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Background and Aims: Besides the incidence of hepatocellular carcinoma, the incidence of some non-hepatic cancers also increases in patients with cirrhosis. We evaluated whether there was an increase in the incidence of non-hepatic cancers in patients with cirrhosis diagnosed before transplantation in our center.Materials and Methods: In this retrospective study, a total sample of 1017 patients with cirrhosis who were followed up at our center was reviewed, of which the data of 37 patients who did not develop non-hepatic cancer were evaluated, and the incidence of cancer was determined. These data were compared with the incidence rate of cancer at our hospital.Results: The incidence of non-hepatic cancers was found to be increased by 4-fold in males and by 9-fold in females (overall 7.5-fold) among patients with cirrhosis compared with that in the control group (p < 0.05). Comparison based on the type of cancers in cirrhotic patients revealed an increase by 93-fold for leukemia, 33-fold for lymphoma, 31-fold for gallbladder cancers, 15.5-fold for gastric cancers, 12-fold for renal cell cancers, 10-fold for sarcomas, 9-fold for urinary bladder cancers, ~6-fold for pancreatic, laryngeal, endometrial, and lung cancers, 4-fold for prostate cancers (p < 0.05), 2.5-fold for colon cancers, and 1.2-fold for breast cancers (p ˃ 0.05).Conclusion: There was an increase in the incidence of all non-hepatic cancers, primarily lymphoma and leukemia, in patients with cirrhosis.

WOS: 000462165400021 PubMed ID: 30289399 This is the first study on the construction of the relationship between a non-obstructive gastric antral web and gastric-outlet obstruction in children and adults. Congenital or acquired gastric antral webs (GAWs) may cause gastric-outlet obstruction in children and adults. Endoscopic methods are often used in the treatment of obstructive GAWs. We report the case of a patient with a congenital non-obstructive antral gastric web. The patient was a 25-year-old male with gastrointestinal hemorrhage followed by dyspeptic complaints. There was a follow-up period for the patient after treatment. Because GAWs are encountered and rarely reported in the literature, the images taken during endoscopic surgery of the patient, as a significant contribution to the literature, are also presented.

We investigated the incidence of and risk factors for liver involvement (LI) in patients with brucellosis in Turkey. Diagnosis was established by blood cultures (BCs) or compatible clinical presentation accompanied by serological evidence. Patients received either a combination of doxycycline plus rifampin for 6 weeks or doxycycline for 6 weeks plus streptomycin intramuscularly for the first 2 weeks. Liver function tests, including those for alanine (ALT) and aspartate aminotransferase (AST) levels, were monitored before and at the end of treatment. One hundred and ninety-five patients were included in the study. Seventy patients had elevated transaminases before treatment. Twenty-six patients had a positive BC for brucellosis. In multivariate analysis, BC positivity (OR=2.44, 95% CI: 1.03-5.78, P=0.043) and serum agglutination titre (SAT) (OR=1.001, 95% CI: 1.00-1.002, P=0.018) were found to be associated with LI. Serum aminotransferase levels were normalized in all patients with bruc, NA

Anastomoz darlıkları kolorektal cerrahinin bilinen bir komplikasyonu olmasına rağmen benign hastalıklarda komplet kolonik anastomoz obstrüksiyonu nadirdir. Benign darlıklar low-anterior rezeksiyon sonrası yapılan kolorektal anastomozda nispeten sık görülen bir komplikasyondur ve kolorektal anastomozların %5-22’sinde gelişebilir. Günümüzde benign anastomoz darlıklarının tedavisinde ilk seçenek endoskopik girişimlerdir. Çeşitli endoskopik teknikler tarif edilmesine rağmen optimal yaklaşım için kontrollü prospektif çalışma verileri eksiktir. Bu çalışmada ileri derecede anastomoz darlığı gelişmiş ve endoskopik balon dilatasyon uygulanan bir hastanın sunulması amaçlandı. Hastaya bir haftalık rektal mesalazin tedavisinden sonra bir kez ayaktan balon dilatasyonu uygulandı ve darlık giderildi. Rektal mesalazin uygulamasının darlık bölgesindeki inflamutuvar sürece olumlu etkisi oldu ve balon dilatasyon sayısını azalttı. Kolorektal darlıkların tedavisinde endoskopik balon dilatasyon 1985’ten beri kullanılmaktadır. Minimal invaziv bir yöntemdir, başarı oranı yüksektir, güvenle direkt görüş altında yapılabilir, tekrarlanabilir ve hastanede yatış gerektirmez., Although anastomotic strictures are a recognized complication of colorectal surgery, complete colonic anastomotic obstruction from benign disease is rare. A benign stricture is a relatively common complication of colorectal anastomosis after low anterior resection and may develop colonic anastomosis in 5%-22% of cases. Today, endoscopic interventions have become the preferred first-line treatment for postoperative large bowel strictures. A variety of endoscopic techniques have been described, but there is a lack of data from controlled prospective trials regarding the optimal approach. In this study, a case of severe anastomotic stricture of the colon, during which endoscopic balloon dilatation was performed, is presented. After a one-week course of treatment with rectal mesalazine, the ambulatory patient underwent balloon dilation only once and the stricture resolved. Rectal mesalazine administration had a positive effect on the inflammatory process at the site of stenosis and reduced the number of balloon dilatations. Endoscopic balloon dilatation has been used since 1985 for the treatment of colorectal strictures. It is a minimally invasive method, has a high success rate, can be performed safely under visual control, can be performed repeatedly, and does not require hospitalization.

Eosinophilic esophagitis (EoE) is a chronic, immune/antigen-mediated esophageal disease characterized with symptoms related to esophageal dysfunction and eosinophil-predominant inflammation. There has been a dramatic increase in the diagnosis of this disease in recent years. The primary objective of this study was to determine the frequency of EoE in adult patients who were evaluated by gastroenterologists in our clinic with esophageal symptoms. Between November 2010 and May 2011, 311 adult patients who were evaluated in our clinic with esophageal symptoms were enrolled prospectively. All patients underwent endoscopy and had biopsies taken. Gastroesophageal reflux disease was excluded by either proton pump inhibitory treatment or 24-hour ambulatory pH monitorization. The diagnosis was confirmed by one independent pathologist. Frequency of EoE in patients with esophageal symptoms was 2.6% (n = 8; four men and four women). Mean age at diagnosis was 40.2 ± 8 years. Heartburn was the predominant symptom in patients (75% of the patients), and 87.5% (n = 7) of patients had more than one symptom at diagnosis. Nearly 38% of the patients (n = 3) had a history of allergic disease. Endoscopic findings were as follows: transient/fixed esophageal rings (25%), white exudates (25%), and normal appearance (50%). Median number of circulating eosinophils was 208 (93-659)/mm(3) . Median number of intraepithelial eosinophils in proximal-middle 1/3 part and distal 1/3 part of esophagus were 0 (0-50)/hpf and 37 (16-50)/hpf, respectively. In conclusion, EoE is not rare in Turkey, and it should be considered in the differential diagnosis of patients with esophageal symptoms.

Ozofagus skuamoz papillomu, genellikle alt ozofagusta soliter bir lezyon olarak gorulen, iyi huylu skuamoz epitelyal polipoid bir tumordur. Prevalans oranlari cok dusuktur ve 1959’dan bu yana literaturde yaklasik 250 vaka bidirilmistir. Kronik mukozal irritasyon ve human papilloma virus enfeksiyonu suclanan etyolojik nedenlerdir. Tipik ozofagus skuamoz papillomunun hicbir ozgun semptomu yoktur. Bizim vakamiz kronik dispeptik sikayetleri olan ve endoskopik olarak reflu ozofajiti saptanan 51 yasindaki erkek hasta idi. Endoskopik incelemede ozofagus 25. cm’de 3-4 mm’lik polipoid olusum izlendi. Buradan aldigimiz biyopsi orneginin patolojik inceleme sonucu ozofagus skuamoz papillomu olarak geldi.

Experience with endoscopic retrograde cholangiopancreatography in the pediatric population is limited. The aim of this study was to evaluate the outcomes of ERCP in the pediatric population performed by adult gastroenterologists with standard duodenoscopes. This study is a structured retrospective review of endoscopic reports, computerized and paper medical records, and radiographic images of patients under the age of 18 who underwent ERCP for any indication at a tertiary referral centre. Data regarding demographic characteristics and medical history of patients, indications, technical success rate, final clinical diagnosis, and complications were analyzed. Forty-eight children with a mean age of 13 years (range 2–17) underwent a total of 65 ERCPs. The indications of ERCP were as follows; suspected choledocholithiasis (55 %), post-liver transplantation anastomotic biliary strictures (21 %), post-surgical bile duct injury (10 %), choledochal cyst (2 %), recurrent or chronic pancreatitis (10 %), and trauma (2 %). The cannulation success rate in the overall procedure was 93.8 %. Therapeutic interventions were performed in 70.7 % of patients. Post ERCP pancreatitis was the most common complication occurring in 9.2 % of patients, and no procedure related mortality occurred. When performed by well-trained adult gastroenterologists, the use of endoscopic retrograde cholangiopancreatography with standard duodenoscopes is safe in pediatric population.

Radyofrekans ablasyon uygulama kolaylığı, güvenilirliği ve başarılı sonuçları nedeni ile primer karaciğer tümörlerinin tedavisinde kullanılmaktadır. Radyofrekans ablasyon karaciğer transplantasyonu öncesi köprü tedavisi olarak da kullanılmaktadır. Burada radyofrekans ablasyonun nadir görülen iki komplikasyonunu bildiriyoruz., Radiofrequency ablation has become widely accepted as an approach against primary liver tumors because of its ease, safety of use and high level of effectiveness. radiofrequency ablation has also been performed as bridge therapy for hepatocellular carcinoma prior to liver transplantation. Herein, we report two rare complications of radiofrequency ablation.

Delirium is a complex neuropsychiatric syndrome that typically involves a plethora of cognitive and non-cognitive symptoms, resulting in a broad spectrum of differential diagnosis dominated by mental disorders. The prevalence of delirium in elderly patients admitting to hospital is 5-55% [1]. Delirium is a common neuropsychiatric syndrome that may occur in several different settings and one of them is vitamin B12 deficiency. Vitamin B12 deficiency causes many cerebral cortex abnormalities such as confusion, mood and memory changes, delirium with or without hallucinations, depression and acute psychotic states [2,3]. Hepatic encephalopathy (HE) describes the spectrum of potentially reversible neuropsychiatric abnormalities seen in patients with liver dysfunction after exclusion of unrelated neurologic and/or metabolic abnormalities. The clinical manifestations of HE is characterized by cognitive and motor deficits of varying severity without specific lesions in the central nervous system. The symptoms range from minimal changes in personality to coma, including delirium [4]. Usually, in the elderly patients with cirrhosis, it is hard to differentiate two clinical situations. Here we report a case of an elderly patient with cirrhosis who experienced delirium due to vitamin B12 deficiency, but was treated as HE before.

Analgesics, including opioids such as meperidine are used for treatment of abdominal pain caused by acute pancreatitis. Meperidine withdrawal syndrome is usually seen after long-term use. We present here an acute panceratitis patient who experienced meperidine withdrawal syndrome after short term use and treated successfully with tramadol and deksketoprofen.

Chylous ascites is the accumulation of lipid-rich lymph in the peritoneal cavity. The usual cause in adults is lymphatic obstruction or leakage caused by malignancy. Non-malignant causes include postoperative trauma, cirrhosis, tuberculosis, pancreatitis and filariasis. A variety of treatment options have been proposed for the management of chylous ascites; however, their effectiveness in idiopathic or primary form is unknown. Here we report a case of chylous acid rapidly resolved with the treatment of fasting, total parenteral nutrition and somatostatin analogue.

The purpose of this study was to evaluate the technical/hemodynamic success, complications, and biochemical/ hematologic consequences of transjugular intrahepatic portosystemic shunt (TIPS) created with 10-mm bare stents in our patients.Data of 27 cirrhotic patients (18 men and 9 women; mean age, 39.7±18.7 years) with a median MELD score 14 (range 7-31) treated with TIPS between January 2000 and August 2010 were evaluated retrospectively.The indications were refractory bleeding varices in 48.2%, refractory ascites in 22.2%, and Budd-Chiari syndrome in 29.6% of the patients. Technical and hemodynamic success rates were 96.3% and 92.3%, respectively. Mean portosystemic pressure gradient decreased from 21.5±5.3 mm Hg to 9±2.7 mm Hg (p0.05). The rate of primary stent patency was 76.9% 1 year after the procedure. No statistically significant difference in shunt dysfunction was found between the groups of patients treated for Budd-Chiari syndrome and other indications (p0.05). One patient (3.7%) had shunt dysfunction due to thrombosis within 24 hours. New and/or worsening hepatic encephalopathy occurred in 34.6% of patients. Increased age (≥40 years) was significantly related to hepatic encephalopathy in both univariate and multivariate analyses (p0.05). Thirty-day mortality rate and 1-year transplant-free survival rate were 0% and 80.7%, respectively.Transjugular intrahepatic portosystemic shunt procedure is a safe treatment for many patients with cirrhosis, but post-procedure hepatic encephalopathy and shunt dysfunction are still problems. Especially, patient age should be taken into consideration in predicting hepatic encephalopathy risk.

e18009 Background: The gastrointestinal tract (GIT) is one of the main target organs in patients with acute GVHD.The aim was to determine the endoscopic and histological findings in acute GVHD with...

Vasoconstrictor therapy with terlipressin and concomitant albumin can improve renal function in patients with hepatorenal syndrome (HRS) type 1, but the efficacy of therapy in patients with active infection is controversial. The aim of this study was to investigate the efficacy, adverse effects, and predictors of terlipressin therapy and to find out whether there was a difference in response rates between the patients with or without active infections. Data of 58 patients with type 1 HRS treated with terlipressin and albumin were retrospectively evaluated. Twenty-six patients (44.8 %) showed complete response to treatment. Response rates of patients with or without active bacterial infection were 47 and 43.9 %, respectively (p > 0.05). Only baseline serum creatinine level was significantly related to response in univariate/ multivariate analyses (p < 0.05). Twenty-three patients (39.6 %) developed adverse effects probably related to treatment. In 8.6 % of patients, treatment was discontinued because of adverse effects of therapy. Four patients (6.9 %) developed ischemic adverse events, including nonfatal myocardial infarction, intestinal ischemia, and cutaneous necrosis. Terlipressin plus albumin therapy improved renal function in nearly half of patients with type 1 HRS. Thus, it seems a reasonable treatment for patients with active bacterial infections. Baseline serum creatinine level is a potential predictor of terlipressin response.