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Approximately 35%-40% of geriatric patients seek medical care for gastrointestinal symptoms at least once a year. At least 1% of the population aged over 80 years is hospitalized each year due to gastrointestinal hemorrhage. Gastrointestinal hemorrhage is frequently observed in this population and associated with high mortality and morbidity. Also, gastrointestinal hemorrhage is one of the main causes of hospitalization among geriatric patients. Geriatric patients with GIH constitute a subgroup of patients requiring special care in hospitals. The bleeding may occur in the upper or lower gastrointestinal tract and manifest itself with a variety of symptoms depending on its location. The incidence and natural course of hemorrhage are affected by antiplatelet and anticoagulant medications. The outcome of gastrointestinal hemorrhage in geriatric patients depends largely on the characteristics of bleeding lesion and comorbidities. Geriatri yaş grubundaki hastaların yaklaşık %35-40’lık bir kısmı, yılda en az 1 kez gastrointestinal semptomlar nedeni ile tıbbi yardıma ihtiyaç duymaktadır. Seksen yaş üstü nüfusun en az %1’i, her yıl gastrointestinal kanama nedeni ile hastaneye yatmak zorunda kalmaktadır. Gastrointestinal kanaması olan geriatric olgular, hastanelerde özel bakım gerektiren hasta grubunu oluşturmaktadır. Geriatrik çağda gastrointestinal kanama sık gözlenmektedir ve beraberinde yüksek morbidite ve mortalite riski taşımaktadır. Kanama üst veya alt gastrointestinal sistemden köken alabilir ve kanama lokalizasyonuna göre semptom çeşitliliği gösterebilmektedir. Kanamanın insidansı ve klinik seyri, hastanın kullandığı antiplatellet veya antikoagülan tedaviden etkilenmektedir. Geriatrik olgulardaki kanamanın seyri çoğunlukla kanayan lezyonun karakteristiğine ve eşlik eden hastalık olup olmamasına bağlıdır.

A 75-year-old woman with a history of Parkinson's disease and chronic constipation developed progressive abdominal distention and pain following consecutive operations for hip fracture. She became bedridden and her nutritional status deteriorated with poor oral intake. She was admitted with abdominal distention, pain, malnutrition, and dehydration. Given her past history and clinical, radiological and endoscopic findings, she was diagnosed with colonic-type chronic intestinal pseudoobstruction. Despite fluid and electrolyte replacement, nutritional support and prokinetic medicines, her condition did not improve. Serial enemas and attempts at colonic decompression failed to relieve severe distention and pain sufficiently. Although prophylactic antibiotic treatment was given, she died of sepsis likely due to bacterial translocation and microperforations. Parkinson's disease may be a predisposing condition to colonictype chronic intestinal pseudoobstruction., Parkinson hastalığı ve kronik konstipasyon öyküsü olan 75 yaşında bayan hastada kalça kırığı için geçirdiği iki operasyon sonrası giderek artan karında şişkinlik ve ağrı başlamış. Bu süreçte yatağa bağımlı hale gelen hastanın oral alım bozukluğu nedeniyle beslenme durumu kötüleşmiş. Hasta abdominal distansiyon, karın ağrısı, malnütrisyon ve dehidratasyon ile servise yatırıldı. Öyküsü, klinik, radyolojik ve endoskopik bulguları eşliğinde kolonik tip kronik intestinal psödoobstrüksiyon tanısı aldı. Sıvı-elektrolit replasmanı, beslenme desteği ve prokinetik ajanlara rağmen durumunda iyileşme olmadı. İleri derecede distansiyon ve karın ağrısını gidermeye yönelik seri enema ve kolonik dekompresyon çabaları sonuçsuz kaldı. Profilaktik antibiyotik tedavisine rağmen muhtemel bakteriyel translokasyon ve mikroperforasyonlara bağlı olarak gelişen sepsis nedeniyle exitus oldu. Parkinson hastalığı kolonik tip kronik intestinal psödoobstrüksiyon için yatkınlık oluşturan bir durum olabilir.

Since its initial use in 1981, percutaneous endoscopic gastrostomy has been the method of choice for many patients requiring nutrition through enteral access. However, in the presence of gastroparesis or distortion of the normal stomach and duodenum anatomy, the risk of aspiration in 30% of patients warrants jejunal feeding. Jejunal feeding was first achievable in 1984 by means of a catheter inserted through the percutaneous endoscopic gastrostomy and advanced to the jejunum (PEG-J). However, the efficacy of this method is unsatisfactory due to the small diameter and clogging or kinking of the catheter used for jejunal feeding as well as to failure to always position it at the desired distance and its retrograde migration into the stomach. As a result, reintervention is often required and aspiration risk is not significantly decreased at all. Direct percutaneous jejunostomy was first described by Shike et al. in 1987 in patients who underwent gastrojejunostomy and/or gastrectomy. In 1991, Shike used this technique in patients with normal stomach and duodenum anatomy. Ponsky modified the technique thereafter and used the "pull technique" of percutaneous endoscopic gastrostomy for direct percutaneous jejunostomy. We herein report six cases with comprehensive information about direct percutaneous jejunostomy performed in our unit., Perkütan endoskopik gastrostomi, 1981 yılında ilk uygulamasını takiben, enteral yaklaşımla beslenmeye ihtiyaç duyan birçok hastada tercih edilen işlem olmuştur. Bununla beraber, gastroparezi veya mide-duodenum anatomisinin bozulması nedeniyle %30 kadar hastada aspirasyon riski belirmiş ve jejunal beslenmeye gereksinim doğmuştur. Jejunal beslenme, ilk defa 1984 yılında kullanılmaya başlanan, perkütan endoskopik gastrostomiden geçirilerek jejunuma ilerletilen bir kateter yardımı ile yapılabilse de bu yöntemin etkinliği, jejunal beslenme için kullanılan kateter çapının dar olması, tıkanması veya kink yapması, kateterin her zaman istenen mesafeye yerleştirilememesi ve mideye geri düşmesi nedeniyle yetersizdir. Sayılan nedenlerden dolayı sıklıkla tekrar girişim gerektirmekte ve ayrıca hastalarda aspirasyon yine de olmaktadır. Direk perkütan endoskopik jejunostomi, ilk olarak 1987'de Shike ve ark. tarafından gastrojejunostomi ve/veya gastrektomi olan hastalarda tanımlanmıştır. 1991 yılında Shike, bu kez anatomik olarak normal mide ve duodenumu olan hastalarda bu tekniği kullanmıştır. Ponsky ise tekniği modifiye ederek perkütan endoskopik gastrostomi için uygulanan pull tekniğini direk perkütan endoskopik jejunostomi için kullanmıştır. Bu yazıda kliniğimizde 6 olgu nedeniyle gerçekleştirilen direk perkütan endoskopik jejunostomi hakkında kapsamlı bilgi sunulmaktadır.

Ectopic pancreas is a congenital heterotopic pancreatic tissue typically found in the gastric antrum incidentally. It is easily recognized by its small cratershaped appearance near pylorus on endoscopy. However, it may appear as large submucosal lesion in rare cases. It may not be possible to differentiate ectopic pancreas from stromal tumor and leiyomyoma in all cases even by tomography or endoscopic ultrasound. We report an unusual case of ectopic pancreas which appeared as submucosal lesion on endoscopy and diagnosed by surgical resection., Ektopik pankreas genellikle mide antrumunda tesadüfen tespit edilen konjenital heterotopik pankreas dokusudur. Endoskopide, pilora yakın küçük krater şeklinde görüntüsüyle kolayca tanınır. Ancak nadir durumlarda büyük submukozal lezyon olarak ta izlenebilir. Tomografi ve endoskopik ultrasonografiyle bile stromal tümörler ve leiyomiyomdan ayırt edilmesi her zaman mümkün olmayabilir. Bu yazıda, üst endoskopide antrumda submukozal lezyon olarak değerlendirilip cerrahi rezeksiyon sonucu tanı alan sıradışı bir ektopik pankreas olgusu sunulmaktadır.

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Background/Aims: The aim of the present study was to analyze the diagnostic accuracy of serum eosinophilic cationic protein (ECP) for eosinophilic esophagitis (EoE) and the correlation of ECP with clinical, histopathological, laboratory, and endoscopic features of EoE. Materials and Methods: Fifteen patients with EoE and 14 healthy controls were included in the study. Demographic parameters were recorded. EoE Endoscopic Reference Score (EREFS) was calculated according to endoscopic features, and esophageal biopsies were obtained by a single experienced endoscopist in a patient group. Serum ECP levels (mu g/mL), absolute eosinophil count (U/mm(3)), and maximum peak of eosinophils/high-power field in esophageal biopsies were analyzed. Results: The median age of all participants was 33.0 (min-max: 18-46) years. There were 27 (93.1%) male patients. Serum ECP level was significantly higher in patients with EoE than in healthy volunteers (20.4 vs. 8.8, p

Background/Aims: To identify cell surface markers selectively expressed by tumor cells and tumor vasculature is the current goal for tumor therapy. One such marker is nerve/glial antigen 2 (NG2), which is a transmembrane glycoprotein. We aimed to investigate the expression of NG2 in colorectal cancer (CRC) and its association with clinicopathological parameters. Methods: Immunohistochemical staining of NG2, vascular endothelial growth factor, and CD34 in 65 patients diagnosed with CRC over a 5-year period was performed. NG2 expression in both tumor cells and tumor vasculature was scored according to the German Reactive Scoring System. The association between NG2 and patient and tumor characteristics was analyzed. Results: NG2 was expressed by tumor cells in 56.9%, tumor vasculature in 43%, and simultaneously by both in 27.6% of the cases. Tumor cell NG2 was more common in elderly patients (p = 0.023) and vascular NG2 was associated with better tumor differentiation (p = 0.035). Notably, vascular NG2 was expressed in half of the patients with left colon cancer, although it was not expressed in a majority of those with right colon cancer (50.9 vs. 17.7%, p = 0.041). Conclusion: Both tumor cell and vascular NG2 expression were shown to be present in a significant number of patients with CRC and this makes NG2 a double target for anti-tumor therapies. Such therapies might be more effective for elderly patients with well-differentiated left colon cancer.