Search

Background: The World Health Organization (WHO) proposed an updated reporting system for pancreaticobiliary cytology, which moves low-grade malignancies to “positive for malignancy” group and serous cystadenoma to “negative for malignancy” group. The WHO system also created two new categories, namely, pancreatic neoplasia-low grade (PaN-Low) and pancreatic neoplasia-high grade (PaN-High), which includes neoplastic mucinous cysts and stratifies them according to their cytologic atypia. The risk of malignancy (ROM) of the new categories of the WHO system needs to be defined. Methods: Cytologic slides of all patients, who underwent endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) biopsy at our institution from January 2010 to December 2021 and had a histopathological or clinical follow-up of at least 6 months, were reviewed and reclassified under the Papanicolaou Society of Cytopathology (PSC) and WHO reporting systems. The absolute ROM was calculated for each category of both reporting systems. Results: A total of 420 EUS-FNA samples from 410 patients were reviewed and reclassified. The absolute ROM for the proposed WHO system was 35% for “nondiagnostic,” 1.0% for “negative for malignancy,” 69.0% for “atypical,” 11% for “PaN-Low,” 100% for “PaN-High,” 91% for “suspicious for malignancy,” and 100% for “malignant.” Comparatively, the absolute ROM under the PSC reporting system was 34% for “nondiagnostic,” 1.0% for negative (for malignancy), 50.0% for “atypical,” 0.0% for “neoplastic: benign,” 16% for “neoplastic: other,” 88% for “suspicious for malignancy,” and 100% for “positive or malignant.” Conclusion: The proposed WHO international reporting system has advantages regarding risk stratification improvement and case management.

Background/aim: This study was designed to identify the effect of pentoxifylline on trinitrobenzene sulfonic acid (TNBS)-induced colitis in rats. Materials and methods: Forty-two female Wistar rats were randomly divided into 7 groups: group A, TNBS + intraperitoneal (IP) pentoxifylline; group B, TNBS + IP saline; group C, TNBS + intrarectal (IR) pentoxifylline; group D, TNBS + IR saline; group E, IP pentoxifylline + TNBS; group F, IP saline + TNBS; group G, IR saline. Pentoxifylline was given daily for 3 days before or 6 days after the induction of colitis. Rats were killed after 6 days. Results: IP and IR pentoxifylline similarly and significantly reduced damage and histopathological scores. Pentoxifylline attenuated the accumulation of malonyldialdehyde and transforming growth factor β1 and the activities of myeloperoxidase, matrix metalloproteinase-3, and tissue inhibitor of metalloproteinases-1, and it also restored superoxide dismutase activity. The IP route was more effective than the IR route in this regard. Administration of IP pentoxifylline before or after induction did not influence all parameters. Conclusions: Pentoxifylline showed a therapeutic effect in this experimental colitis model. IP administration seemed to be better. This effect may occur as a result of inhibition of oxidative stress and metalloproteinase activity.

Background/Aims: To assess the utility of the DR-70 immunoassay in the diagnosis of gastric cancer. Materials and Methods: A total of 29 patients with histologically proven malignant gastric tumor and 29 healthy blood donors were enrolled in this study. DR-70 immunoassay was performed using an enzyme-linked immunosorbent assay kit to quantify the serum levels of fibrin degradation products. Results: The DR-70 values in patients with gastric cancer significantly differed from the values in controls (p

Soliter rektal ulser sendromu (SRUS), siklikla genc-eriskin yas grubunda gorulen etiyolojisi tam olarak bilinmeyen kronik bir hastaliktir. Tani semptomlar, endoskopik bulgular ve histopatolojik incelemelerin kombinasyonu ile mumkundur. Bu yazida maligniteyi taklit eden soliter rektal ulser olgusu sunulmustur .

Aim: To analyze the risk factors of lamivudine treatment failure (LTF) for the long-term use in patients with low viral load (LVL). Material and Methods: In this multicenter study, 548 antiviral naïve noncirrhotic adult patients with LVL (for HBeAg+ patients HBV DNA 9 copies/ml and for HBeAg- patients HBV DNA 7 copies/ml) were enrolled. As a control group, 46 lamivudine-initiated patients with high viral load (HVL) were included. Primary outcome was switching to or adding on another antiviral drug as a consequence of primary nonresponse, partial response, viral breakthrough or adverse events. Secondary outcomes included LTF rates at 1, 2, 3, 4 and 5 years and LTF-related viral and host factors. Results: Among 594 patients, 294 had to change lamivudine at the follow-up. Primary nonresponse, partial response, viral breakthrough or adverse events frequencies were 6.8, 1.6, 64.5 and 0.1%, respectively. Five-year LTF rates were 61.3 and 84.2% in patients with LVL and HVL, respectively. Among patients with LVL, patients with Conclusion: Similar to patients with HVL, first-line lamivudine therapy is not efficient for long-term use in patients with LVL. LTF risk is so high even in the absence of worse predictive factors.

Summary Aim In addition to suppressing fibrinolysis, thrombin activatable fibrinolysis inhibitor (TAFI) was suggested to be involved in inflammation. To date, no study has been published that reports the role of TAFI in acute pancreatitis (AP). Therefore, the objective of the present study was to investigate the role of plasma TAFI as an indicator of inflammation in AP, and its association with disease severity. Methods Plasma TAFI antigen levels quantitatively determined by using ELISA kits in 21 AP patients at onset and remission and 17 healthy controls. Associations of TAFI with inflammatory markers to determine AP and disease severity were assessed. To predict the severity of AP, modified Glasgow prognostic score (mGPS) and computerized tomography severity index (CTSI) were used for each subject. Results Plasma TAFI levels was higher in AP patients at onset of the disease compared with healthy controls. The disease severity according to mGPS was significantly correlated with TAFI levels. Overall, accuracy of TAFI in determining AP was 83.3% with a sensitivity, specificity, NPV and PPV of 80.9%, 85.7%, 81.8%, and 85% respectively (AUC: 0.915). Conclusions The present study for the first time demonstrated that TAFI is elevated in AP. The appraisal of TAFI levels in patients with AP in conjunction with other markers of inflammation may provide additional information in estimating AP severity.

Summary Aim Cholangiocarcinoma (CCA) is a primary neoplastic tumor of the epithelial lining of the biliary tree which carries a poor prognosis despite combined therapeutic strategies. Although the exact etiology remains obscure, it has been suggested that locally produced Angiotensin II (Ang II) in intrahepatic CCA tissues plays a key role in the proliferation and activation of CCA. In the present study, we aimed to analyze the relationship between the levels of circulating angiotensin converting enzyme (ACE), an important molecule of the renin-angiotensin system (RAS), and biliary disorders. Patients and methods The study group comprised 19 extrahepatic cholangiocarcinoma (EHCC) (16 patients with hilar, three patients with distal CCA), and 15 choledocolithiasis (CL) patients, with 15 controls. Median age of EHCC, CL and healthy controls were 67 (48–82), 65 (29–87) and 56 (23–74) respectively. ACE was measured by monitoring the alteration in absorbance at 340 nm of the hydrolysis of furylacrylolylphenylalanylglycylglycine (FAPGG) to FAP and GG on an analyzer. The ACE activity in the sample was determined by comparing the sample reaction rate to that obtained with the ACE calibrator. Results Serum mean ACE levels were 56.6 ± 27.4 U/L, 32.9 ± 14.6 U/L and 28.6 ± 10.6 U/L for patients with EHCC, CL and healthy controls, respectively. Serum ACE levels were significantly higher in patients with EHCC compared to CL and control groups. No significant differences with respect to ACE levels were observed between CL and control groups. Conclusion Circulating ACE in the context of RAS might be associated with EHCC development by creating a local environment enriched with cytokines and other growth factors that may promote cholangiocyte turnover.

The quality of colon cleansing and the tolerance of patients to the procedure are two major determinants of the quality of a colonoscopy. Many bowel-cleansing regimens are known, but there is no ideal regimen. Alverine citrate (Relaxyl, Spasmonal) is a spasmolytic agent that has been shown to affect responses of mechanoreceptors of the intestine to both mechanical and chemical stimuli. Patients who underwent colonoscopies at four centers were randomly assigned two different bowel-cleansing procedures. The bowel-cleansing methods were oral sodium phosphate (NaP) (Group I) and oral NaP plus alverine citrate (Group II). Patients were randomized into one of these regimens. The quality of colon cleansing was assessed by an endoscopist with an empirical, clinically meaningful 3-point scale. Both groups were similar with respect to age, gender, and pre- and postcolonoscopic diagnosis. In Group I, 76 patients (47 women and 29 men; aged 39.53 ± 7.87 years) and in Group II, 71 patients (41 women and 30 men; aged 39.78 ± 8.27 years) were included in the study. In Groups I and II, 37 (48.7%) and 41 (57.7%) patients had perfect bowel cleansing, respectively. The overall colon cleansing in the group with NaP plus alverine citrate was comparable with that in the NaP group. The tolerability of patients to the colonoscopy in the two groups was also similar. Based on the present data, adding oral alverine citrate to NaP does not increase either the quality of bowel cleansing or the tolerance of patients to the procedure.

OBJECTIVE: To investigate the diagnostic value of a terminal ileum biopsy in chronic non-bloody diarrhea with normal endoscopic appearance. METHODS: Patients who had a terminal ileum biopsy performed between January 2007 and January 2010 during a colonoscopy despite normal endoscopic appearance were reviewed. They were divided into two groups according to the indication for the colonoscopy: non-bloody diarrhea and non-diarrhea; and their histopathological findings were compared. RESULTS: By screening the colonoscopy records, 473 patients were found to have had a terminal ileum biopsy. Of these patients, 178 were excluded for various reasons. Finally, 295 patients were suitable for analysis. The non-bloody diarrhea group consisted of 135 patients, while the remaining 160 patients constituted the non-diarrhea group. A histopathological examination of the terminal ileum biopsy specimens in the non-bloody diarrhea group revealed an abnormal histology in eight patients (5.9%), compared with five patients (3.1%) in the non-diarrhea group. No statistically significant difference was found between the two groups (P = 0.26). CONCLUSION: Although performing a biopsy of the terminal ileum despite a macroscopically normal appearance may offer some additional benefit to the diagnosis of chronic non-bloody diarrhea, prospective trials are needed for assessing the diagnostic value of a terminal ileum biopsy in patients with chronic diarrhea.

Hepatoportal sclerosis (HPS) is a clinicopathologic condition that is clinically characterized by portal hypertension (varices and portosystemic collateral vessels), splenomegaly and pancytopenia, in the absence of cirrhosis. Although the etiology is obscure, a number of theories such as immunologic and vascular endothelial cellular abnormalities have been put forward to explain the underlying pathophysiology. Angiotensin-converting enzyme (ACE), an important molecule of the renin–angiotensin system (RAS), is also known as a regulatory molecule in systemic and portal circulation in distinct disorders. The aim of the present study was to investigate the possible role of the ACE in the context of RAS in HPS pathogenesis. The study was conducted on 30 HPS patients (16 men, 14 women; median age 36 years, range 18–63) and 20 healthy controls. The clinical features of HPS patients including demographics, laboratory, and ultrasonography findings were summarized. Serum ACE levels were measured by using commercially available kits. Serum median ACE levels were 36 (8–174) U/l and 16 (8–43) U/l for the HPS patients and controls, respectively. Serum ACE levels were significantly higher in patients with HPS compared to the control group (P

Background: The aim of this study was to evaluate the prevalence and features of the major cutaneous manifestations (erythema nodosum [EN] and pyoderma gangrenosum [PG]) and to determine the associations between cutaneous manifestations and other extraintestinal manifestations in patients with inflammatory bowel disease (IBD). Methods: The mucocutaneous manifestations of patients with IBD were studied between December 2002 and June 2007. All patients underwent a detailed whole body examination by a gastroenterologist and dermatologist. Results: In all, 352 patients were included in this study; 34 patients (9.3%) presented with at least 1 major cutaneous manifestation. The prevalence of EN (26 patients) and PG (8 patients) in IBD was 7.4% and 2.3%, respectively. EN was more common in Crohn's disease (16/118) than ulcerative colitis (10/234) (P = 0.002). EN was found to be related to disease activity of the bowel (P = 0.026). The prevalence of arthritis was significantly higher in the IBD patients with EN (11/26) than in IBD patients without EN (53/326) (P = 0.006). Arthritis was more common in IBD patients with PG (7/8) than in IBD patients without PG (57/344) (P = 0.00). IBD patients with PG were significantly more likely to have uveitis (1/8) compared with IBD patients without PG (5/344) (P = 0.017). Conclusions: We found the prevalence of 2 important cutaneous manifestations to be 9.3% in IBD in Turkish patients. EN was found to be more common in Crohn's disease and is associated with an active episode of bowel disease and peripheral arthritis. In addition, PG was connected with uveitis and peripheral arthritis. (Inflamm Bowel Dis 2009)

Background: Cancer antigen 125 (CA‐125) is a tumor marker used for the diagnosis and monitoring of ovarian carcinoma. It can also be elevated in endometriosis, inflammations, and in nongynecological malignancies. Up to date, serum CA‐125 levels in inflammatory bowel diseases (IBD) have not been studied before. Aim: To assess the levels of CA‐125 in patients with ulcerative colitis (UC) and Crohn's disease (CD). Methods: Serum levels of CA‐125 were investigated in 68 cases with UC (male/female: 47/21), 32 CD (male/female: 21/11), and 31 healthy controls (male/female: 16/15). Levels of CA‐125 were also compared among UC patients according to lesion location, severity, and activity of CD. Results: Serum CA‐125 levels were 17.29±24.50 U/ml, 15.56±20.74 U/ml, and 8.85±2.62 U/ml in patients with UC, CD, and healthy controls, respectively. Serum CA‐125 levels were significantly higher in UC compared to control group (P=0.001). Serum CA‐125 levels were higher in CD patients compared to control group but there was no significance (P=0.087). Serum CA‐125 levels were higher in pancolitis compared to distal type and left‐sided UC. Conclusions: Our data suggest that serum CA‐125 levels may be increased in patients with IBDs. J. Clin. Lab. Anal. 23:244–248, 2009. © 2009 Wiley‐Liss, Inc.

Background: Thrombosis in the portal system causes a wide spectrum of clinical pictures. There are few published studies describing the clinical features and consequences of portal venous system thrombosis. We aimed to document presentations and outcomes in patients with thrombosis in the portal and/or splenic veins. Patients and Methods: The study included 95 patients who were diagnosed with portal venous system thrombosis in the period September 2001 to April 2006. Demographics, clinical presentation, diagnostic investigation, management, morbidity, and mortality were recorded in their follow-up. Results: Of the 95 patients with portal vein thrombosis (PVT), 35 had isolated PVT (IPVT), 27 had isolated splenic vein thrombosis (ISVT), and 33 had thrombosis in both the portal and splenic veins (PSVT). The mean follow-up periods after diagnosis of IPVT, ISVT, and PSVT were 36, 31, and 32 months, respectively. Abdominal pain and gastrointestinal bleeding were the most common symptoms at presentation in the IPVT and PSVT groups, whereas abdominal pain was the dominant symptom in the ISVT group. During the follow-up period, no bleeding was seen in 26 of the 35 (74%) patients with IPVT, in 23 of the 33 (70%) patients with PSVT, and in 24 of the 27 (89%) patients with ISVT. Biliopathy developed during follow-up in 11 of 35 patients with IPVT, in 1 of 27 with ISVT, and in 5 of 33 with PSVT. In the ISVT group, there were 11 deaths, and one each in the IPVT and PSVT groups. Conclusions: The etiology of PVT varies in portal and splenic veins. IPVT has a higher morbidity (bleeding and portal biliopathy), whereas ISVT that is not associated with an underlying malignancy has a favorable prognosis.

Objetivos:Inflamacao ocular e uma manifestacao extra-intestinal comum de doenca inflamatoria do intestino (IBD) e pode ser paralela a atividade da doenca. Neste estudo, investigamos se a espessura da coroideia pode ser util para avaliar a atividade da IBD.Metodo:Um total de 62 olhos de 31 pacientes com IBD [10 com doenca de Crohn (CD) e 21 colite ulcerosa (UC)] alem de 104 olhos de 52 doadores de sangue saudaveis foram incluidos neste estudo. A espessura da coroide foi medida utilizando-se imagens de tomografia de coerencia optica com profundidade aprimorada. O indice de atividade da doenca Crohn (CDAI) e o indice de Truelove Witts modificado foram usados para avaliar atividade da doenca em CD e UC, respectivamente.Resultados:Nao houve diferenca significativa entre os pacientes com IBD e controles saudaveis em termos de medicoes da espessura da coroide subfoveal media em regiao 3000 μm nasal e 3000 μm temporal (p>0,05). Com base na analise univariada; idade, tabagismo, local do envolvimento em CD (ileal ou ileo-cecal), CDAI, atividade CD e indice de atividade endoscopica da UC foram significativamente correlacionados com a espessura da coroide (p

Small-cell lung carcinoma represents a group of highly malignant tumors characterized by early and widespread metastais even at the time of diagnosis. However, the pancreas is a relatively infrequent site of metastasis by this neoplasm. A 57-year-old patient was admitted with an intense cough and complaints of abdominal discomfort. A chest X-Ray showed no evidence of lung mass but did show signs of lymphadenopathy. In addition, there was little evidence for malignancy based on a transbronchial needle aspiration. In contrast, there was a mass in the head portion of the pancreas. We diagnosed a case of small-cell lung carcinoma metastasis in the pancreas by using an endoscopic ultrasound-guided fine-needle aspiration biopsy. This case demonstrates that endoscopic ultrasound-guided fine-needle aspiration biopsy is an important tool in the diagnosis of metastatic pancreatic neoplasms.

Objective: This study was designed to identify the effect of rivaroxaban, a direct factor Xa inhibitor, on trinitrobenzene sulfonic acid (TNBS)-induced colitis in rats. Materials and Methods: Twenty-four female Wistar rats were divided into 4 groups of 6 each. Group 1 received TNBS + rivaroxaban, group 2 received TNBS + methylprednisolone, group 3 received TNBS and group 4 received a saline enema. Colitis was induced in the rats by the intracolonic administration of TNBS. Rivaroxaban and methylprednisolone were given by oral gavage daily for 7 days. The rats were killed 7 days after the induction of colitis. Results: Rivaroxaban and methylprednisolone significantly reduced gross damage and histopathological scores. Rivaroxaban was more effective than methylprednisolone in terms of microscopic mucosal healing. Rivaroxaban attenuated the accumulation of malonyldialdehyde (MDA) and transforming growth-factor β1 (TGF-β1) and the activites of myeloperoxidase (MPO), matrix metalloproteinase-3 and tissue inhibitor of metalloproteinases-1. Methylprednisolone reduced only the activity of MPO and the accumulation of MDA and TGF-β1. Superoxide dismutase activity showed a restoration to normal levels after rivaroxaban and methylprednisolone administration. Conclusions: Rivaroxaban showed a therapeutic effect in the TNBS model of experimental colitis, and it seemed to be at least as effective as methylprednisolone. This effect may be brought about by the inhibition of oxidative stress and metalloproteinase activity associated with tissue injury and remodeling.

Our aim was to analyze patients diagnosed with left-sided portal hypertension prospectively and to document the complications at follow-up. Twenty-four patients with isolated splenic vein thrombosis (diagnosed by ultrasonography or angiography or intraoperatively) and/or isolated fundal varices (diagnosed by endoscopy or endosonography) were involved in this study. Demographics, clinical presentation, diagnostic and therapeutic procedures, and morbidity and mortality were recorded in their follow-up. There were 11 and 13 left-sided portal hypertension cases associated with pancreatic diseases and nonpancreatic disorders, respectively. Chronic abdominal pain and gastrointestinal bleeding were the two most common complaints. All patients except one had isolated esophageal (2 cases) or fundal (21 cases) varices. Thirteen patients had splenomegaly on ultrasonography. On Doppler sonography, the splenic vein could be evaluated in 21 of the 24 patients (9 and 6 had complete and partial occlusion, respectively, and 6 had patent blood flow). Urgent intervention with therapeutic endoscopy and splenectomy was performed for two patients each. Medical therapy was begun for three patients according to the underlying diseases. Three patients underwent elective surgery. Two patients were lost to follow-up after the first visit and the mean follow-up of the remaining 22 patients after diagnosis of left-sided portal hypertension was 20 months. Only one patient (with pancreas cancer) had gastrointestinal bleeding at follow-up. All patients with pancreas and gastric cancer died within 2-12 months. Left-sided portal hypertension has various etiologies. It may be difficult to diagnose this entity both endoscopically and radiologically. Treatment should be directed at the underlying diseases. Recurrent hemorrhage due to left-sided portal hypertension is not usual and the prognosis depends mainly on the underlying etiology.

Crohn's Disease (CD) and Intestinal Tuberculosis (ITB) share confusingly similar clinical, endoscopic, radiological and pathological manifestations. There is no simple test for differentiating ITB from CD. Although there are a number of sensitive and specific parameters for distinguishing between CD and ITB, the differential diagnosis still remains challenging and both clinical suspicion and appropriate clinical and laboratory studies are required to establish the diagnosis. Correct diagnosis is crucial because the therapy strategies of the two diseases are dramatically different. Treatment of ITB with immunosuppressive agents would lead to worsening of the patients' condition. Likewise, unnecessary antituberculosis therapy would delay the treatment of CD. Another important consideration is the risk of reactivation TB in patients with inflammatory bowel diseases which has been significantly increased following the widespread use of anti-Tumor Necrosis Factor Alpha (TNF-α) therapy. The majority of reactivation cases are extrapulmonary or disseminated TB. And it is widely recommended that patients with IBD who are to receive TNF inhibitor therapy should be screened for evidence of latent TB. This paper mainly reviews current literature on differential diagnosis between CD and ITB, and summarizes strategies to reduce the TB risk among candidates for TNF antagonist therapy in this specific patient population.

We read the article by Zissimopoulos et al. with great interest [1]. They aimed to assess the role of Chromogranin A (CgA) in evaluating the disease activity and responsiveness to medical treatment...

The aim of this study was to investigate the changes in serum lipid profiles in biliary obstruction associated with benign and malignant conditions and to find whether they can be used as adjunctive biochemical tumor markers in the differential diagnosis.One hundred and twenty patients (60 malignant, 60 benign) who underwent endoscopic retrograde cholangiopancreatography with the clinical picture of intrahepatic and extrahepatic cholestasis were reviewed in the period from January to July 2008.In the malignant group, significantly higher cholesterol (P0.001), low-density lipoprotein (P0.001), and triglycerides (P0.001) were observed, whereas high-density lipoprotein (P0.001) levels were lower. The receiver operating characteristic analysis showed that high-density lipoprotein 19.5 mg/dl or less [sensitivity: 88.3%, specificity: 83.3%, area under the curve: 0.906 (0.851-0.961), P0.001] and total to -high-density lipoprotein cholesterol ratio at least 17.7 [sensitivity: 80.0%, specificity: 93.1%, area under the curve: 0.921 (0.871-0.971)] were strong predictors of malignant biliary obstruction.Serum lipid profile may be used as an adjunctive marker to identify malignant causes of the obstructive jaundice.

WOS: 000313112900020, PubMed ID: 23063679, BACKGROUND & AIMS: Data are limited on the efficacy and safety of tenofovir and entecavir when given for more than 1 year to patients with hepatitis B-related cirrhosis. We investigated the long-term safety and efficacy of these antiviral drugs in patients with chronic hepatitis B virus (HBV) infection, with compensated or decompensated cirrhosis, and compared results with those from lamivudine. METHODS: We performed a retrospective analysis of data from 227 adult patients with chronic HBV infection who were diagnosed with cirrhosis, beginning in 2005, at 18 centers throughout Turkey. There were 104 patients who had decompensated cirrhosis, and 197 patients were treatment naive before. Seventy-two patients received tenofovir (followed up for 21.4 +/- 9.7 mo), 77 patients received entecavir (followed up for 24.0 +/- 13.3 mo), and 74 patients received lamivudine (followed up for 36.5 +/- 24.1 mo). We collected data on patient demographics and baseline characteristics. Laboratory test results, clinical outcomes, and drug-related adverse events were compared among groups. RESULTS: Levels of HBV DNA less than 400 copies/mL were achieved in 91.5%, 92.5%, and 77% of patients receiving tenofovir, entecavir, or lamivudine, respectively. Levels of alanine aminotransferase normalized in 86.8%, 92.1%, and 71.8% of patients who received tenofovir, entecavir, and lamivudine, respectively. Child-Turcotte-Pugh scores increased among 8.5% of patients who received tenofovir, 15.6% who received entecavir, and 27.4% who received lamivudine. Frequencies of complications from cirrhosis, including hepatic encephalopathy, variceal bleeding, hepatocellular carcinoma, and mortality, were similar among groups. Lamivudine had to be changed to another drug for 32.4% of the patients. CONCLUSIONS: Tenofovir and entecavir are effective and safe for long-term use in patients with compensated or decompensated cirrhosis from HBV infection.

To evaluate the indications, diagnostic yield, therapeutic interventions, complications and safety of double balloon enteroscopy (DBE) in clinical practice.The medical records of the patients who underwent DBE at the Turkiye Yuksek Ihtisas Hospital between October 2007 and January 2010 were examined to note the demographic data, indications for the examination, results of previous non-invasive small bowel imaging and endoscopic procedures and the results of DBE including findings, endoscopic interventions, complications and pathological reports.A total of 139 procedures were performed in 118 patients. DBE was performed 81 times through mouth and 26 times through anus and additionally both approaches were used 16 times in the same patients. Panenteroscopy was successfully performed in 13 of 16 patients (87.5%) in whom it was attempted. The most common indication was obscure gastrointestinal bleeding (28.8%). DBE had an overall diagnostic and/or therapeutic contribution in 63 (53.4%) patients. The main pathologies detected on DBE were polyps (12.7%), infammation (10.7%) and vascular lesions (3.4%). Complications were recognized in four cases (3.4%) but no major complication occured.Our retrospective analysis showed that DBE is a useful, safe and well-tolerated method with a diagnostic and therapeutic impact for the management of small bowel diseases.

Differentiation of benign obstructive jaundice from malignant obstructive jaundice still remains difficult, despite improvements in diagnostic modalities. The aim of this study is to evaluate the usefulness of red cell distribution width (RDW) in differentiating benign and malignant causes of obstructive jaundice.One hundred and ninety four consecutive patients (101 malignant, 93 benign) with a history of obstructive jaundice were reviewed in the period between January 2008 and August 2009. Definition of biliary strictures was suggested by cholangiographic features and supported by brush cytology, fine needle aspiration (FNA) and the presence of mass or metastases by imaging and/or clinical followup. Patients were divided into two groups, benign and malignant, based on the discharge diagnosis.The receiver operating characteristic analysis showed that a RDW of 14.8% was the best cut-off value for predicting a malignant biliary stricture with a sensitivity of 72% and a specificity of 69% (AUC=0.755, 95% CI=0.649-0.810). RDW was increased (14.8%) in 31.6% of benign cases and 68.4% of malignancies. Depressed RDW levels (14.8%) were found in 72.9% of benign cases and 27.1% of malignancies, which was statistically significant (p0.001).Our results show that RDW is useful in the differentiation of benign from malignant causes of biliary obstruction when using an optimized cut-off value. In patients in whom biliary obstruction is suspected, an elevated RDW value may be a reliable additional predictor for differentiating the underlying etiology of biliary obstruction.

Hepatoportal sclerosis (HPS) is a clinical syndrome of unspecified etiology depicted by enlarged spleen and portal hypertension in the lack of other chronic liver disease findings, hematological disorders or any infectious disease in the liver. Nitric oxide (NO) molecule has many important functions in human body including phagocytosis in macrophages, neural transmission and endothelial relaxation. Although there is no data in literature that depicts the role of NO in HPS pathogenesis, this study was conducted in order to evaluate the potential role of NO in patients with HPS.The study participants included 24 HPS patients and 20 healthy controls. The median age of HPS and control patients was 41.2 ± 13.9 and 46.5 ± 12.4 years, respectively. NO was predicted as nitric oxide metabolites (NOx) by Griess reaction after transformation of nitrate to nitrite by nitrate reductase using the commercially obtainable Nitric Oxide Assay Kit.Serum NOx levels were 2.69 ± 2.98 μmol/L and 0.85 ± 1.05 μmol/L for the HPS patients and controls, respectively. Serum NO levels were significantly higher in patients with HPS compared to the control group (p0.001). ROC curve analysis suggested that the optimum NOx cut-off point for HPS was 1.305 with sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 83.3%, 90 %, 90.9 %, and 81.8% respectively.Circulating NO concentration was notably higher in patients with HPS in comparison to the control group. Our study verified that an elevated level of NO might have a role in the pathogenesis of HPS.

Acute pancreatitis (AP) constitutes a systemic inflammatory process which is often accompanied by thrombosis and bleeding disorders. The role of platelets in the pathophysiology of the disease has not been elucidated yet. Mean platelet volume (MPV) is an index of platelet activation and reported to be influenced by inflammation. The objective of the present study is to assess whether platelet volume would be useful in predicting disease severity in AP. Additionally possible relationship of MPV with clinical and radiologic parameters in conjunction with other inflammatory markers during AP was also investigated.A total of 144 AP patients (male/female: 87/57), and 40 healthy subjects (male/female: 23/17) were enrolled in this study. Mean platelet volume and inflammatory parameters were measured for all study participants. Modified Glasgow Prognostic Score (mGPS) and the computerized tomography severity index (CTSI) were used as to predict the disease severity in AP patients.A statistically significant decrease in MPV levels was observed in AP patients (8.06 ± 0.71 fL) compared with healthy controls (8.63 ± 0.62 fL) (P0.001). According to the mGPS, overall accuracy of MPV in determining severe AP was 72.7% with a sensitivity, specificity, NPV and PPV of 70.6%, 73.9%, 81.9%, and 60 respectively (AUC: 0.762). Overall accuracy of MPV in predicting disease severity according to CTSI was not superior compared with other inflammation markers.The present study demonstrated that MPV is decreased in AP. Assessment of MPV with other inflammatory markers may provide additional information about disease severity in AP.

To the Editor, Gastric cancers exhibit different gross appearances, ranging from well-defined protuberant to diffuse infiltrating tumors (1). Multiple biopsies, usually 6 or more, are required to minimize the false-negative rate. However, endoscopy alone does not allow sufficient histopathologic diagnosis of submucosal tumors of the stomach. We present a case of signet ring cell gastric cancer that was not obtained by histopathological diagnosis by multiple endoscopic biopsies.

Serrated adenoma of the stomach has been very rarely reported. A 34-year-old woman underwent upper gastrointestinal endoscopy showing a serrated adenoma polyp at the posterior wall of the junction of the fundus and body of the stomach. The polyp was situated in a technically difficult area to perform a polypectomy with a snare. A banding ligation of the polyp was performed with a pneumoactivated esophageal variceal ligation device. At the follow-up, the base of the polyp was free of adenoma. Beside several other polypectomy techniques, the band ligation technique may be used in removing of the gastric polyps, which is cheap, safe and technically easy to perform.

Background and Aim: Rebleeding has remained the most important determinant of poor prognosis in peptic ulcer bleeding. Gastric acid plays an important role in the pathogenesis of rebleeding. We aimed to compare the efficiency of intermittent and continuous pantoprazole infusion treatment on peptic ulcer rebleeding after endoscopic therapy. Materials and Method: In this prospective study, patients with active peptic ulcer bleeding or non-bleeding visible vessel were treated initially with endoscopic therapy. They were randomized to receive intermittent or continuous intravenous pantoprazole treatment. Rebleeding rate, duration of hospital stay, need for total blood transfusion and need for urgent surgery were compared among both groups. Results: Rebleeding rate (6.1 vs. 8.3%), duration of hospital stay (4.17 vs. 4.41), need for total blood transfusion (2.18 vs. 2.59) and need for urgent surgery (4.1 vs. 4.2%) were similar in intermittent and continuous pantoprazole infusion therapy groups, respectively. There was no bleeding-related death in either group. Conclusion: In patients with peptic ulcer bleeding, intermittent and continuous pantoprazole infusion after successful endoscopic therapy have comparable outcomes in reducing rebleeding. Both have similar effects on hospital stay, need for blood transfusion and urgent surgery. Intermittent administration has application and cost advantages over continuous infusion.

This Case Study discusses a 57-year-old male diagnosed with an aortoenteric fistula secondary to aortic graft surgery. The case highlights the importance of performing multidetector CT as soon as possible in patients who are suspected to have this condition so a quick diagnosis can be made. Background A 57-year-old male with an aortobifemoral bypass graft presented to a gastroenterology clinic with a 3-month history of intermittent hematemesis, melena and fever. The patient had received antibiotic therapy 2 months before for the same symptoms; however, following brief regression (∼3 weeks) the symptoms had returned. Investigations Physical examination; analysis of full blood count; measurement of erythrocyte sedimentation rate, C-reactive protein levels, liver enzymes, electrolytes, renal function, serum cholesterol and serum triglyceride; HIV serology; blood, sputum, urine and stool culture analysis; performance of esophagogastroduodenoscopy, colonoscopy, abdominal ultrasonography and multidetector CT scanning. Diagnosis Aortoenteric fistula with an inflammatory mass surrounding the aortobifemoral bypass graft. Management Laparotomy with removal of the aortobifemoral bypass graft, performance of an extra-anatomic right axillofemoral bypass graft and an extra-anatomic right-left femorofemoral bypass graft.

Autosomal-dominant polycystic kidney disease is an inherited disorder characterized by multiple cysts in kidneys and other organs. A 63-year-old man was evaluated for the etiology of recurrent pancreatitis and chronic renal failure. Multiple cysts of kidneys, liver, and pancreas and pancreas divisum was diagnosed. Pancreatitis should be included in the differential diagnosis of abdominal pain in patients with ADPKD. Pancreas divisum may be a predisposing factor for acute pancreatitis in these patients.

Endoscopic retrograde cholangiography (ERCP) has a greater potential for procedure-related complications than other endoscopic procedures in the upper gastrointestinal tract (1). Extraluminal hemorrhagic complications after ERCP are relatively rare but potentially life threatening and, thus, should be identified and treated rapidly (2). In this report, we describe a very rare complication—subcapsular hepatic hematoma—resulting from a guide wire–associated injury that developed 2 days after ERCP. A 41-year-old man was admitted to our hospital with the complaints of new-onset (few hours) right upper quadrant pain. He was known to have hilar cholangiocarcinoma for the last 8 months and his last biliary stent had been replaced 2 days before as an out-patient in our ERCP unit. Physical examination revealed left upper quadrant tenderness and subfebrile fever (37.8◦C). Laboratory data were as follows: hemoglobin 12.1 g/dL, hematocrit 38%, MCV 93 fL, white blood cell count 13.5 × 109/L, platelet count 437 × 109/L. Serum biochemical tests were within normal limits other than alkaline phosphatase 2140 U/L (38–155 IU/L); γ -glutamyltransferase, 508 U/L (15–60 U/L); total bilirubin, 6.16 mg/dL (0.1– 2.0 mg/dL); and direct bilirubin, 4.74 mg/dL (0.1–0.8 mg/dL). Abdominal sonography revealed a 78× 41mm in diameter collection in the anterior part of the liver (Figure 1). There were 3 stents in the common bile duct and intrahepatic biliary ducts. Computerized tomography demonstrated the subcapsular hematoma. He was hospitalized and followed with palliative measurements including intravenous fluid replacement, antibiotics

Dear Sir, Crohn's disease (CD) is an inflammatory disease of the digestive tract, which could affect any part of the gastrointestinal tract from mouth to anus, causing a wide variety of symptoms. It is often associated with extra-intestinal manifestations, complications, and other autoimmune disorders. Although dermatofibromas (DF) are benign dermal nodules mostly affecting the extremities, shoulders, and buttocks of young adults it has not been reported among the skin manifestations of CD. Reported herein is the first case of a newly diagnosed CD with dermatofibroma. A 19-year-old female had been in good health until 15 days before hospital admission when she complained of fatigue, abdominal pain, and rectal bleeding of bright red blood. Physical examination revealed pallor, tachycardia and hypotension (blood pressure 90/45 mmHg), and mild abdominal tenderness. Her laboratory analyses were within …

Successful Endoscopic Closure of Anastomotic Leakage Following Anterior Resection of the Rectum by Endoclip Application

To the Editors, A double pylorus is a relatively unusual endoscopic finding that has been reported in 0.001–0.4% of upper gastrointestinal endoscopies [1]. It can be either congenital or acquired. In most cases, it is a complication of peptic ulcer resulting from intramural penetration of the ulcer [2]. An 85-year-old female was admitted to our hospital with symptoms of hematemesis and melena. The patient was still using multiple medications for hypertension and coronary heart disease. Physical examinations revealed hypovolemic findings at time of admission to our hospital, cold sweating, tachycardia (pulse rate 124 beats per minute), and systolic blood pressure of 90 mmHg. Rectal digital examinations revealed melena. Complete blood count revealed hemoglobin level and hematocrit value of 5.8 g/dL and 17.9%, respectively. The endoscopic view from the antrum represented a gastroduodenal fistula located on the lesser curve of the antrum and near the anatomic pylorus. The endoscope could be passed through both of the ducts, from the antrum to the duodenal bulb (Figs. 1 and 2). Further endoscopic examination showed a deep duodenal ulcer (about 1.5 cm in diameter) on the anterior wall of the duodenal bulb (Fig. 3). Penetration to the antrum could be clearly demonstrated. There was coffee-ground appearance, representing blood in stomach, and multiple ulcers with various diameters on gastric mucosa, including the fundus and proximal part of the corpus. Active bleeding was not observed during endoscopic examination. Therefore, we did not perform any therapeutic procedures. The patient was hospitalized and oral alimentation stopped, and we administered intravenous proton pump inhibitor medication. Rebleeding did not occur during the 7 days of follow-up period and the patient was discharged. Double pylorus is a rare anomaly found in less than 0.4% of upper endoscopies [1, 2]. It is seen twice as often in males when compared with females [2]. Frequently, it is a complication of peptic ulcer disease, resulting from penetration of the peptic ulcer and the creation of a fistula between the duodenal bulb and the prepyloric antrum. Occasionally it may be congenital or secondary to gastric carcinoma [3, 4]. The location of the second duct is commonly in the lesser curvature of the gastric antrum, near the anatomic pylorus. Similarly, our patient’s endoscopic