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Background: Colonic transit is delayed in two-thirds of patients with dyssynergic defecation. As a result, it's possible that dyssynergic defecation and slow transit constipation are linked. There is a scarcity of research on the coexistence of dyssynergic defecation and slow transit constipation, as well as the efficacy of biofeedback therapy in this group of patients. Methods: The results of anorectal manometry and MR defecography were used to make the diagnosis of dyssynergic defecation. The colon transit time was measured with the help of 24 specially marked markers. All of the patients were given biofeedback therapy. Results: The average age of the 17 patients with dyssynergic defecation in the study was 45.6 years. The colon transit time was prolonged in seven patients (41.2%). In anorectal manometry, 7 patients (41.2%) had improved dyssynergic defecation after dyssynergic defecation. When the relationship between colon transit time and biofeedback therapy was investigated, it was discovered that normal colon transit time was found in 85.7 percent of those who benefited from biofeedback therapy, while slow transit constipation was found in 60% of those who did not. Conclusion: In patients with pre- biofeedback therapy and dyssynergic defecation, colon transit time should be evaluated, and it should be kept in mind that these patients may be resistant to treatment in the case of accompanying slow transit constipation.

Introduction This study aimed to investigate selective muscle involvement by shear wave elastography (SWE) in patients with spinal muscular atrophy (SMA) types 2 and 3 and to compare SWE values with magnetic resonance imaging (MRI) in demonstrating muscle involvement. Methods Seventeen patients with SMA types 2 and3 were included in the study. SWE was used to evaluate stiffness of the upper and lower extremities and paraspinal muscles. Involvement of the paraspinal muscles was evaluated using 1.5-T MRI. Results Among the upper extremity muscles, SWE values were the highest for the triceps brachii; however, no significant difference was noted (p = 0.23). In post hoc analysis, a significant difference was observed between triceps brachii and biceps brachii (p = 0.003). Patients with a longer disease duration have the highest SWE values for the triceps brachii (r = 0.67, p = 0.003). Among the lower extremity muscles, SWE values for the iliopsoas were significantly higher than the gluteus maximus (p Conclusion This is the first study to report muscle involvement assessed by SWE in patients with SMA types 2 and 3. Our findings are similar to the presence of selective muscle involvement demonstrated in previous studies, and also SWE and MRI values were similar. SWE is an alternative noninvasive practical method that can be used to demonstrate muscle involvement in patients with SMA, to understand the pathogenesis of segmental involvement, and to guide future treatments or to monitor the effectiveness of existing new treatment options.

Giriş ve Amaç: Bu çalışmada 85 yaş üstü hastalarda endoskopik retrograd kolanjiyopankreatografinin endikasyonları, bulguları, başarısı ve komplikasyonları araştırıldı. Gereç ve Yöntem: Bu çalışmada 2015-2019 yılları arasında endoskopik retrograd kolanjiyopankreatografi yapılan hastaların kayıtları incelenmiş ve çalışma 85 yaş üzeri 289 hasta ile yapılmıştır. Bulgular: Çalışma 169 kadın (%58) ve 120 erkek (%42) olmak üzere toplam 289 hasta ile yapılmıştır. Hastaların ortalama yaşı 88 idi (85-108). Endoskopik retrograd kolanjiyopankreatografinin en sık endikasyonları izole karaciğer enzim yüksekliği (%39), kolanjit (%32) ve karaciğer enzim yüksekliği olmaksızın karın ağrısıydı (%21). Hastaların %66’sına yatırılarak, %87.2’sine sadece tek seans endoskopik retrograd kolanjiyopankreatografi yapılmıştı. Hastaların %28’inde divertikül mevcuttu ve %25’i sfinkterotomiliydi. Hastaların %99’u ilk seansta, tamamı ise ikinci seansta kanülize edildi. 241 hastada selektif (%83), 48 hastada precut (%16) yöntemi kullanıldı. En sık endoskopik retrograd kolanjiyopankreatografi bulguları koledok taşı (%71) ve malign biliyer darlıktı (%12). En sık görülen maligniteler ise pankreas kanseri (%38) ve kolanjiyokanserdi (%32). Taş çıkanlarda teknik başarı %99, malign hastalarda ise %100 idi. Çalışmamızda en sık görülen komplikasyonlar post-endoskopik retrograd kolanjiyopankreatografi pankreatiti (%5.8) ve kanama (%2) idi. Bir hastada tip 1 perforasyon gelişti ve hasta exitus oldu. Üç yıllık takipte mortalite oranı %26 iken 30 günlük mortalite oranı %8 olarak bulunmuştur. Sonuç: Eşlik eden kronik hastalıklara rağmen, 85 yaş ve üstü hastalarda endoskopik retrograd kolanjiyopankreatografi güvenli ve etkili bir tedavi yöntemidir., Background and Aims: We investigated the indications, findings, and success and complication rates using endoscopic retrograde cholangiopancreatography in patients aged ≥85 years. Materials and Methods: The study included 289 patients aged ≥85 years. The records of patients who had undergone endoscopic retrograde cholangiopancreatography between 2015 and 2019 were examined. Results: The study population included 169 females (58%) and 120 males (42%) with a mean age of 88 years (range, 85-108 years). The most common indications for endoscopic retrograde cholangiopancreatography were isolated liver enzyme level elevation (39%), cholangitis (32%), and abdominal pain without elevated liver enzyme levels (21%). Of the total, 66% patients were hospitalized and 87.2% patients required only 1 endoscopic retrograde cholangiopancreatography session. Diverticulum was present in 28% patients, and 25% had prior sphincterotomy. Cannulation in the first session was performed for 99% patients and in the second session for the remaining. Of the total, selective method was used in 241 patients (83%) and precut method in 48 patients (16%). The most common endoscopic retrograde cholangiopancreatography findings included choledochal stone (71%) and malignant biliary stenosis (12%). The most common malignancies included pancreatic cancer (38%) and cholangiocarcinoma (32%). A 99% technical success was achieved in patients with stone, which was 100% in patients with malignancy. The most common complications included post- endoscopic retrograde cholangiopancreatography pancreatitis (5.8%) and bleeding (2%). One patient experienced type 1 perforation and died. The 30-day mortality rate was 8%, which increased to 26% at the 3-year follow-up. Conclusion: Despite concomitant chronic diseases, endoscopic retrograde cholangiopancreatography is a safe and effective treatment for patients aged ≥85 years.

Background: Rectal indomethacin or a topical spray of epinephrine to the papilla of Vater has each shown efficacy alone in the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP). We supposed that a submucosal epinephrine injection would be more effective and longer acting than a topical epinephrine spray and therefore would further reduce the incidence of PEP. Patients and Methods: A retrospective analysis was conducted of 412 patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) between January 2017 and December 2019. These patients were divided into 2 groups: the indomethacin group and the indomethacin plus the submucosal epinephrine injection group. The incidence rates and severity of PEP, post-ERCP hyperamylasemia, other outcomes, and any other adverse events were compared between the groups. Results: Baseline demographic and clinical characteristics and procedure-related parameters were similar between the 2 groups. The incidence of PEP was 0.4% in the epinephrine group compared with 5.1% in the indomethacin group (P

Endoscopic retrograde cholangiopancreatography (ERCP) in patients with Billroth II gastrectomy is a difficult procedure. Although different endoscopes are used in these patients, comparative studies are limited. The aim of this study was to assess the efficacy and the safety of the forward-viewing gastroscope compared with the side-viewing duodenoscope. This study was conducted on 75 Billroth II gastrectomy patients who underwent ERCP by the same experienced endoscopist. Procedures were performed using side-viewing duodenoscope in the first 41 patients and forward-viewing gastroscope in the subsequent 34 patients. The success and complication rates of ERCP were compared between the two groups. Afferent loop intubation was achieved in 39 patients (95.1%) in the side-viewing duodenoscope group and in 34 patients (100%) in the forward-viewing gastroscope group (P = 0.49). The rates of reaching the papilla was 70.7% (n = 29) and 91.1% (n = 31), respectively (P = 0.06). Cannulation success rate after reaching the papilla was 100% in the side-viewing duodenoscope group and 90.3% in the forward-viewing gastroscope group. In the side-viewing duodenoscope group, 11 patients underwent sphincterotomy (EST), 14 patients underwent both EST and endoscopic papillary balloon dilatation (EPBD), and 4 patients underwent only EPBD. All but one patients in the forward-viewing gastroscope group underwent EPBD without EST. The technical and the clinical success rate did not statistically differ between the groups (70.7% vs. 82.3%, 68.3% vs. 79.4%, respectively). Adverse events included jejunal perforation in one patient (2.4%) in the side-viewing duodenoscope group, and pancreatitis in one patient (2.9%) in the forward-viewing gastroscope group (P > 0.05). This study indicates that forward-viewing gastroscope is as effective as side-viewing duodenoscope for ERCP in patients with Billroth II gastrectomy. Furthermore, EPBD without prior EST appears to be a safe and effective procedure in these patients.

Introduction: COVID-19 disease may pose a considerable health threat to healthy individuals and individuals with comorbidity. The SARS-CoV-2 virus affects the respiratory tract and may cause damage to the pancreas by binding to the ACE-2 receptor in the pancreas. In our study, we investigated the effects of hyperlipasemia on morbidity and mortality in patients diagnosed with COVID-19. Material and Method: In this study, 2350 patients diagnosed with COVID-19 between November 2020 and December 2020 were retrospectively reviewed. Other possible causes of hyperlipasemia were excluded. Hyperlipasemia secondary to COVID-19 was detected in 338 patients. These patients were divided into two groups based on their lipase elevation rates. Results: Hyperlipasemia was detected in 14.4% of the patients diagnosed with COVID-19, and severe hyperlipasemia (>3x) was detected in 2.3%. The mean age of the patients was 64±13.8 (18-92), of which 59.5% (201) were male. In our study, 24 patients (1%) were diagnosed with acute pancreatitis. When compared according to lipase level, a significant difference was found between the groups regarding the history of HT, CCI score, development of ARF at follow-up, development of ARDS, need for ICU hospitalization, need for intubation, length of stay in ICU, and death rates. A weak correlation was found in the correlation analysis between hyperlipasemia and ARDS development and mortality. Conclusion: Elevated lipase levels were associated with poor prognosis and mortality in patients with COVID-19 infection.

43 yaşında kadın hasta acil servise karın ağrısı, sarılık ve idrar renginde koyulaşma şikâyeti ile başvurdu. Hastanın adet düzensizliği nedeniyle bir ay didrogesteron preperatı aldığı öğrenildi. Labaratuar değerlerinde karaciğer enzimlerinde yükseklik saptanan ve diğer etyolojik faktörler dışlanan hastada ilaca bağlı toksik hepatit düşünüldü. Hastaya karaciğer biyopsisi yapıldı, biyopsi sonucu toksik hepatit ile uyumlu gelen hastanın ilacı kesildi ve hastaya destek tedavisi başlandı. Takipte enzimleri ve kliniği düzelen hasta önerilerle taburcu edildi. Didrogesteron her ne kadar güvenli bir ilaç olarak bilinse de ilaç kullanımında sarılık gelişen hastalarda ilacın indüklediği toksik hepatit akla gelmelidir., 43 years old female patient admitted to our clinic with icter, abdominal pain and darkness in urine. It was learned that she used a didrogesterone preparation for one month due to menstrual irregularity. Drug-induced toxic hepatitis was considered in the patient whose liver enzymes were increased and other etiological factors were excluded. Liver biopsy was performed and the biopsy was compatible with toxic hepatitis. The drug was discontinued and supportive treatment was initiated. At follow up liver enzymes regressed and patient discharged. Although didrogesterone is known to be a safe drug, drug-induced toxic hepatitis should be considered in cases of jaundice.

Asthma is the most common chronic inflammatory disease of childhood, but there are no useful and easily accessible laboratory tests routinely used in the diagnosis and follow-up of this disease in children. Therefore, this study aimed to investigate the roles of white blood cell (WBC) count, platelet count, mean platelet volume (MPV), and eosinophil percentage as full blood count inflammatory markers in evaluating the control level and follow-up of asthma in the pediatric age group.A retrospective review of patient records and files of 3,580 patients diagnosed with asthma at the University of Health Sciences in Ankara, Turkey was performed. Patients who met inclusion/exclusion criteria were divided into two groups based on the asthma control level: controlled and uncontrolled. Laboratory data were compared according to the asthma control levels, drug use status, and atopy status of the patients.A total of 348 patients between 4 and 18 years of age, who were followed-up with the diagnosis of asthma, were included in this study. A significant difference was found between the controlled and uncontrolled groups of asthma patients in terms of the eosinophil percentage (mean ± SD, respectively; 3.493 ± 2.24; 4.992 ± 3.43;Our study showed that the percentage of eosinophils can be used as an asthma control parameter, but additional prospective studies would be desirable to confirm our results.

Giriş ve Amaç: Bu çalışmada, asit sodyum düzeyinin prognostik amaçlarla kullanılabilirliği ve iki yıllık mortalite, spontan bakteriyel peritonit, hepatik ensefalopati ve hepatorenal sendrom ile ilişkisi araştırıldı. Gereç ve Yöntem: Bu çalışma Temmuz ve Ekim 2018 tarihleri arasında karaciğer sirozu olup asit sodyum düzeyi çalışılan hastalarla yapıldı. Şiddetli kalp yetmezliği, nefrotik sendrom veya elektrolit bozukluğu olan hastalar; başvuru sırasında spontan bakteriyel peritonit, hepatik ensefalopati veya hepatorenal sendromu olan hastalar ve başka bir nedenden ötürü diüretik kullanan hastalar çalışma dışı bırakıldı. Bulgular: Çalışma 72 sirotik hasta ile yapıldı [32 kadın (%44.4) ve 40 erkek (%55.6)]. Hastalar iki yıl boyunca takip edildi ve 33 hastada mortalite gelişti (%45.8). 13 hastada hepatik ensefalopati (%18.1), 13 hastada hepatorenal sendrom (%18.1) ve 32 hastada spontan bakteriyel peritonit (%44.4) gelişti. Hepatik ensefalopati, hepatorenal sendrom ve spontan bakteriyel peritonit gelişme oranı derin hiponatremi grubunda diğer hiponatremi gruplarına göre daha yüksekti (p < 0.05). Ortalama Child-Pugh ve Model for End-Stage Liver Disease-Na skorları orta ve derin hiponatremi gruplarında diğer gruplara göre daha yüksekti (p < 0.05). Asit sıvısında hiponatremi mortalite için bağımsız bir prediktör olarak bulundu ve mortalite riski derin hiponatremisi olan hastalarda hiponatremi olmayan hastalara göre 29.55 kat daha fazla bulundu. Sonuç: Bu çalışmada asit sıvısında 125 mEq/L’den daha düşük sodyum düzeyi ile artmış sirotik komplikasyonlar ve mortalite arasında ilişki olduğu gösterilmiştir., Background and Aims: In this study, we investigated the usefulness of the ascites sodium level for prognostic purposes and its association with 2-year mortality, spontaneous bacterial peritonitis, hepatic encephalopathy, and hepatorenal syndrome. Material and Methods: This study was performed between July and October 2018 in patients with liver cirrhosis in whom the ascites sodium level was studied. Patients with severe heart failure, nephrotic syndrome, or electrolyte disturbance; patients who had spontaneous bacterial peritonitis, hepatic encephalopathy or hepatorenal syndrome at admission; and patients who used diuretics for another reason were excluded from the study. Results: The study population consisted of 72 cirrhotic patients [32 females (44.4%) and 40 males (55.6%)]. The patients were followed up for 2 years, and mortality developed in 33 patients (45.8%). During follow-up, hepatic encephalopathy developed in 13 patients (18.1%), hepatorenal syndrome in 13 patients (18.1%), and spontaneous bacterial peritonitis in 32 patients (44.4%). Hepatic encephalopathy, hepatorenal syndrome, and the spontaneous bacterial peritonitis ratio were higher in the deep hyponatremia group compared with other hyponatremia groups (p < 0.05). The mean Child-Pugh and Model for End-Stage Liver Disease-Na scores were similar in the moderate and deep hyponatremia groups, and they were higher than in the other groups (p < 0.05). The mortality rate was found to be higher in the deep hyponatremia group than in the other hyponatremia groups (p < 0.05). Hyponatremia in ascites was found to be an independent predictor of mortality, and patients in the deep hyponatremia group had a 29.55-fold increased risk of mortality compared with those patients without hyponatremia. Conclusion: In this study, it was shown that deep hyponatremia less than 125 mEq/L in ascites was associated with increased cirrhotic complications and mortality.

Backgroundand Aims: In this study, we investigated the relationship between C-reaktiveprotein (CRP)/Albumin ratio (CAR) and hepatocellular carcinoma (HCC), hepaticencephalopathy (HES), mortality, Child-Pugh and MELD scores in newly diagnosedcirrhotic patients.Material and Methods: This study was performed retrospectively by examining newlydiagnosed cirrhotic patients records who applied to Gastroenterology andHepatology polyclinic between 2011 and 2017. Patients who diagnosed with HES, HCC or spontaneous bacterialperitonitis at admission and those younger than 18 years old were excluded fromthe study.Results:The study population was consisted of 118 patients,78 men (66.1%) and 40 women (33.9%). The meanage of the patients was 50.3±11.7 years. Themost common etiologic factors of cirrhosis were hepatitis B (37.3%),cryptogenic (17.8%) and hepatitis C (11.9%). Themean follow-up period of the patients was 48 months. In the multivariatestepwise Cox regression model in which risk factors were included; HESdevelopment (HR: 4,21; p=0,001), initial MELD score (HR: 1,17; p, Giriş ve Amaç: Bu çalışmada yeni tanı siroz hastalarında tanı anındaki C-reaktifprotein (CRP)/Albümin oranının (CAO) hepatosellüler karsinom (HCC), hepatikensefalopati (HES), mortalite, Child-Pugh ve MELD skorları ile ilişkisiniaraştırdık.Gereç ve Yöntem: Buçalışma 2011-2017 yılları arasında Gastroenteroloji ve Hepatoloji polikliniğebaşvuran yeni tanı siroz hastalarının hasta kayıtları incelenerek retrospektifolarak yapılmıştır. Çalışmaya alınma anında spontan bakteriyel peritonit, HESveya HCC tanısı olanlar ve 18 yaşından küçük olanlar çalışmadan dışlanmıştır.Bulgular: Araştırmapopülasyonu 78 erkek (%66,1) ve 40 kadın (%33,9) hasta olmak üzere 118 kişidenoluştu. Hastaların ortalama yaşı 50,3±11,7 yıldı. Hastalarda sirozun en sıketyolojik faktörleri hepatit B (%37,3), kriptojenik (%17,8) ve hepatit C(%11,9) idi. Hastaların ortalama takipsüresi 48 aydı. Risk faktörlerinin dahil edildiği çok değişkenli stepwise Coxregresyon modelinde; HES gelişmesi (HR:4,21; p=0,001), başlangıç MELD skoru(HR:1,17; p

Objective: In this study, we investigated the technical and clinical success and complications of transpapillary gallbladder drainage with endoscopic retrograde cholangiopancreatography in patients with gallbladder or cystic duct related diseases accompanied by comorbid conditions. Material and Methods: This study was performed on 19 patients with acute cholecystitis who had already an indication for endoscopic retrograde cholangiopancreatography due to choledocholitiasis, cholangitis or Mirizzi syndrome between 2011-2017. After choledochal and cystic duct stones had been removed, or choledochal stents had been placed according to indication, transpapillary gallbladder drainage with nasocystic drain or pigtail stent were provided in all patients. The technical and clinical success of transpapillary gallbladder drainage and the complications of the procedure were evaluated. Results: 15 (79%) of the patients had at least one comorbid disease. Cystic duct stones were observed in 10 patients. Balloon lavage to all patients with cystic duct stones, basket and mechanical lithotripsy to 3 patients, and balon dilatation to the entrance of cystic duct to one patient were applied. Transpapillary gallbladder drainage was provided with 7F nasocystic drain in 8 patients, stent made from 7F nasobiliary drain in 6 patients, 7F double pigtail stent in 3 patients and 10F double pigtail stent in 2 patients. In this study, the technical success of transpapillary gallbladder drainage was found 100% and clinical success was found 89%. No complications including death were observed due to the procedure. Conclusion: Transpapillary gallbladder drainage with endoscopic retrograde cholangiopancreatography is a successful and less complicated procedure in patients who have gallbladder or cystic duct related diseases with comorbid conditions.

Giriş ve Amaç: Kopuk pankreatik kanal sendromu pankreas kanalınınbütünlüğünün bozulmasıyla karakterizedir. Nadir görülen bu sendrom önemli bir morbidite ve mortalite nedenidir. Biz bu çalışmada kliniğimizde kopuk pankreatik kanal sendromu tanısı olan hastaların demografik özelliklerini, endoskopik retrograd kolanjiopankreatografi bulgularını ve bu hastaların aldıkları endoskopik tedavileri araştırdık. Gereç ve Yöntem: Bu çalışma Türkiye Yüksek İhtisas Hastanesi Gastroenteroloji Kliniği, Endoskopik Retrograd Kolanjiopankreatografi Ünitesinde Ocak 2010-Ocak 2017 tarihleri arasında kopuk pankreatik kanal sendromu tanısı alan hastalarla yapıldı. Kopuk pankreatik kanal senromlu hastalar etiyolojilerindeki nedenin pankreatit olup olmamasına göre ikiye ayrıldı. Kanal rüptürü 10 hastada olmak üzere en sık pankreas boynunda izlendi. Kanal rüptürünün baş ve boyunda olduğu hastalar distal grup, gövde ve kuyrukta olduğu hastalar ise proksimal grup olarak tanımlandı. Bulgular: Toplam 17 hastada kopuk pankreatik kanal sendromu vardı. Bu hastaların yaş ortancası 46 olup 14 hasta erkek, 3 hasta kadındı. Bu hastalara toplamda 27 endoskopik retrograd kolanjiopankreatografi seansı uygulandı. Etiyolojik neden olarak 9 hastada akut pankreatit, 2 hastada kronik pankreatit, 4 hastada travma ve 2 hastada ise insülinomadan dolayı yapılan pankreatektomi etiyolojik neden olarak izlendi. Akut pankreatit öyküsü olan hastaların 5 tanesi biliyer orjinliydi. 17 hastanın15’inde psödokist, 1 hastada ise walled-off nekroz vardı. Kanalrüptürünün distalde ve proksimalde olduğu hastalar arasında endoskopikretrograd kolanjiopankreatografi işlem sayısı ve pankreatite yolaçan etiyolojik nedenler karşılaştırıldı ve anlamlı bir farklılık bulunmadı(sırasıyla p=0,215, p=0,278). Sonuç: Çalışmamızda literatürle uyumluolarak kopuk pankreatik kanal sendromlu hastalarda en sık etiyolojikneden olarak akut pankreatit izlendi. Hastalarımızın çoğunda kopukpankreatik kanal sendromu boyun kısmında lokalize olup bu bulgu da literatürleuyumluydu. Bu sendroma uygun tanı konulamaması ve gereklitedavinin yapılamaması hastaların morbidite ve mortalitelerinde artışayol açacaktır.

Dear Editor; Often during routine gastroenterology examinations, ulcers and strictures in the colon and small intestine are encountered in patients. Differential diagnosis of ulcers in these patients may not always be easy. Graft-versus-host disease (GVHD) is a serious complication that can be life-threatening after allogeneic bone marrow transplantation (1). Since the introduction of modern immunosuppressive treatment regimens, clinical symptoms, radiographic and histological findings are rarely seen in chronic graft-versus-host disease (CGVHD) (2). However, CGVHD patients often present with various gastrointestinal symptoms such as esophageal reflux, dysphagia, bloating, weight loss, and diarrhea (2). Edema, erythema, diffuse polypoid lesions, multiple ulcers, and strictures in the mucosa can be observed in the endoscopic examination of intestinal GVHD (3). We present a patient who was diagnosed with CGVHD in a colonoscopic examination performed for iron deficiency anemia. A 52-year-old female patient was referred to our gastroenterology outpatient clinic for endoscopic examination after the laboratory tests revealed iron deficiency anemia. The patient's medical history revealed that she had undergone autologous stem cell transplantation in 2012 and allogeneic stem cell transplantation in 2016 with a diagnosis of Non-Hodgkin lymphoma. A hysterectomy had been performed due to myoma. When the patient's complaints were questioned, there were no gastrointestinal complaints such as bloating, constipation, diarrhea, or abdominal pain. Physical examination revealed multiple psoriasis colored rashes on the skin on the neck and nape (Figure 1). White blood cell count in laboratory tests: 8920 x103/μL, platelet: 470 x103/μL, Hgb: 10.9 g/dl, aspartate aminotransferase: 47 U/L, alanine transaminase: 39 U/L, alkaline phosphatase: 99 U/L, total bilirubin: 0.56 mg/dl, albumin: 4.2 g/dL, serum iron: 115 u/dl, total iron-binding capacity: 274 u/dl, ferritin: 12 u/L, vitamin B12: 353 ng/L were detected. The colonoscopic examination showed that, in the ascending colon, the lumen was narrowed fibrotically, not allowing the endoscope to pass proximally (Figure 2). In addition, multiple ulcerated lesions extending perpendicular to the lumen, covered with white exudate, causing shrinkage in the mucosa, and approximately 5-6 mm diameter were observed in the ascending colon, transverse colon, and descending colon (Figure 3). In the pathological examination of the biopsies taken from the lesions, the patient was diagnosed with CGVHD after intense inflammation in the lamina propria. Apoptosis in the crypts was observed, and cytomegalovirus (CMV) was excluded (Figure 4). Endoscopic images of GVHD-induced gastrointestinal involvement vary, and the involvement of lesions may be focal or diffuse (4,5). Various lesions such as mild mucosal erythema, edema, prominent ulcers, lytic mucosal lesions can be seen in the upper and lower gastrointestinal tract (GIS) in endoscopic evaluation. The demonstration of apoptosis is very supportive for diagnosis. The diagnosis of gastrointestinal GVHD is made by endoscopic examination and mucosal biopsy, in the endoscopic biopsy (3). Other causes of apoptotic colopathy, especially CMV, should be considered in the differential diagnosis. Thus, chronic GVHD should be considered in the differential diagnosis of strictures and ulcers in a colonoscopic examination.

Pediatrik tromboz epidemiyolojisi, patofizyolojisi ve tedavi oncelikleri nedeniyle eriskin tromboz yonetiminden cok farkli ozelliklere sahiptir. Tromboz teshisi konan cocuklar, multidisipliner bir ekip tarafindan tani, tedavi ve takip suresince degerlendirilmelidir. Burada pediatrik tromboz hastalarimizin yonetildigi 2 yillik multidisipliner tromboz konseyi deneyimimizi sunuyoruz. Kasim 2017-Agustos 2019 tarihleri arasinda 61 cocuk (95 basvuru) icin tromboz konseyi olgu sunumlarini ve konsey sonuclarini geriye donuk olarak inceledik. Degerlendirilen hastalarda erkek/kadin orani 1,54 saptandi, cocuklar ve adolesanlar cogunluktaydi. Hastalarin klinik ve radyolojik durumlarina gore tedavi ve profilaksi sureleri belirlendi. Olgularimiz icinde serebral arteriyel ve sinovenoz tromboz olgulari daha fazla idi. Kazanilmis risk faktorleri, kalitsal olanlardan daha fazla olup, infeksiyon ve Faktor VIII yuksekligi sik idi. Otuz dokuz hastaya (%64) farkli sureler boyunca K vitamini antagonistleri, aspirin veya LMVH ile primer veya sekonder profilaksi uygulandi. Pediatrik trombozda kanita dayali kilavuzlarin iyilestirilmesi icin tedavi ve profilaksi yonetimi uzerine daha fazla calismaya ihtiyac vardir. Multidisipliner tromboz konseyi komplike pediatrik trombozlu cocuk hastalarda hasta bakimini iyilestirebilir.

Background/aims We aimed to investigate the association of bezoar with endoscopic findings, risk factors for bezoar occurrence, and the success of endoscopic treatment in a tertiary center. Materials and methods This retrospective study was conducted between January 2012 and December 2015. Overall, 8200 endoscopy records were examined and 66 patients with bezoar were included in the study. Results We enrolled 29 (44%) female and 37 (56%) male patients in this study. The mean age of the patients was 63±9.4 years. The most frequent risk factors were history of gastrointestinal surgery (23%), diabetes mellitus (17%), trichophagia (9%), and anxiety disorder (6%). Gastric ulcer, duodenal ulcer, erosive gastritis, and reflux esophagitis were present in 27%, 11%, 20%, and 23% of the patients, respectively. While bezoars were most commonly observed in the stomach (70%), the majority of them were phytobezoars (91%). The mean number of interventions for each patient was 1.5 (range, 1-6). Endoscopy was successful in removing bezoars in 86.5% of the patients. Among those referred to surgery, seven patients underwent gastrostomy (10.5%); one (1.5%) patient underwent gastroenterostomy because of concomitant pyloric stenosis; and one (1.5%) patient underwent fistula repair surgery due to the development of duodenal fistula caused by bezoar. Conclusion The findings of this study indicated that bezoars are more common among subjects with history of gastrointestinal surgery, diabetes mellitus, or psychiatric disorders; bezoars are closely related to peptic ulcer and reflux esophagitis; and they can be successfully treated with endoscopy.

[Abstract Not Available] WOS:000572115500019 2-s2.0-85091601532 PubMed: 32303089

Kanama, endoskopik retrograd kolanjiyopankreatografinin (ERCP) ciddi komplikasyonlarından biri olup insidansı %1-2 arasında değişir. Kanama sıklıkla endoskopik sfinkterotomi ile ilişkilidir, bununla beraber vaka serilerinde sfinkterotomi ilişkisiz kanamalar da bildirilmiştir. Biliyer metal stentin barsak duvarında yaptığı irritasyona bağlı oluşan kanamalar sfinkterotomi ilişkisiz kanamalara örnek gösterilebilir. Biliyer stent öyküsü olan hastaların stentin olduğu yerde ağrı ile gelmesi stentin barsak duvarına yaptığı irritasyonu akla getirir. Literatürde migre olmadan deformasyonla barsak duvarı irritasyonu yapan ve kanamaya yol açan biliyer metal stent görülmemiştir. Burada öncesinden ERCP ile biliyer metal stent konulan ve metal stentin deformasyonuna bağlı duodenumda oluşan ülserin yol açtığı kanama ile gelen hastamızı sunduk.

Background and Aims: This study investigated the etiologic causes, stenosis locations, and endoscopic treatment options of caustic gastrointestinal injury. Material and Methods: This study was performed retrospectively, with 41 patients who were treated endoscopically for stenosis caused by caustic damage between 2005 and 2015. Data such as patients’ demographic characteristics, surgical information, ingested material, and stenosis locations were obtained from their medical records. Results: This study comprised 41 patients. The mean age of patients was 32±9.2 years. Of these, 25 patients were males (61%), and 16 were females (39%). The median number of endoscopy procedures was 9 and ranged from 1 to 32. The most common cause of caustic damage was ozone water (19%), degreasers (15%), and descaling agents (15%). Endoscopic examination revealed stenosis in the middle esophagus (41%), but less frequently in the proximal esophagus (19%), distal esophagus (19%), anastomosis (10%), and the entire esophagus (7%). Six patients were operated for strictures (15%). Savary-Gilliard and balloon dilatation were the most frequently applied treatments. Two patients had local steroid injections, and two had stents. Conclusion: Esophageal stenosis because of caustic ingestion develops most frequently by ingesting cleaning agents and most commonly involves the middle part of the esophagus, with the most commonly used treatment options being balloon and Savary-Gilliard dilatation., Giriş ve Amaç: Bu çalışmada gastrointestinal kostik yaralanma sonrası endoskopik tedavi uygulanan hastaların etiyolojik nedenlerini, darlık yerlerini ve uygulanan tedavileri araştırdık. Gereç ve Yöntem: Bu çalışma 2005-2015 yılları arasında kostik hasara bağlı darlık nedeniyle endoskopik olarak tedavi edilen 41 hasta ile retrospektif olarak yapılmıştır. Hastaların demografik özellikleri, ameliyat bilgileri, ne içtikleri ve darlık yerleri dosyalarından kaydedilmiştir. Bulgular: Bu çalışma 41 hasta ile yapılmıştır. Hastaların ortalama yaşı 32±9.2 idi. Hastaların 25’i erkek (%61), 16’sı ise kadındı (%39). Hastaların median işlem sayısı 9 olup, işlem sayısı 1 ile 32 arasında değişmekteydi. Kostik hasarın en sık sebebi ozon suyu (%19), yağ çözücü (%15) ve kireç çözücü (%15) idi. Endoskopik incelemede darlıklar en sık orta özofagusta (%41) görülmekle birlikte daha az sıklıkla proksimal özofagus (%19), distal özofagus (%19), anastomoz (%10) ve tüm özofagusta (%7) görülmekteydi. 6 hastanın darlıklar nedeniyle opere edildiği görüldü (%15). Hastalara yapılan terapötik işlemler incelendiğinde en sık buji ve balon dilatasyonu uygulandığı görüldü. İki hastaya lokal steroid enjeksiyonu ve iki hastaya da stent takıldığı görüldü. Sonuç: Kostik madde içimine bağlı özofagus darlığı en sık olarak temizlik maddelerinin içimine bağlı olarak gelişmekte, en sık özofagus orta kısmını tutmakta ve tedavide en sık balon ve buji dilatasyon tedavisi kullanılmaktadır.

Giriş ve Amaç: Perkütan endoskopik gastrostomi uzun süreli enteral nütrisyona gereksinim duyan hastalarda beslenme için tercih edilen yöntemdir. Bu çalışmada perkütan endoskopik gastrostomi uygulanan hastalarımızdaki kısa ve uzun dönem sonuçlarımızı araştırdık. Gereç ve Yöntem: Bu çalışma Haziran 2017-Mayıs 2019 tarihleri arasında hastanemiz endoskopi ünitesinde perkütan endoskopik gastrostomi uygulanan hastalar ile yapıldı. Hastaların perkütan endoskopik gastrostomi endikasyonları, işlem detayları, takip süreleri ve gelişen komplikasyonlar retrospektif olarak hasta dosyalarından kaydedildi. Bulgular: Çalışmaya dahil edilen 58 hastanın 34’ü (%58.6) erkek, 24’ü ise (%41.4) kadındı. Hastaların ortalama yaşları 68.4 yıl idi (18-94). Üç hasta dışındaki 55 hastaya perkütan endoskopik gastrostomi başarıyla uygulandı (%94.8). En sık perkütan endoskopik gastrostomi yerleştirme endikasyonu nörolojik hastalıklardı (%84.4). Diğer endikasyonlar ise multitravma, malignite ve septisemiydi. Larenks kanseri nedeniyle total larenjektomili bir hastada özofagus darlığı nedeniyle balon dilatasyonu yapıldıktan sonra perkütan endoskopik gastrostomi yerleştirildi. Perkütan endoskopik gastrostomi prosedürüne bağlı olarak 4 hastada minör komplikasyonlar gözlendi (%7.3). Mortalite dahil hiçbir hastada majör komplikasyon görülmedi. Perkütan endoskopik gastrostomi prosedürü sonrası bir aylık dönem içinde 5 hastada (%8.6), bir aydan uzun dönemde ise 27 hastada diğer sebeplere bağlı mortalite gelişti (%46.6). Ölen 32 hastanın ortalama takip süresi 82 gün iken (4-355) kalan 23 hastanın ortalama takip süresi ise 279 gün idi (18-657). Sonuç: Perkütan endoskopik gastrostomi; beslenme desteğinin enteral olarak sağlanmasında güvenli, gereğinde yatak başında kolayca uygulanabilen, minimal invaziv, iyi tolere edilen ve düşük komplikasyon oranına sahip bir uygulamadır.

Background The American Society for Gastrointestinal Endoscopy (ASGE) has recently published a guideline for suspected CBDS with the intention of reducing unnecessary ERCP and thereby complications. The aim of this study was to assess the diagnostic efficacy of the ASGE guideline. Methods Data of patients who underwent ERCP with suspected CBDS were analyzed retrospectively. Patients were classified into high, intermediate and low risk groups based on predictors that have been suggested by the ASGE. Very strong predictors of the presence of ductal stones included: CBDS on transabdominal ultrasonography (US), clinical ascending cholangitis or total bilirubin (TBIL) >4 mg/dL). Strong predictors included dilated CBD >6 mm on US with gallbladder in situ and TBIL level of 1.8–4.0 mg/dL whereas moderate predictor included abnormal liver biochemical test other than bilirubin, age more than 55 years and clinical findings of biliary pancreatitis. Results Of 888 enrolled patients, 704 had CBDS demonstrated by ERCP and the remainder did not. All very strong and strong predictors were found to be significantly higher among patients who had CBDS. Detection of CBDS by ultrasonography and a dilated common biliary duct were observed to be independent risk factors associated with the existence of CBDS. The high risk group had a high (86.7%) positive predictive value (PPV), however, sensitivity and specificity were observed to be moderate (67.8% and 60.3% respectively). PPV was 67.9% in the intermediate risk group and the sensitivity and specificity were very low (31.9% and 42.3%). Discussion The probability of CBDS was observed to be high in the intermediate and high risk groups. However due to low sensitivity and specificity values, the ASGE guideline needs additional or different predictors.

Background. Most common bile duct (CBD) stones can be removed with standard techniques using endoscopic retrograde cholangiopancreatography (ERCP), but in some cases additional methods are needed. In this study we aimed to investigate the management of patients with difficult stones and the factors that affect the outcome of patients that have undergone periodic endobiliary stenting. Materials and Methods. Data of 1529 patients with naive papilla who had undergone ERCP with an indication of CBD stones was evaluated retrospectively. Stones that could not be removed with standard techniques were defined as “difficult stones.” Cholangiograms of patients who had difficult stones were revised prospectively. Results. Two hundred and eight patients (13.6%) had difficult stones; 150 of these patients were followed up with periodic endobiliary stenting and successful biliary clearance was achieved in 85.3% of them. Both CBD (p<0.001) and largest stone size (p<0.001) were observed to be significantly reduced between the first and the last procedure. This difference was even more significant in successfully treated patients. Conclusions. Periodic endobiliary stenting can be used as an effective treatment for patients with difficult stones. Sizes of the CBD and of the largest stone are independent risk factors that affect the success rate.

Giriş ve Amaç: Periampuller bölge tümörleri tüm gastrointestinal malignensilerinyaklaşık %0,5-2’sini oluşturmaktadır. Bu tümörler arasında en sıkolarak pankreas başı ve ampulla vateri kanseri görülmektedir. Bu tümörlerinerken tanısı ve benign lezyonlardan ayırımı tedavi şeklinin belirlenmesindeönem taşımaktadır. Çalışmamızın amacı, papiller forseps biyopsinin pankreastümürü ve ampulla vateri tümörü tanısında etkinliğinin değerlendirilmesive iki tümöre ait özelliklerin karşılaştırılmasıdır. Gereç ve Yöntem: ÇalışmaTürkiye Yüksek İhtisas Hastanesi endoskopik retrograd kolanjiopankreatografiünitesinde 7 yıllık periyotta endoskopik retrograd kolanjiopankreatografiyapılan ve papiller forseps biyopsisi alınan hastalar geriye yönelik tarandı.Bulgular: Çalışmaya toplam 135 hasta dahil edildi. Toplam 58 (%50) hastadamalignite tespit edildi. En sık saptanan malign tümörler ampulla vaterikanseri ve pankreas başı kanseri idi [sırası ile hastaların %28.4 (n=33) ve%12.1 (n=14)]. Papiller forseps biyopsinin periampuller bölge tümörü tanısındaspesifitesi %96.7 ve sensitivitesi %72.4 ölçüldü. Papilin endoskopikgörünümüne göre endoskopistin yorumunun periampuller bölge tümörü tanısındasensitivitesi %64.3 olarak ölçüldü. Pankreas başı kanseri ile ampullavateri kanseri arasında hastaların verileri iki kanser grubu arasında karşılaş-tırıldığında sadece CA-19.9 değerleri iki grup arasında farklıydı (sırası ile365 U/ml ve 78 U/ml; p=0.01). Sonuç: Periampuller bölge tümörleri’ninayırıcı tanısında duedonoskop eşliğinde gerçekleştirilen papiller forseps biyopsisioldukça yararlı bir yöntemdir. Ek olarak malign hastaların ayırımındapapilin endoskopi görünümünün değerlendirilmesi ve tümör markırlarınınkullanımı ile bu yöntemin etkinliği daha da arttırılabilir., Background and Aims: Periampullary area tumors account for about 0.5-2% of all gastrointestinal malignancies. Malignant tumors of pancreatic headand ampulla vater are the most seen tumors of this region. The early diagnosisof these tumors and separation from benign lesions are importantin choosing a treatment modality. The aim of our study is to evaluate theactivity of papillary forceps biopsy in the diagnosis of pancreatic and ampullavater tumors, and to compare the two tumors’ properties. Materials andMethods: Patients in whom papillary forceps biopsy was performed werescreened retrospectively in the endoscopic retrograde cholangiopancreatographyunit of Türkiye Yüksek İhtisas Hospital within 7-year period. Results:A total of 135 patients were included in the study. Malignancy was detectedin 50% of patients (n=58). The most frequent malignant tumors wereampulla vater cancer and pancreatic cancer [28.4% of patients (n=33); and12.1% (n=14), respectively]. The specificity of papillary forceps biopsy in thediagnosis of periampullary area tumors was found to be 96.7%, and sensitivitywas 72.4%. When the endoscopist view was evaluated according to thepapillary endoscopic appearance, sensitivity was measured as 64.3%. OnlyCA-19-9 levels were statistically different between pancreatic head cancerand ampulla vater cancer groups (365 U/ml and 78 U/mL, respectively; p =0.01). Conclusion: Papillary forceps biopsy performed with duodonoscopyis a useful method in the differential diagnosis of periampullary tumors. Thismethod can be further improved by the evaluation of endoscopic apparanceof papillae and additionally by using tumor markers.

Girişve Amaç: Shatzki halkası özofagus alt kısmında lümeni halkaveya yüzük şeklinde daraltan yapılardır. Bu çalışmada Shatzki halkasının endoskopikbulgular ve diğer hastalıklar ile ilişkisini araştırmayı amaçladık. Gereç ve Yöntem: Bu çalışma Ocak2014-Aralık 2015 tarihleri arasında endoskopi yapılan hastaların kayıtlarıincelenerek retrospektif olarak yapılmıştır. Toplamda 5.000 endoskopi kaydıincelenmiş ve Shatzki halkası tespit edilen 104 hasta çalışmaya dahiledilmiştir. Bulgular: Araştırma popülasyonu 46 kadın (%44,2) ve 58 erkek (%55,8) erkek hasta olmak üzere 104 kişiden oluştu.Hastaların ortalama yaşı 60,8±14,1 yıldı. Hastaların en sık başvuruendikasyonları disfaji (%26), dispepsi (%38,5) ve karın ağrısı (%28,8) idi.Endoskopi bulguları incelendiğinde hastaların %53,8’inde reflü özofajit,%50’sinde hiatal herni tespit edildi. Özofageal divertikül %4,8, başka web %1,özofageal ülser %5.7, özofageal polip %0,9, özofagus varisleri %1,9, özofagusmotilite bozuklukluğu (hipertrofik alt özofagus sfinkteri) %1,9 ve Barrettözofagus %3,8 hastada tespit edildi. Hastaların %58’inde Helicobacter pylori, %19’unda demir eksikliği anemisi ve %5,7’sinde vitamin B12 eksikliği saptandı. Sonuç:Shatzkihalkası aralıklı disfajinin önemli sebeplerinden biri olup reflü özofajit,hiatal herni ve demir eksikliği anemisi ile birliktelik göstermektedir., Background and aim: The Schatzki ring is a ring-shaped luminalconstriction in the lower part of the esophagus. In this study, we aimed toinvestigate the relationship of the Schatzki ring with endoscopic findings and otherdiseases. Material and Methods: Thisstudy was retrospectively conducted by examining the records of patients whounderwent endoscopy between January 2014 and December 2015. A total of 5.000endoscopic recordings were examined, and 104 patients with Schatzki ring were included in the study. Results: The study population consistedof 104 patients, 46 (44.2%)female and 58 (55.8%)male. The mean patient age was 60.8±14.1 years. The most frequent admission indications were dysphagia(26%), dyspepsia (38.5%), and abdominal pain (28.8%). When endoscopic findings were examined,53.8% of patients had reflux esophagitis and 50% had hiatal hernia. Esophageal diverticulum waspresent in 4.8%; other esophageal web, in 1%; esophageal ulcer, in 5.7%; esophageal polyp, in 0.9%; esophageal varices, in 1.9%; esophagus motility disorder(hypertrophic lower esophageal sphincter), in 1.9%; and Barret’s esophagus, in 3.8%. Helicobacterpylori was diagnosed in 58% of patients; iron deficiency anemia, in 19%; and B12 deficiency, in 5.7%. Conclusion:The Schatzki ring is one of the important causes ofintermittent dysphagia and is associated with reflux esophagitis, hiatalhernia, and iron deficiency anemia.

Hidatik kistin safra yollarına rüptüre olması sık görülenbir komplikasyondur (%5-25). İntrabiliyer rüptüre bağlı oluşankomplikasyonlardan biri de akut pankreatittir. Karaciğer kist hidatiğinintedavisinde ideal yaklaşım tartışmalıdır. Tedavide cerrahi yöntemler, perkütanaspirasyon, enjeksiyon ve reaspirasyon metodu ve endoskopik yöntemlerletedaviler (sfinkterotomi, nazobiliyer drenaj kateteri yerleştirilmesi, stentyerleştirilmesi, kist evakuasyonu) kullanılabilir. Uygun hastalarda safrayollarına rüptüre olmuş hidatik kistin tedavisinde endoskopik kist evakuasyonutek başına güvenli ve etkin bir tedavi metodudur., Ruptureof hydatic cysts into the biliary system is a common complication with 5%-25%frequency. Rupture into the biliary system can cause acute pancreatitis. Theideal treatment modality of liver hydatic cysts is controversial; however,surgery and endoscopic methods such as sphincterotomy, stent insertion, andcyst evacuation are well-known treatment options. In appropriate patients,endoscopic cyst evacuation is a safe and effective endoscopic treatmentmodality.

Backgrounds and Aim: After the colonoscopic polypectomy, patients were followed-up according to international guidelines. In this study, we aimed to determine whether there was compliance with follow-up intervals as specified by the guidelines. Also, we researched whether there is any beneficial effect of reduced follow-up intervals for detecting AAP and/or colon carcinoma. Material and Methods: Patients who had a colonoscopy between January 2008 and December 2015 in Türkiye Yüksek İhtisas Training and Research Hospital, Gastroenterology Department, Endoscopy Unit were enrolled in the study. Patients who had detected adenoma on their first colonoscopy were divided into two groups: Group A and Group B. In Group A, colonoscopic surveillance was performed earlier according to the current guideline, and in Group B, colonoscopic surveillance was performed properly according to the current guideline. Between the two groups, the detection rate of AAP and/or colon carcinoma were compared. Results: Overall, 270 patients (mean age: 56.8 years) were included in the study. At their first colonoscopies, 759 polyps, 528 adenomas, and 95 AAPs were detected. In our clinical practice, the interval between the first and second colonoscopy was 21 months. Group A had 228 patients (84.1%), and Group B had 42 patients (15.9%). Between the two groups, the detection rates of AAP and cancer could be compared. Between the two groups, the presence of AAP (6.6% vs. 11.9%; p = 0.2) and colon carcinoma (0.4% vs. 0%; p = 1.0) was not different. Conclusion: Compared with current guidelines, reduced follow-up intervals between the first and second colonoscopies are not associated with conferring additional beneficial effects to patients., Giriş ve Amaç: Kolonoskopikpolipektomi yapıldıktan sonra hastalar uluslararası kılavuzlarca önerilen takiparalıklarına göre izlenir. Bu çalışmada klinik pratikte, kılavuzlarcabelirlenmiş olan takip aralıklarına uyulup uyulmadığı ve takip aralığınıkısaltmanın advanced adenomatöz polip (AAP) ve/veya kolon kanseri saptanmasıüzerine önleyici etkisi olup olmadığının araştırılması amaçlanmıştır.Gereç ve Yöntem:Türkiye Yüksek İhtisas Eğitim ve Araştırma Hastanesi Gastroenteroloji KliniğiEndoskopi Ünitesinde Ocak 2008-Aralık 2015 tarihleri arasında kolonoskopiyapılan 2178 hastanın verileri retrospektif olarak incelendi. İlk kolonoskopideadenomsaptanan olgular, kılavuzların belirttiğinden daha erken takip kolonoskopisiyapılan (Grup A) ve kılavuzların önerdiği sürede takip kolonoskopisi yapılanlar(Grup B) şeklinde 2 gruba ayrılarak AAP ve kanser varlığı açısından karşılaştırıldı.Bulgular: Çalışmaya başlangıç kolonoskopi esnasında yaşortalaması 56,8 olan 270 olgu dahil edildi. Bu hastaların ilk kolonoskopisinde759 polip, 582 adenom ve 95 AAP tespit edildi. Klinik uygulamamızda ilkkolonoskopi ile ikinci kolonoskopi arası ortanca süre 21 aydı. Olguların 228(%84,1)’i Grup A, 42 (%15,9)’si ise Grup B’de idi. İki grup arasında takipkolonoskopi esnasında AAP (%6,6 vs. %11,9, p=0,2) veya kanser (%0,4 vs. %0 p=1.0) varlığı açısındananlamlı bir fark bulunmadı.Sonuç:İlkkolonoskopide polip saptanan hastalara kılavuzlara göre belirtilen süreden dahakısa aralıklarda takip kolonoskopi yapmanın anlamlı düzeyde ek bir faydasıgösterilememiştir.

We aimed to investigate the prognostic importance of platelet-lymphocyte ratio (PLR) and neutro - phil-lymphocyte ratio(NLR) combination for patients diagnosed with acute pancreatitis and its relationship with mortality.This retrospective study was included 142 patients diagnosed with acute pancreatitis. Ranson, Atlanta and BISAP 0h, 24h and 48h scores of the patients were calculated by examining their patient files. The patients were divided into three groups as low-risk, medium-risk and high-risk patients according to their PLR and NLR levels.The number of patients with acute pancreatitis complications such as necrotizing pancreatitis, acute renal failure, sepsis and cholangitis was significantly higher in the high-risk group compared to other groups. Mortality rate was found to be 90% in the high-risk group, 16% in the medium-risk group, and 1.9% in the low-risk group. The number of patients with a Ranson score of 5 and 6, a severe Atlanta score, a BISAP 0h score of 3 and 4, a BISAP 24h and 48h score of 4 and 5 was higher in the high-risk group compared to other groups. PLR-NLR combination, Atlanta and Ranson scores, and C-reactive protein level were determined to be independent risk factors predicting mortality in stepwise regression model. PLR-NLR combination had the highest area under curve value in terms of predicting acute claspancreatitis prognosis and had a similar diagnostic discrimination with other scoring systems.In our study it was found that PLR-NLR combination had a similar prognostic importance with other scoring systems used to determine acute pancreatitis prognosis.Svrha ovog istraživanja je da se utvrdi značajnost kombinacije trombocitno-limfocitnog odnosa (PLR) i neutrofilnolimfocitnog odnosa (NLR) za dijagnostikovanje aktunog pankreatitisa kao i u odnosu na mortalitet.Retrospektivno izučavanje obuhvatilo je 142 pacijenta sa dijagnozom akutnog pankreatitisa. Ranson, Atlanta i BISAP 0h, 24h i 48h skorovi kod pacijenata računati su uvidom u istorije bolesti pacijenata. Pacijenti su podeljeni u tri grupe i to niskog, srednjeg i visokog rizika prema nivoima njihovih PLR i NLR.Broj pacijenata sa akutnim pankreasnim komplikacijama kao što su nekrotizirajuči pankreatitis, akutni renalni poremečaj, sepsa i holangitis bili su znaćajno viši u grupi sa visokim rizikom u odnosu na druge grupe. Nađeno je da je kod visoko rizićne grupe mortalitet iznosio 90%, 16% kod grupe sa srednjim rizikom i 1,9% kod grupe niskog rizika. Broj pacijenata sa Ranson skorom 5 i 6, teškim Atlanta skorom, i BISAP 0h skorom 3 i 4, i BISAP 24h i 48h skorom 4 i 5 je bio viši u grupi sa visokim rizikom u odnosu na druge grupe. Utvrđeno je da su PLR-NLR kombinacija, Atlanta i Ranson skorovi, i nivo C-reaktivnog proteina bili nezavisni faktori rizika u predviđanju mortalitea u regresionom modelu. PLR-NLR kombinacija je imala največu površinu ispod vrednosti krive u predviđanju prognoze akutnog pankreatitisa i slićnu dijagnostićku diskriminaciju sa drugim skor sistemima.U našem izučavanju nađeno je da PLR-NLR kombinacija ima sličan prognostički značaj sa drugim skor sistemima koji se koriste za utvrđivanje prognoze akutnog pankreatitisa.

Background Serum C-reactive protein (CRP) increases and albumin decreases in patients with inflammation and infection. However, their role in patients with acute pancreatitis is not clear. The present study was to investigate the predictive significance of the CRP/albumin ratio for the prognosis and mortality in acute pancreatitis patients. Methods This study was performed retrospectively with 192 acute pancreatitis patients between January 2002 and June 2015. Ranson scores, Atlanta classification and CRP/albumin ratios of the patients were calculated. Results The CRP/albumin ratio was higher in deceased patients compared to survivors. The CRP/albumin ratio was positively correlated with Ranson score and Atlanta classification in particular and with important prognostic markers such as hospitalization time, CRP and erythrocyte sedimentation rate. In addition to the CRP/albumin ratio, necrotizing pancreatitis type, moderately severe and severe Atlanta classification, and total Ranson score were independent risk factors of mortality. It was found that an increase of 1 unit in the CRP/albumin ratio resulted in an increase of 1.52 times in mortality risk. A prediction value about CRP/albumin ratio >16.28 was found to be a significant marker in predicting mortality with 92.1% sensitivity and 58.0% specificity. It was seen that Ranson and Atlanta classification were higher in patients with CRP/albumin ratio >16.28 compared with those with CRP/albumin ratio ≤16.28. Patients with CRP/albumin ratio >16.28 had a 19.3 times higher chance of death. Conclusion The CRP/albumin ratio is a novel but promising, easy-to-measure, repeatable, non-invasive inflammation-based prognostic score in acute pancreatitis.

Elli altı yaşında erkek hasta karaciğer nakli sonrası anastomoz darlığı ve kolanjit tanısı ile kliniğimize başvurdu. Hastaya perkütan transhepatik kolanjiografi (PTK) yapıldı. Kolanjit tanısı ile imipenem başlandı. Ancak ateş ve beyaz küre değerinde yükseklik olması üzerine imipenem tedavisinin 10. gününde teikoplanin eklendi. İlaç başlandıktan bir gün sonra tonik klonik epileptik nöbetleri oldu. Kranial bilgisayarlı tomografi (BT), elektroensefalografi (EEG) ve kranial magnetik rezonans görüntüleme (MRG) çekildi. Sadece MRG’de kronik iskemik değişiklikler saptandı. Laboratuvar analizinde kan sodyum 124 mEq/L saptanan hastaya replasman tedavisi yapıldı. Hastaya levetiracetam başlandı. Epileptik atakları tekrarlayan hastada metabolik asidoz gelişti ve entübe edildi. Teikoplanin verilmesinden hemen sonra başlaması ve diğer etiyolojik faktörlerin dışlanması nedeniyle nöbetlerin teikoplanine bağlı olabileceği düşünüldü ve hastanın ilacı kesildi. İlaç kesilmesi sonrası nöbetler kesildi. Ancak ventilatöre bağlı pnömoni gelişen hasta exitus oldu. Enfekte ve teikoplanin alan bir hastada nöbet varlığında ilaca bağlı nöbet akılda tutulmalıdır.

Primary sclerosing cholangitis (PSC) is a chronic cholestatic liver disease. Cholangiocarcinoma (CCA) is one of the feared complications of PSC. In our study, we aim to establish the success of brush cytology and CA 19-9 in putting the diagnosis of CCA. The data of 30 PSC patients was retrospectively screened whom had brush cytology performed due to dominant strictures. The definitive diagnosis was established by histopathological examination or via radiological/clinic follow-up for at least 12 months. A total of four patients were excluded from the study. Twenty-six patients diagnosed with PSC, six of which were also diagnosed with CCA, were included in the study. The sensitivity and the specificity of the brush cytology in the diagnosis of CCA in PSC patients were 66.7 and 95 %, respectively. CA 19-9 had high correlation with bilirubin level. The optimal level of CA 19-9 in the diagnosis of CCA was determined to be 138.5 U/ml. Superiority of Ramage scoring over CA 19-9 in the diagnosis of CCA in PSC patients was not established (sensitivity and specificity were 50 %, 94.7 % and 83.3 %, 85 %, respectively). Brush cytology has moderate sensitivity in differentiating strictures in PSC patients. CA 19-9 has high sensitivity but bilirubin level can affect the CA 19-9. Therefore, advanced techniques and parameters are needed for detecting CCA in PSC patients.

BACKGROUND/AIMS We aimed to assess the effect of azathioprine on mucosal healing in patients with inflammatory bowel diseases (IBD). Artificial neural networks were applied to IBD data for predicting mucosal remission. MATERIALS AND METHODS Two thousand seven hundred patients with IBD were evaluated. According to the computer-based study, data of 129 patients with IBD were used. Artificial neural networks were performed and tested. RESULTS Endoscopic mucosal healing was found in 37% patients with IBD. Male gender group showed a negative impact on the efficacy of azathioprine (p

Nazobiliyer drenaj başlıca; akut süpüratif kolanjit, safra yollarına açılmış kist hidatik, postoperatif safra kaçakları ve kolestaz ilişkili özellikle kaşıntı gibi semptomların giderilmesinde tercih edilen endoskopik drenaj metodlarından biridir. Nazobiliyer drenajın çeşitli avantajlarının yanında, işlem süresini uzatması, oral kaviteden nazal yola geçirirken nadir de olsa zedelenmeye sebep olması, uyumsuz hastalarda kateterin yerinden çıkması ve hastada rahatsızlık hissi oluşturması gibi dezavantajları söz konusudur. Ancak nazobiliyer drenaj nedeniyle akut böbrek yetmezliği gelişimi ile ilgili literatürde bir veri yoktur. Burada koledok distalde muhtemel malign darlık ön tanısı ile nazobiliyer drenaj konulup cerrahiye refere edilen ancak bu süreçte aşırı biliyer drenaj ilişkili akut böbrek yetmezliği gelişen olguyu sunuyoruz., Nasobiliary drainage, an endoscopic drainage method, is used mainly for the treatment of symptoms such as acute suppurative cholangitis, hydatid cyst rupture into the bile duct, postoperative biliary drainage, and pruritus associated with cholestasis. In addition to its various benefits, nasobiliary drainage has disadvantages, including prolongation of the procedure, damage while passing from the oral cavity to nasal route, though rare, dislocation of the catheter in incompatible patients, and patient discomfort. However, there is no previous report in the literature indicating the occurrence of acute renal failure due to nasobiliary drainage. In this report, we present a case who was referred to surgery after nasobiliary drainage placement due to a preliminary diagnosis of malignant narrowing in the distal choledochus; however, acute renal failure developed during the procedure because of excessive biliary drainage.

Walled-off nekroz, nekrotizan pankreatit geciren hastalarda gorulebilen ciddi bir komplikasyondur. Walled-off nekroz klinik olarak asemptomatik olabilecegi gibi farkli ates, bulanti-kusma, karin agrisi gibi semptomlarla da kendini gosterebilir. Endoskopik nekrozektomi son yillarda kullanim sikligi artan bir tedavi yontemidir. Perkutan drenaja kiyasla basari sansi yuksektir. Cerrahi nekrozektomiye kiyasla da daha az mortaliteye sahiptir.

Kistik lenfanjiomlar, lenfatik sistemin nadir gorulen, benign, yavas buyuyen lezyonlaridir. Semptomlar kistin buyuklugune, lokalizasyonuna ve gelisebilecek olan komplikasyonlara bagli olarak degisik karakterde olabilirler. Radyolojik bulgular ve igne aspirasyon biyopsisi kistik lenfanjiomlari diger kistik lezyonlardan ayirt etmede yetersiz kalmaktadir. Bu nedenle pankreatik lenfanjiomun kesin tanisi cerrahi eksizyon ve histopatolojik inceleme ile konulabilir. Karin agrisi yakinmasi ile basvuran ve tetiklerinde retroperitoneal alanda kistik lezyon saptanan bir lenfanjiom olgusunu sunuyoruz.

Gastrointestinal sistemde divertiküllerin kolondan sonra en sık izlendiği bölge duodenumdur. Duodenal divertiküller sık izlenen lezyonlardır. Genellikle duodenum ikinci ve üçüncü kıtasında lokalizedirler. Pankreas başına olan yakınlıklarından dolayı da görüntüleme yöntemlerinde pankreasın kistik maligniteleri ile karışabilirler., The duodenum is the second most frequently affected area by diverticulum after colon; the occurance is quite common. They are most frequently located in the second or third portions of the duodenum, and by nature of their proximity to the head of the pancreas, can be mistaken for cystic pancreatic neoplasms by diagnostic imaging.