findings of imaging studies and other parameters were collected from the electronic medical records and analyzed. PEP was defined according to the Cotton criteria. Results: 74 female and 41 male patients with mean age of 63 years (13 – 89) underwent PPS insertion. Hyperamylasaemia was detected in 66 cases (57%), while PEP developed in 10 cases (8.7%), 2 of them were severe, one was moderate, the rest were mild. The risk factors of PEP were unsuccesful PPS insertion (p < 0.001), presence of juxtapapillary diverticulum (p < 0.001), and when stent dislodgement occurs within 24 hours (p = 0.07). The development of PEP after PPS insertion did not correlate with age and sex of the patients, opacification of pancreatic duct, absence of distal bile duct dilatation or precut papillotomy. Other complications of PPS were proximal stent migration into the pacreatic duct in one case, and mild pancreatitis 17 days after PPS insertion. Conclusions: PEP can develop after PPS insertion in some patients. The risk of this complication is associated with unsuccesful stent insertion, juxtapapillary diverticulum and early stent dislodgement. Proximal stent migration and stent occlusion are rare complications of PPS. The latter can be prevented by stent removal if spontaneous passage is not observed within 5 – 10 days after insertion.

Introduction: Epiphrenic diverticula are very rarely seen and are often associated with achalasia, oesophageal body dysmotility and a high resting lower oesophageal sphincter pressure.

Background: Diffuse esophageal spasm (DES) and achalasia share both clinical and manometric characteristics. The progression of certain primary esophageal motor disorders to classic achalasia has been documented.

Background: Achalasia cardia is a rare primary esophageal motor disorder characterised by aperistalsis of the esophageal body and impaired lower esophageal sphincter relaxation. Pneumatic dilation is an effective treatment for achalasia. The aim of this study was to identify which factors are predictive for a good long-term success.

Introduction: Eosinophilic oesophagitis (EoO) is a rare, increasingly recognised disease, caused by allergens. The authors summarized the diagnostic and therapeutic edifications of their 3 EoO cases.

PEG tube insertion is indicated in prolonged conditions (oncological, neurological, etc.) where adequate oral feeding is not possible, and there is no contraindication. The PEG tube insertion might not be possible in patients with oesophageal, pharyngeal or laryngeal tumor, because the bumper of the PEG tube can stuck in the stricture of the upper GI tract.

Introduction: Oesophageal perforations are often treated in recent years with covered metallic stents avoiding invasive surgical intervention. Dilatation of severe corrosive strictures carries an increased risk of perforation. The authors report on double stent and drainage treatment of an oesophageal and later a subcardial perforation after dilatations of multiple corrosive stenoses.

Background: Achalasia is an esophageal motility disorder characterised by aperistalsis of the esophageal body and impaired lower esophageal sphincter. The pathophysiology of the motor abnormalities is not well understood. The aim of this study was to determine the efficacy of balloon dilation in patients with cardial achalasia. Patients and methods: 354 consecutive patients (179 females, 175 males) were included in the study who had been treated by balloon dilation during a period from 1981 to 2010. The diagnosis was suggested by endoscopy and confirmed by esophageal manometry or barium esophagogram. The severity of achalasia was determined by esophagogram. Both before and after the balloon dilation symptom score, diameter of esophageal body, diameter of the cardia, maximal pressure of the lower esophageal sphincter, vector volume and the sphincter asymmetry were determined. Results: Balloon dilation led to a significant decrease of the symptom score. Both the maximal pressure of the lower esophageal sphincter and the vector volume decreased significantly. Sphincter asymmetry tends to decrease, but no statistical significance could be obtained during the treatment period. The diameter of the esophageal body decreased and the diameter of the cardia increased, but not significantly. Conclusion: Balloon dilation is a reproducible and effective technique, which achieves a very satisfactory control of the achalasia symptoms and the esophageal function.

Introduction: Oesophageal cancer occurs frequently in heavy smokers and drinkers. This is a praedisposition for oropharyngeal and laryngeal cancer too. GERD and peptic stenosis occurs often in this group of patient. In the last 10 years the senior author (JS) detected 2 laryngeal carcinoma, 1 leukoplakia, several vocal cord paralyses, 3 oral and tongue tumors during upper endoscopy. A case of an early stage vocal cord tumor detected by upper GI endoscopy will be reported.

Introduction: Absorption of nutrients in short bowel syndrome (SBS) is seriously impaired. The adequate treatment of SBS are parenteral and enteral fluid, electrolyte, nutrient and vitamin substitutions. If more than 80 percent of the small bowel is resected, generally life-long total or supplementary parenteral nutrition is required. A 63 year-old male patient with the hystory of ulcerative colitis and mesalazine therapy since 1986 has been treated several times for entamoeba histolytica and dyspar infection. In 2003 the relapse of ulcerative colitis was treated with olsalazine and parenteral methyprednisolon, but on the second day of therapy acute abdomen developed. Laparotomy revealed ileal necrosis. Resection and later reresection was necessary due to progressive ileal necrosis. In 2004 subtotal colectomy, ileostomy with rectal restoration and also ileal segment resection were performed for necrosis. After the surgery only 80cm of small bowel remained. His weight decreased from 79 to 50kg, laboratory tests showed severe malnutrition, electrolyte disorder and frequent tetanic cramps occured. Initially parenteral infusion with calcium, potassium, magnesium and orally Protifar, Fantomal and Ensure were administered. Since 2005 the patient has been on methylprednisolone, oral and rectal mesalamine, high-dose oral potassium, calcium, magnesium, ferrous sulfate, folic acid, A, B1, B6, C, E vitamins. At present the patient is symptom-free, and only fed orally, and his laboratory parameters are normal. In the last 5 years his body weight has been constant at 55kg, and there was no need for hospitalization. Conclusion: Our case demonstrates possible adaptation in the absorption of small intestine, therefore the expansive and uncomfortable parenteral nutrition can be replaced to enteral nutrition.

Achalasia is a primary esophageal motor disorder characterized by degenerative changes of the myenteric plexus. The pathophysiology of the motor abnormalities is not well understood. We describe a case of a 85-year-old woman. She has suffered from progressive symptoms of dysphagia for liquid and solid foods and aspiration for the previous 6 months, she has lost 22kg of weight during this period. Because of the entire unable of swallowing, PEG implantation has been made in another institute. In our Hospital endoscopy showed esophageal mycosis, barium swallow examination suggested Zenker diverticula's suspicion. On esophageal manometry peristaltic waves weren't seen in the esophagus, and the lower and upper esophageal sphincter did not relax with the swallow. So manometry showed cardiac and crycopharyngeal achalasia simultaneously. Both upper and lower esophageal sphincter pneumatic ballon dilatation was performed. Upper sphincter dilatation is repeated twice. The diameter of the upper esophageal sphincter was 22mm after the dilatations, the diameter of the lower esophageal sphincter was 35mm. Her symptoms resolved rapidly after ballon dilatation, she has put on 15kg. In cardial achalasia most of earlier studies described an increased residual pressure in the UES or reduction in the duration of UES relaxation with swallowing, but crycopharyngeal and cardial achalasia in the same patient haven't been described yet.

Introduction: Eosinophilic oesophagitis (EoO) is a rare, increasingly recognised disease, caused by food-, aero-, or other allergens. The authors reported a case with stenosis, treated with balloon dilatation.

Introduction: The adenoma-carcinoma sequence is well-known at tumors of Vater papilla, too. These could be removed endoscopically or surgically with ampullectomy or partial pancreatoduodenectomy.

Introduction: Boerhaave syndrome involves spontaneous rupture of the esophagus after forceful vomiting in alcoholics.

Introduction: In May of 1979, we were the first in the world to use balloon catheter dilatation of the oesophagus. In this paper, we would like to summarize our 30 years of experience on the balloon catheter dilatation of peptic stenosis.

The primary lymphoma of the stomach is relatively uncommon. It accounts for less than 3% of gastric malignancies. The vast majority of them are non-Hodgkin's lymphomas of B cell origin. For diagnosis endoscopic biopsy, some times big particle biopsy is needed, because of the deep spreading of the disease. Compared to adenocarcinoma nonsurgical treatment is preferred and the outcome is far better.

In recent years new approaches have emerged in the treatment of oesophageal perforation and suture insufficiencies by using covered metal stents. We successfully treated postoperative oesophageal suture insufficiency and the complications of Ultraflex stent treatment with per cutan drainage and Boubella ES metal stent.

A 66 years old female, with a history of surgical removal of thymus carcinoma, presented with progressive dysphagy and severe vomiting. Endoscopy revealed dilated tubular oesophagus, retention oesophagitis, mycosis and cardiac stenosis, manometry proved achalasia. After two times pneumatic dilatation dysphagy resolved, but gastric distension and noisea occured caused by gastric retention with delayed gastric emptying. In the background of the symptoms gastroparesis was suggested, therefore pyloric botulinus toxin injections were performed. Afterwards gastric emptying improved. The case was complicated by normochromic, normocytic anemia, crista biopsy and flowcytometry revealed pure red cell anaemia.

Introduction: The stenosis of the colon has benign forms like postsurgical, postirradiation, IBD caused strictures or malignant forms. The treatment of the stricture is determined by its severity and origin. Therapy includes dilatation, stent implantation or operation. We report on the ballon dilatation of multiple colonic stenoses in a Crohn's disease patient.