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Background: the ischemic colitis is intestinal the most frequent cause of ischemia. With this work we determine the demographic and clinical characteristics, and the usefulness of the colonoscopy in the patients with ischemic colitis diagnosed in our centre in relation to a change of therapeutic attitude. Method: retrospective study in which were selected 112 patients diagnosed with ischemic colitis by colonoscopy and biopsy, in a period of five years. It was analyzed: age, sex, reason for examination, factors of cardiovascular risk, endoscopic degree of ischemia, change in the therapeutic attitude, treatment and outcome. Results: the average age was of 73.64 ± 12.10 years with an equal incidence in women (50.9%) and the men (49.1%). The associated factors were the HTA (61.1%), tobacco (37.2%) and antecedents of cardiovascular episode (52.2%). The most frequent reason for colonoscopy was rectorrhagia (53.6%) followed of the abdominal pain (30.4%), being urgent the 65.3%. Colonoscopy allowed a change in the therapeutic attitude in the 50 increasing in the urgent one to the 65.75%. Global mortality was of 27.67%. The serious ischemic colitis (25%) was more frequent in men (64.3%) in urgent indication (85.71%) and attends with high mortality (53.57%). Surgical treatment in the 57.14% was made with a good evolution in the 50%, whereas the patients with mild or moderate ischemic colitis had a better prognosis (favourable evolution in 80.95%) with smaller requirement of the surgical treatment (4.76%), p < 0.05. Conclusion: the colitis ischemic are more frequent in the older age. The most frequent symptoms are the rectorrhagia and the abdominal pain. The colonoscopy is a useful technique to evaluate the gravity and it induces a change of attitude according to the result of the same one. The evidence of a serious colitis supposed an increase of the necessity of surgery and worse prognosis.Introducción: la colitis isquémica es la causa más frecuente de isquemia intestinal. Realizamos un estudio con el objetivo de analizar las características demográficas, clínicas y la utilidad de la colonoscopia en los pacientes diagnosticados de colitis isquémica en nuestro centro en relación a un cambio de actitud terapéutica. Método: estudio retrospectivo en el que se seleccionaron 112 pacientes diagnosticados de colitis isquémica mediante colonoscopia y biopsia, en un periodo de tiempo de cinco años. Se analizaron: edad, sexo, motivo de exploración, factores de riesgo cardiovascular, grado endoscópico de isquemia, cambio en la actitud terapéutica, tratamiento y evolución. Resultados: la edad media de nuestros pacientes fue de 73,6 ± 12,1 años con una incidencia similar en ambos sexos (50,9% mujeres y 49,1% hombres). Los factores de riesgo asociados fueron la hipertensión arterial (61,1%), el tabaco (37,2%) y antecedente de accidente cardiovascular previo (52,2%). El motivo más frecuente de realización de colonoscopia fue rectorragia (53,6%) seguido de dolor abdominal (30,4%), realizándose de forma urgente en el 65,3% de los casos. La colonoscopia permitió un cambio en la actitud terapéutica en el 50% de los casos, aumentando en la urgente al 65,75%. La mortalidad global fue del 27,67%. La colitis isquémica grave (25%) fue más frecuente en varones (64,3%), y cuando la indicación de colonoscopia fue urgente (85,71%) y cursó con mortalidad alta (53,57%). En estos se realizó tratamiento quirúrgico en el 57,14% de los casos con una evolución favorable en el 50%, mientras que los pacientes con colitis isquémica leve o moderada tuvieron un pronóstico mejor, con evolución favorable en el 80,95% de los casos y con menor requerimiento de tratamiento quirúrgico (4,76%, p < 0,05). Conclusión: la colitis isquémica es más frecuente en la edad avanzada. La sintomatología más común es la rectorragia y el dolor abdominal. La colonoscopia permite evaluar la gravedad e induce un cambio de actitud según el resultado de la misma. La evidencia de una colitis grave supuso un aumento de la necesidad de cirugía y peor pronóstico.

Metastatic choriocarcinoma is a rare nonseminomatous germ-cell tumor with a characteristic hemorrhagic tendency due to its trophoblastic origin. Gastrointestinal tube involvement is present in less than 5% of cases, and location or therapy of these lesions can be achieved by endoscopy, angiography or surgery. Despite its being a highly curable malignant disease, the ocurrence of gastrointestinal bleeding worsens prognosis. We report a case of metastatic choriocarcinoma which manifested as melaena and was diagnosed by the presence of metastatic lesions in the stomach and right bowel on endoscopy.El coriocarcinoma metastático es una infrecuente tumoración de células germinales con una marcada tendencia hemorrágica debido a su origen trofloblástico. La invasión del tubo digestivo ocurre en menos del 5% de los casos. A pesar de ser una enfermedad maligna con buena respuesta a la quimioterapia, la hemorragia gastrointestinal ensombrece el pronóstico. Presentamos un caso de un paciente de 37 años con un coriocarcinoma diseminado en el que la presentación clínica fue hemorragia digestiva en forma de melenas, encontrándose por endoscopia lesiones metastáticas en estómago y colon derecho.

Objectives: Gastrointestinal endoscopy, like all diagnostic and therapeutic techniques, must be preceded by written informed consent. The aim of this study was to evaluate the patients' acceptance and understanding of the aim of informed consent as well as to determine their perception of the investigation., Methods: For 2 months, informed consent forms were given together with a questionnaire to 221 consecutive patients who underwent diagnostic gastrointestinal endoscopy., Results: Distribution of the patients according to level of education was: university graduated (6.5%), high-school graduate (21.1%) those who had completed primary school (48.6%) and those with no schooling (23.9%). The document was read by 144 patients (65.1%) and the attending physician had previously explained it to 69.6%. Informed consent was understood by 90.7% of the patients who read the document. Understanding was related to education (university and high-school graduates (83.3%) vs. those who had completed primary school or who had no schooling (60%); p < 0.005) and was not related to the information given by the attending physician. Patients' opinion on the aim of informed consent was: absolve the doctor of responsibility (42%), provide information in the patients' interests (51.1%) and senseless document (42%). Signing the document provoked fear in 20% of those surveyed. This fear was greater in patients who had not been informed by the attending physician (31.2% vs. 14.5%; p > 0.01)., Conclusions: Informed consent is understood by most patients who read the form but a significant proportion perceive it as designed to defend the physician. When the technique is explained by the attending physician and the doctor performing the procedure, acceptance is increased and fear is reduced.

Endoscopic ligation is a new technique that shows an efficacy for acute hemorrhage and prevention similar to sclerotherapy. Its principal advantage is the smaller number of complications (2%), which seem to be related to the presence of post-treatment ulcers which are indeed more extensive but more superficial. In our preliminary study on 8 patients, eradication of varices in 62.5% was obtained. The mean number of bands placed at each ligation session was of 2.4 +/- 0.96 and the mean number of treatment sessions to achieve the eradication was 3.4 +/- 1.5. The complications that appear during the positioning of bands, a minimum bleeding was observed during the polyp formation, and in one occasion, the partial detachment of an eschar followed the bleeding was also observed. Rebleeding occurred in two patients (25%), and in other patient, spontaneous bacterial peritonitis was observed. The two patients who presented recurrent variceal bleeding, received a transjugular intrahepatic portosystemic shunt to control their hemorrhage.