Besides the technical equipment, the endoscopic team's theoretical and practical skills, the success of endoscopic intervention is influenced by the patient's general condition. Advanced age, severe co-morbidities may increase the risk, especially in case of operative endoscopy. The decision is more complicated when alarm symptoms urge the examination. The endoscopic examination of digestive system, biliary track and pancreas in advanced age can safely be performed as alternatives of surgical intervention. It is important to know the exact stage of cardiovascular and pulmonary diseases, besides, in case of stroke the patient's cooperation is very important. In everyday practice the most common problems are the endoscopic examination of the patient in oral anticoagulant and/or thrombocyte aggregation inhibition therapy and the question of suspending, modifying or restarting the therapy. Examining the patients with implanted electronic device as well as antibiotic prophylaxis in expanding range of indications are special issues. The gastroenterologist makes the decision based on the knowledge of the endoscopic intervention, the patient's risk classification, the indications, the contradictions and the alternative diagnostic possibilities. This review attempts to give an overview with some practical aspects.