A second level hospital must assure to the patients a 24 hours service of emergency endoscopy. Since 1989 in the Policlinico 'Umberto I' University 'La Sapienza' of Rome, a dedicated operative unit is active. The Authors present their experience of last five years (2001-2005). The endoscopic diagnosis for appropriate therapeutics reduced time and costs of the hospitalization. The Endoscopic Operative Unit resolved the emergency in two/four hours. Neverthless, in some cases, the referall to Unit was not appropriated.