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Ari D, Ödemiş B, Başpinar B, Atay A, Erdoğan Ç. Ectopic Opening of Common Bile Duct to Duodenal Bulb: A Single Tertiary Center Experience. Surg Laparosc Endosc Percutan Tech 2023; 33:640-644. [PMID: 37725829 DOI: 10.1097/sle.0000000000001219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 07/31/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND The ectopic opening of the common bile duct(CBD) into the duodenal bulb is a rare biliary anomaly. The study aimed to reveal the experience with clinical and endoscopic outcomes in these patients. MATERIALS AND METHODS This study was conducted on 57 consecutive patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) for ectopic opening of the CBD into the duodenal bulb at our institution between 2010 and 2020. RESULTS The median age was 59 years (49 males). A total of 146 ERCP procedures were performed (once in 26 patients and 2 or more times in 31 patients). Ten patients had a history of unsuccessful ERCP in an external center. The median follow-up time was 14.6 months. All patients had a slit-like opening of the CBD into the duodenal bulb, apical stenosis, and hook-shaped distal CBD. ERCP findings were CBD stone or dilatation in 55 patients and post-cholecystectomy biliary leakage in 2 patients. Balloon dilatation was performed for apical stenosis in 7 patients and distal CBD stenosis in 26 patients. During the first ERCP session, biliary stent/nasobiliary drainage was placed in 37 patients, and CBD stones were extracted in 19 patients without stenting. Biliodigestive anastomosis was applied to 13 patients, 5 of whom had recurrent cholangitis, 7 required recurrent ERCP, and one was due to the technical difficulty of ERCP. CONCLUSIONS Ectopic biliary opening should be remembered if the papilla cannot be seen in its usual place in a patient with apical stenosis. ERCP should be performed in experienced hands, and surgery should be considered in the need for recurrent ERCP.
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Affiliation(s)
- Derya Ari
- Department of Gastroenterology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
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Ödemiş B, Durak MB, Atay A, Başpınar B, Erdoğan Ç. A Step-Up Approach Using Alternative Endoscopic Modalities Is an Effective Strategy for Postoperative and Traumatic Pancreatic Duct Disruption. Dig Dis Sci 2023; 68:3745-3755. [PMID: 37358637 DOI: 10.1007/s10620-023-07996-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 02/21/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND AND AIMS Standard endotherapy for pancreatic duct (PD) disruption is pancreatic stenting and sphincterotomy. In patients refractory to standard treatment, treatment algorithm is currently not standardized. This study aims to report the 10-year experience with the endoscopic treatment of postoperative or traumatic PD disruption and to share our algorithmic approach. METHODS This retrospective study was conducted on 30 consecutive patients who underwent endoscopic treatment for postoperative (n = 26) or traumatic (n = 4) PD disruption between 2011 and 2021. Standard treatment was initially applied to all patients. Endoscopic modalities used with a step-up approach in patients unresponsive to standard treatment were stent upsizing and N-butyl-2-cyanoacrilate (NBCA) injection for partial disruption, and the bridging of the disruption with a stent and cystogastrostomy for complete disruption. RESULTS PD disruption was partial in 26 and complete in 4 patients. Cannulation and stenting of PD was successful in all patients and sphincterotomy was performed in 22 patients. Standard treatment was successful in 20 patients (66.6%). The resolution of PD disruption in 9 of 10 patients refractory to standard treatment was achieved with stent upsizing in 4, NBCA injection in 2, the bridging of the complete disruption in one, and cystogastrostomy after spontaneously and intentionally developed pseudocyst in one patient each. Overall, therapeutic success rate was 96.6% (100% for partial, 75% for complete disruption). Procedural complications occurred in 7 patients. CONCLUSIONS Standart treatment for PD disruption is usually effective. In patients refractory to standard treatment, the outcome may be improved by step-up approach using alternative endoscopic modalities.
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Affiliation(s)
- Bülent Ödemiş
- Department of Gastroenterology, Ankara City Hospital, University of Health Sciences, Bilkent Avenue, 06800, Çankaya, Ankara, Turkey.
| | - Muhammed Bahaddin Durak
- Department of Gastroenterology, Ankara City Hospital, University of Health Sciences, Bilkent Avenue, 06800, Çankaya, Ankara, Turkey
| | - Ali Atay
- Department of Gastroenterology, Ankara City Hospital, University of Health Sciences, Bilkent Avenue, 06800, Çankaya, Ankara, Turkey
| | - Batuhan Başpınar
- Department of Gastroenterology, Ankara City Hospital, University of Health Sciences, Bilkent Avenue, 06800, Çankaya, Ankara, Turkey
| | - Çağdaş Erdoğan
- Department of Gastroenterology, Ankara City Hospital, University of Health Sciences, Bilkent Avenue, 06800, Çankaya, Ankara, Turkey
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Coşkun O, Ödemiş B. POST-ERCP RARE COMPLICATION: PNEUMOMEDIASTINUM. Gastroenterol Nurs 2023; 46:329-331. [PMID: 37126089 DOI: 10.1097/sga.0000000000000719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 10/10/2022] [Indexed: 05/02/2023] Open
Affiliation(s)
- Orhan Coşkun
- Orhan Coşkun, MD, is at Department of Gastroenterology, University of Health Sciences, Ankara City Training and Research Hospital, Ankara City Hospital, Ankara, Turkey
- Bülent Ödemiş, MD, is at Department of Gastroenterology, University of Health Sciences, Ankara City Training and Research Hospital, Ankara City Hospital, Ankara, Turkey
| | - Bülent Ödemiş
- Orhan Coşkun, MD, is at Department of Gastroenterology, University of Health Sciences, Ankara City Training and Research Hospital, Ankara City Hospital, Ankara, Turkey
- Bülent Ödemiş, MD, is at Department of Gastroenterology, University of Health Sciences, Ankara City Training and Research Hospital, Ankara City Hospital, Ankara, Turkey
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Başpinar B, Ödemiş B, Erdoğan Ç, Yüksel M. Suprapapillary Needle Knife Fistulotomy Versus Conventional Precut Sphincterotomy in Difficult Biliary Cannulation: A Retrospective Comparative Study. Surg Laparosc Endosc Percutan Tech 2022; 32:700-706. [PMID: 36375111 DOI: 10.1097/sle.0000000000001123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 10/24/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Endoscopic retrograde cholangiopancreatography (ERCP) is an important therapeutic tool for many biliary diseases. Selective biliary cannulation is the first step of the treatment process. Needle knife fistulotomy (NKF) and conventional precut sphincterotomy (CPS) are widely used in difficult biliary cannulation. However, there are different results in their effectiveness and safety. This study aimed to compare both methods regarding cannulation success and adverse event profile. MATERIALS AND METHODS All eligible consecutive patients with naive papillae who underwent biliary ERCP by a single experienced endoscopist over a 3-year period were included retrospectively. The standard cannulation method with a guidewire-loaded sphincterotome was initially used for biliary cannulation in all patients. Cannulation was accepted as difficult in the case of failure of standard cannulation within 5 minutes or despite 5 attempts or insertion of the guidewire to the pancreatic duct 5 times. Three modalities in patients with difficult biliary cannulation were employed according to the structure and configuration of the papillae in addition to unintentional pancreatic cannulation: (1) NKF, (2) CPS, (3) Double guidewire technique or guidewire orientation/precut following pancreatic stenting. Latter was excluded to enable direct comparison between NKF and CPS groups. RESULTS A total of 644 patients were recruited. Analyses were performed with 541 patients after the exclusion of 103 patients. Mean (SD) age was 60.4 (18.2) years, and 257 (47.5%) patients were male. While standard cannulation was successful in 366 (67.6%), difficult biliary cannulation was observed in 175 (32.4%) patients. NKF was performed in 101 (57.7%) patients, and cannulation success was 100% in the first ERCP session. In contrast, CPS was performed in 74 (42.3%) patients with a lower cannulation success rate (79.7%) than NKF ( P <0.001). Post-ERCP pancreatitis rate was higher in CPS (9.5%) than NKF group (3.0%, P =0.063). Bleeding and cholangitis were similar in both groups. CONCLUSIONS In patients with difficult biliary cannulation with appropriate papillary structure and configuration, NKF should be used as the first choice in experienced hands because of high biliary cannulation success and low Post-ERCP pancreatitis risk.
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Affiliation(s)
- Batuhan Başpinar
- Department of Gastroenterology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
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Asfuroğlu Kalkan E, Kalkan Ç, Kaçar S, Barutçu S, Yüksel M, Güçbey Türker Ö, Göre B, Canlı T, Asfuroğlu U, Barutçu Asfuroğlu B, Hamamcı M, Kılıç V, Köseoğlu T, Özaslan E, Ödemiş B, Kılıç M, Yüksel İ, Ersoy O, Altıparmak E, Ateş İ, Soykan İ. Similarities and Differences Between Gerontal and Young Patients with Acute Pancreatitis: Evaluation of Clinical Characteristics and Outcomes. Turk J Gastroenterol 2022; 33:874-884. [PMID: 36205509 PMCID: PMC9623137 DOI: 10.5152/tjg.2022.22227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Background: Acute pancreatitis is an abrupt inflammatory disease of the exocrine pancreas and it can occur in different severities. It is becoming more common and more mortal in the gerontal population. The aim of our study was to explore the similarities and differences between young and gerontal patients with acute pancreatitis, with a special emphasis on patients over 80 years of age. Methods: Medical records of patients (n = 1150) with acute pancreatitis were analyzed retrospectively. Several scoring systems including Bedside index for severity in acute pancreatitis, Ranson’s score, Harmless acute pancreatitis score, Acute Physiology and Chronic Health Evaluation, Balthazar Grade, Glasgow score, and Japanese severity score were applied at admission. Patients were divided into 3 groups; group I, young group (n = 706), if they were aged <65 years; group II, older group (n = 338), if they were aged ≥65 years to <80 years; group III, octogenarian group (n = 106), if they were aged ≥ 0 years. Results: In total, 1150 patients with acute pancreatitis were analyzed. Octogenarian group (n = 42, 39.6%) showed a more severe acute pancreatitis compared to patients in group I (n = 15, 2.1%) and II (n = 50, 14.8%, P < .001). Complications were more common in patients in group III (P < .001). Mortality rate was higher in patients in group III (n = 53, 50%) compared to group I (n = 8, 1.1%) and group II (n = 53, 15.7%) (P < .001). Conclusion: Gerontal patients with acute pancreatitis tend to have more severe disease and systemic and local complications. Mortality rates were higher in older patients compared to younger patients.
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Affiliation(s)
- Emra Asfuroğlu Kalkan
- Department of Internal Medicine, Ankara City Hospital, Ministry of Health, Ankara, Turkey
| | - Çağdaş Kalkan
- Department of Gastroenterology, Ankara City Hospital, Ministry of Health, Ankara, Turkey
| | - Sabite Kaçar
- Department of Gastroenterology, Ankara City Hospital, Ministry of Health, Ankara, Turkey
| | - Sezgin Barutçu
- Department of Gastroenterology, Gaziantep University Hospital, Gaziantep, Turkey
| | - Mahmut Yüksel
- Department of Gastroenterology, Ankara City Hospital, Ministry of Health, Ankara, Turkey
| | - Özge Güçbey Türker
- Department of Internal Medicine, Ankara City Hospital, Ministry of Health, Ankara, Turkey
| | - Burak Göre
- Department of Internal Medicine, Ankara City Hospital, Ministry of Health, Ankara, Turkey
| | - Tolga Canlı
- Department of Internal Medicine, Ankara City Hospital, Ministry of Health, Ankara, Turkey
| | - Umut Asfuroğlu
- Department of Radiology, Ministry of Health, Abdulkadir Yüksel Hospital, Gaziantep, Turkey
| | | | - Mevlüt Hamamcı
- Department of Gastroenterology, Ankara City Hospital, Ministry of Health, Ankara, Turkey
| | - Vedat Kılıç
- Department of Gastroenterology, Ankara City Hospital, Ministry of Health, Ankara, Turkey
| | - Tankut Köseoğlu
- Department of Gastroenterology, Ankara City Hospital, Ministry of Health, Ankara, Turkey
| | - Ersan Özaslan
- Department of Gastroenterology, Ankara City Hospital, Ministry of Health, Ankara, Turkey
| | - Bülent Ödemiş
- Department of Gastroenterology, Ankara City Hospital, Ministry of Health, Ankara, Turkey
| | - Mesut Kılıç
- Department of Gastroenterology, Ankara City Hospital, Ministry of Health, Ankara, Turkey
| | - İlhami Yüksel
- Department of Gastroenterology, Ankara City Hospital, Ministry of Health, Ankara, Turkey
| | - Osman Ersoy
- Department of Gastroenterology, Ankara City Hospital, Ministry of Health, Ankara, Turkey
| | - Emin Altıparmak
- Department of Gastroenterology, Ankara City Hospital, Ministry of Health, Ankara, Turkey
| | - İhsan Ateş
- Department of Internal Medicine, Ankara City Hospital, Ministry of Health, Ankara, Turkey
| | - İrfan Soykan
- Department of Gastroenterology, Ankara University Faculty of Medicine, İbni-Sina Hospital, Ankara, Turkey,Corresponding author: İrfan Soykan, e-mail:
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Ödemiş B, Başpınar B, Tola M, Torun S. Magnetic Compression Anastomosis Is a Good Treatment Option for Patients with Completely Obstructed Benign Biliary Strictures: A Case Series Study. Dig Dis Sci 2022; 67:4906-4918. [PMID: 35050430 DOI: 10.1007/s10620-022-07381-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 01/01/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Completely obstructed benign biliary strictures (BBS) is a difficult-to-treat condition. Surgery is the main treatment modality with high morbidity and mortality. Recently, the magnetic compression anastomosis (MCA) technique was employed in such cases with low complication rates. AIMS To evaluate the effectiveness of the MCA in completely obstructed BBS. METHODS 21 MCA procedures were performed in 19 patients with completely obstructed BBS. All patients had percutaneous biliary access. Magnets were located to the proximal side of the obstruction via percutaneous biliary sheath and the distal side endoscopically. The procedure was terminated as the magnets attracted. Either self-expandable fully covered metallic stent and/or a growing number of plastic stents were introduced after recanalization was achieved. RESULT A total number of 19 patients with completely obstructed BBS resulting from cholecystectomy or liver transplant underwent 21 MCA procedures. Among those, 19 (90.5%) interventions were successful. The median stricture length that had been measured after magnet attraction was 4 mm (range 1-10 mm). The median magnet coupling time in successful cases was 9 days (range 4-27 days). No correlation was found between magnet coupling time and stricture length (p = 0.27). Complications were observed in 6 (cholangitis:1, magnet migration:2, magnet entrapment:3) of 19 successful MCA procedures. Fifteen of the 19 successful procedures had at least a period of stent-free follow-up. Recurrence of stenosis occurred in 7 procedures, of which 4 remained stent-free with retreatment. Eventually, 12 procedures had stent-free last status. CONCLUSIONS MCA is an effective and safe treatment option in completely obstructed BBS. Further studies are required for procedural standardization.
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Affiliation(s)
- Bülent Ödemiş
- Department of Gastroenterology and Hepatology, Ankara City Hospital, Bilkent Avenue Çankaya, 06800, Ankara, Turkey.
| | - Batuhan Başpınar
- Department of Gastroenterology and Hepatology, Ankara City Hospital, Bilkent Avenue Çankaya, 06800, Ankara, Turkey
| | - Muharrem Tola
- Department of Radiology, Division of Interventional Radiology, Ankara City Hospital, Bilkent Avenue Çankaya, 06800, Ankara, Turkey
| | - Serkan Torun
- Faculty of Medicine, Department of Gastroenterology, Düzce University, Konuralp Campus, Beçiyörükler District, 81010, Merkez, Düzce, Turkey
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Ödemiş B, Erdoğan Ç, Başpınar B, Coşkun O, Kılıç MZY. Endoscopic treatment of Bouveret syndrome with Holmium laser lithotripsy. Endoscopy 2022; 54:E997-E998. [PMID: 35926539 PMCID: PMC9736820 DOI: 10.1055/a-1887-5539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Bülent Ödemiş
- Department of Gastroenterology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Çağdaş Erdoğan
- Department of Gastroenterology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Batuhan Başpınar
- Department of Gastroenterology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Orhan Coşkun
- Department of Gastroenterology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Mesut Zeki Yalın Kılıç
- Department of Gastroenterology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
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Turan Gökçe D, Ödemiş B, Erdoğan Ç. Magnetic compression anastomosis using a double-balloon enteroscope for complete obstruction of Roux-en-Y hepaticojejunostomy anastomosis. Endoscopy 2022; 54:E945-E947. [PMID: 35835155 PMCID: PMC9736798 DOI: 10.1055/a-1841-5734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
| | - Bülent Ödemiş
- Ankara City Hospital, Department of Gastroenterology , Ankara, Turkey
| | - Çağdaş Erdoğan
- Ankara City Hospital, Department of Gastroenterology , Ankara, Turkey
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Ödemiş B, Başpınar B, Erdoğan Ç, Ogutmen Koc D, Özel Coşkun BD, Torun S. A rare case of a windsock-shaped intraluminal duodenal diverticulum treated successfully with endoscopic diverticulectomy. Endoscopy 2022; 54:E914-E915. [PMID: 35777382 PMCID: PMC9735393 DOI: 10.1055/a-1864-9201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Bülent Ödemiş
- University of Health Sciences, Ankara City Hospital, Department of Gastroenterology, Ankara, Turkey
| | - Batuhan Başpınar
- University of Health Sciences, Ankara City Hospital, Department of Gastroenterology, Ankara, Turkey
| | - Çağdaş Erdoğan
- University of Health Sciences, Ankara City Hospital, Department of Gastroenterology, Ankara, Turkey
| | - Deniz Ogutmen Koc
- İstanbul Gaziosmanpaşa Teaching and Research Hospital, Department of Gastroenterology, İstanbul, Turkey
| | - Banu Demet Özel Coşkun
- University of Health Sciences, Ankara City Hospital, Department of Gastroenterology, Ankara, Turkey
| | - Serkan Torun
- Düzce University, Faculty of Medicine, Department of Gastroenterology, Düzce, Turkey
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Gökbulut V, Ödemiş B, Öztürk Ö, Yamak B, Tenlik İ, Yüsra Abaylı S, Öztürk H. A Rare Complication of ERCP. Turk J Gastroenterol 2022; 33:365-367. [PMID: 35550545 PMCID: PMC9153951 DOI: 10.5152/tjg.2020.19549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 09/17/2019] [Indexed: 06/15/2023]
Affiliation(s)
- Volkan Gökbulut
- Department of Gastroenterology, Türkiye Yüksek Ihtisas Training and Research Hospital, Ankara, Turkey
| | - Bülent Ödemiş
- Department of Gastroenterology, Türkiye Yüksek Ihtisas Training and Research Hospital, Ankara, Turkey
| | - Ömer Öztürk
- Department of Gastroenterology, Türkiye Yüksek Ihtisas Training and Research Hospital, Ankara, Turkey
| | - Bülent Yamak
- Department of Gastroenterology, Türkiye Yüksek Ihtisas Training and Research Hospital, Ankara, Turkey
| | - İlyas Tenlik
- Department of Gastroenterology, Türkiye Yüksek Ihtisas Training and Research Hospital, Ankara, Turkey
| | - Selcen Yüsra Abaylı
- Department of Departure of Underwater and Hyperbaric Medicine, Dışkapı Yıldırım Beyazıt Education and Research Hospital, Ankara, Turkey
| | - Handan Öztürk
- Department of Departure of Underwater and Hyperbaric Medicine, Dışkapı Yıldırım Beyazıt Education and Research Hospital, Ankara, Turkey
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Taşkıran İ, Ödemiş B, Yıldız H, Parlak E. Is Outpatient ERCP Safe for Choledocholithiasis? meandros 2022. [DOI: 10.4274/meandros.galenos.2021.70370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
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Ödemiş B, Durak MB, Cengiz M. Endoscopic Ampullectomy of Benign Ampullary Lesions: Outcomes From a Single Center Study. Surg Laparosc Endosc Percutan Tech 2021; 30:270-275. [PMID: 32150118 DOI: 10.1097/sle.0000000000000775] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Endoscopic ampullectomy (EA) offers an insignificantly intrusive strategy for viably treating mucosal and occasionally submucosal lesions of the ampulla of Vater and encompassing periampullary area with high achievement and is more secure. The aim of this study was to present safety, efficacy, and outcomes of EA in the treatment of benign lesions of ampulla Vater performed by single experienced endoscopists in a high volume center. METHODS This retrospective study was conducted in patients referred to our hospital (Turkey High Speciality Training and Research Hospital, Turkey) for endoscopic evaluation of ampullary benign lesions over an 8-year period (between October 2011 and September 2019). Success rate was defined as complete resection of lesions. RESULTS Twenty-nine patients with a median age of 64 years were included. Twenty-five patients had lesions confined to the ampulla vateri (86.2%). Accordingly, 2 lesions had intraductal extension adenoma (IDA) (6.9%) and 2 were lateral spreading adenoma (6.9%). The median size of the lesion was 17.5 mm (10 to 36 mm). Nineteen lesions (65.5%) were resected en bloc and 10 lesions (34.5%) were resected in piecemeal manner. Complete resection was achieved in 21 of 23 patients with benign ampullary lesions. The procedure success rate was 91.3%. Complications occurred in 6 patients (20.6%) of these 3 had (10.3%) bleeding, 2 (6.8%) had pancreatitis, and 1 had (3.4%) perforation. Four patients (13.7%) had a recurrence. CONCLUSIONS Deep resection of the benign ampullary lesions increases the complete resection rate, cannulation rate of the pancreatic duct, and stenting rate of the pancreatic duct. EA is a safe and successful procedure in patients with benign lesions of ampulla vater.
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Affiliation(s)
- Bülent Ödemiş
- Department of Gastroenterology, Turkey High Speciality Training and Research Hospital
| | - Muhammed B Durak
- Department of Gastroenterology, Turkey High Speciality Training and Research Hospital
| | - Mustafa Cengiz
- Department of Gastroenterology, Dr. A. Y. Ankara Oncology Training and Research Hospital, Ankara, Turkey
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Ödemiş B, Başpınar B, Torun S, Coşkun O. Magnet-assisted endoscopic choledochoduodenostomy in anomalous opening of the common bile duct into the duodenal bulb. Endoscopy 2020; 52:E386-E387. [PMID: 32303089 DOI: 10.1055/a-1144-2378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Bülent Ödemiş
- Department of Gastroenterology and Hepatology, Ankara City Hospital, Ankara, Turkey
| | - Batuhan Başpınar
- Department of Gastroenterology and Hepatology, Ankara City Hospital, Ankara, Turkey
| | - Serkan Torun
- Faculty of Medicine, Department of Gastroenterology, Düzce University, Düzce, Turkey
| | - Orhan Coşkun
- Department of Gastroenterology, Sabuncuoğlu Şerefeddin Teaching Hospital, Amasya University, Amasya, Turkey
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Kaplan M, Dişibeyaz S, Ödemiş B, Parlak E, Öztaş E, Gökbulut V. Endoscopic retrograde cholangiography via a permanent access loop. Turk J Gastroenterol 2020; 31:318-323. [PMID: 32412902 DOI: 10.5152/tjg.2020.19229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND/AIMS The aim of this study was to investigate the indications, technical and clinical success, and complications of the endoscopic retrograde cholangiography (ERC) via a permanent access loop (PAL). MATERIALS AND METHODS Twenty patients who underwent ERC through PAL between 2009 and 2017 were included in this study. The technical success was described as achieving access to the bile ducts through PAL and the clinical success was described as the clinical and laboratory improvement of the patients after the procedure. RESULTS The study was performed with 20 patients. The median follow-up duration was 24 months (3-96) and the median number of ERC sessions was 3.9 (1-10). The most common ERC indications through PAL were stones (40%) and cholangitis (30%). In 16 patients (75%), anastomotic or branched strictures were observed. The improvement of strictures via intermittent stenting and dilatation was observed in 6 patients, but no improvement was observed in 5 patients. The treatment of those 5 patients continues. In this study, the technical success was 100% and clinical success was 85%. While no mortality due to PAL-mediated ERC was observed, free wall perforation was seen in one patient who was referred to surgery. CONCLUSION PAL-mediated ERC procedure is a technique with high technical and clinical success and low complication rate in patients who require frequent percutaneous procedures and those with difficult access to the biliary tract.
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Affiliation(s)
- Mustafa Kaplan
- Department of Gastroenterology, Yüksek Ihtisas Training and Research Hospital, Ankara, Turkey
| | - Selçuk Dişibeyaz
- Department of Gastroenterology, Osmangazi University School of Medicine, Eskişehir, Turkey
| | - Bülent Ödemiş
- Department of Gastroenterology, Yüksek Ihtisas Training and Research Hospital, Ankara, Turkey
| | - Erkan Parlak
- Department of Gastroenterology, Hacettepe University School of Medicine Ankara, Turkey
| | - Erkin Öztaş
- Department of Gastroenterology, Osmangazi University School of Medicine, Eskişehir, Turkey
| | - Volkan Gökbulut
- Department of Gastroenterology, Yüksek Ihtisas Training and Research Hospital, Ankara, Turkey
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Attila T, Parlak E, Alper E, Dişibeyaz S, Çiçek B, Ödemiş B. Endoscopic papillectomy of benign ampullary lesions: Outcomes from a multicenter study. Turk J Gastroenterol 2018; 29:325-334. [PMID: 29755017 DOI: 10.5152/tjg.2018.17378] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND/AIMS Endoscopic papillectomy (EP) has emerged as an alternative to surgery in the management of ampullary lesions. The aim of this study is to evaluate feasibility, efficacy, safety, outcome, and impact of EP in the management of benign ampullary lesions. MATERIALS AND METHODS This is a multicenter, retrospective study of 44 patients who had EP of benign ampullary lesions. RESULTS Over the 11-year period, 44 (55.7%) of 79 patients underwent EP for benign ampullary lesions. Complete resection was achieved in 40 patients (91%). An underlying adenocarcinoma was the only risk factor for incomplete resection. Twenty-eight lesions (63.6%) were resected en-bloc and 16 lesions (36.4%) were resected in piecemeal fashion. Post-papillectomy histopathologic diagnoses were tubular adenoma in 14 patients (32%), invasive adenocarcinoma in 9 patients (20.5%), tubullovillous adenoma in 7 patients (16%), tubullovillous adenoma with carcinoma limited to the mucosal layer in 5 patients (11.3%), adenoma with high-grade dysplasia in 4 patients (9%), neuroendocrine tumor in 1 patient (2.3%), ganglioneuroma in 1 patient (2.3%), hamartomatous polyp in 1 patient (2.3%), adenofibroma in 1 patients (2.3%), and Brunner gland hyperplasia in 1 patient (2.3%). Seven (15.9%) procedure-related complications occurred: 3 (6.8%) bleeding, 2 (4.5%) pancreatitis, 1 (2.3%) abdominal pain, and 1 (2.3%) stent migration to the pancreatic duct. Seven patients (17%) had recurrence. CONCLUSION Endoscopic papillectomy is a safe and effective method and can be considered as a first-line approach in patients with benign ampullary lesions with intent for cure. It also allows for correct histological diagnosis and staging.
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Affiliation(s)
- Tan Attila
- Division of Gastroenterology and Hepatology, Koç University School of Medicine, İstanbul, Turkey; Division of Gastroenterology and Hepatology, American Hospital, İstanbul, Turkey
| | - Erkan Parlak
- Division of Gastroenterology and Hepatology, Sakarya University School of Medicine, Sakarya, Turkey; Division of Gastroenterology and Hepatology, Ankara High Speciality Training and Research Hospital, Ankara, Turkey
| | - Emrah Alper
- Division of Gastroenterology and Hepatology, İzmir Katip Çelebi University Atatürk Training and Research Hospital, İzmir, Turkey
| | - Selçuk Dişibeyaz
- Division of Gastroenterology and Hepatology, Ankara High Speciality Training and Research Hospital, Ankara, Turkey
| | - Bahattin Çiçek
- Division of Gastroenterology and Hepatology, Acıbadem University School of Medicine, İstanbul, Turkey
| | - Bülent Ödemiş
- Division of Gastroenterology and Hepatology, Ankara High Speciality Training and Research Hospital, Ankara, Turkey
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Akpınar MY, Saygılı F, Öztaş E, Coşkun O, Ödemiş B. Deforme biliyer metal stente bağlı gelişen gastrointestinal sistem kanaması. Ege Tıp Dergisi 2018. [DOI: 10.19161/etd.414399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Torun S, Kuzu UB, Ödemiş B. An unusual and unpleasant experience with ERCP: nasal septum damage. Endoscopy 2017; 48:E348. [PMID: 27852085 DOI: 10.1055/s-0042-118454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Serkan Torun
- Department of Gastroenterology, Bartın State Hospital, Bartın, Turkey
| | - Ufuk Barış Kuzu
- Department of Gastroenterology, Turkiye Yuksek Ihtisas Education and Research Hospital, Bartın, Turkey
| | - Bülent Ödemiş
- Department of Gastroenterology, Turkiye Yuksek Ihtisas Education and Research Hospital, Bartın, Turkey
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18
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Kuzu UB, Ödemiş B, Dişibeyaz S, Parlak E, Öztaş E, Saygılı F, Yıldız H, Kaplan M, Coskun O, Aksoy A, Arı D, Suna N, Kayaçetin E. Management of suspected common bile duct stone: diagnostic yield of current guidelines. HPB (Oxford) 2017; 19:126-132. [PMID: 27914763 DOI: 10.1016/j.hpb.2016.11.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Revised: 10/22/2016] [Accepted: 11/08/2016] [Indexed: 12/12/2022]
Abstract
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.
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Affiliation(s)
- Ufuk B Kuzu
- Department of Gastroenterology, Turkiye Yuksek Ihtisas Education and Research Hospital, Turkey.
| | - Bülent Ödemiş
- Department of Gastroenterology, Turkiye Yuksek Ihtisas Education and Research Hospital, Turkey
| | - Selçuk Dişibeyaz
- Department of Gastroenterology, Turkiye Yuksek Ihtisas Education and Research Hospital, Turkey
| | - Erkan Parlak
- Department of Gastroenterology, Turkiye Yuksek Ihtisas Education and Research Hospital, Turkey
| | - Erkin Öztaş
- Department of Gastroenterology, Turkiye Yuksek Ihtisas Education and Research Hospital, Turkey
| | - Fatih Saygılı
- Department of Gastroenterology, Turkiye Yuksek Ihtisas Education and Research Hospital, Turkey
| | - Hakan Yıldız
- Department of Gastroenterology, Turkiye Yuksek Ihtisas Education and Research Hospital, Turkey
| | - Mustafa Kaplan
- Department of Gastroenterology, Turkiye Yuksek Ihtisas Education and Research Hospital, Turkey
| | - Orhan Coskun
- Department of Gastroenterology, Turkiye Yuksek Ihtisas Education and Research Hospital, Turkey
| | - Adem Aksoy
- Department of Gastroenterology, Turkiye Yuksek Ihtisas Education and Research Hospital, Turkey
| | - Derya Arı
- Department of Gastroenterology, Turkiye Yuksek Ihtisas Education and Research Hospital, Turkey
| | - Nuretdin Suna
- Department of Gastroenterology, Turkiye Yuksek Ihtisas Education and Research Hospital, Turkey
| | - Ertuğrul Kayaçetin
- Department of Gastroenterology, Turkiye Yuksek Ihtisas Education and Research Hospital, Turkey
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Akpınar MY, Oztas E, Ödemiş B, Aydog G, Akdogan O, Kuzu UB. Diffuse nodular duodenitis in a woman presenting with dyspepsia and weight loss. Acta Gastroenterol Belg 2017; 80:91. [PMID: 29364111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Duodenal nodularity is an uncommon endoscopic finding charac-trized by numerous visible mucosal nodules in the duodenum. It is important to consider giardiasis in patients with symptoms include abdominal pain, nausea, anorexia, diarrhea, vomiting, weight loss and abdominal distension. It is also important to remind giardiasis in patients with duodenal nodularity.
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Kuzu UB, Ödemiş B, Suna N, Yıldız H, Parlak E, Dişibeyaz S, Torun S, Akpınar MY, Coşkun O, Turhan N, Yüksel M, Kayaçetin E. The Detection of Cholangiocarcinoma in Primary Sclerosing Cholangitis Patients: Single Center Experience. J Gastrointest Cancer 2016; 47:8-14. [PMID: 26537791 DOI: 10.1007/s12029-015-9777-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE 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. METHODS 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. RESULTS 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). CONCLUSION 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.
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Affiliation(s)
- Ufuk Barış Kuzu
- Department of Gastroenterology, Turkiye Yuksek Ihtisas Education and Research Hospital, Sıhhiye, Ankara, Turkey.
| | - Bülent Ödemiş
- Department of Gastroenterology, Turkiye Yuksek Ihtisas Education and Research Hospital, Sıhhiye, Ankara, Turkey
| | - Nuretdin Suna
- Department of Gastroenterology, Turkiye Yuksek Ihtisas Education and Research Hospital, Sıhhiye, Ankara, Turkey
| | - Hakan Yıldız
- Department of Gastroenterology, Turkiye Yuksek Ihtisas Education and Research Hospital, Sıhhiye, Ankara, Turkey
| | - Erkan Parlak
- Department of Gastroenterology, Turkiye Yuksek Ihtisas Education and Research Hospital, Sıhhiye, Ankara, Turkey
| | - Selçuk Dişibeyaz
- Department of Gastroenterology, Turkiye Yuksek Ihtisas Education and Research Hospital, Sıhhiye, Ankara, Turkey
| | - Serkan Torun
- Department of Gastroenterology, Turkiye Yuksek Ihtisas Education and Research Hospital, Sıhhiye, Ankara, Turkey
| | - Muhammet Yener Akpınar
- Department of Gastroenterology, Turkiye Yuksek Ihtisas Education and Research Hospital, Sıhhiye, Ankara, Turkey
| | - Orhan Coşkun
- Department of Gastroenterology, Turkiye Yuksek Ihtisas Education and Research Hospital, Sıhhiye, Ankara, Turkey
| | - Nesrin Turhan
- Department of Pathology, Turkiye Yuksek Ihtisas Education and Research Hospital, Sıhhiye, Ankara, Turkey
| | - Mahmut Yüksel
- Department of Gastroenterology, Turkiye Yuksek Ihtisas Education and Research Hospital, Sıhhiye, Ankara, Turkey
| | - Ertuğrul Kayaçetin
- Department of Gastroenterology, Turkiye Yuksek Ihtisas Education and Research Hospital, Sıhhiye, Ankara, Turkey
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Dişibeyaz S, Suna N, Kuzu UB, Saygılı F, Öztaş E, Ödemiş B, Önal İK, Kılıç ZMY, Akdoğan M, Kayaçetin E. Double balloon enteroscopy: A 7-year experience at a tertiary care Centre. Eur J Intern Med 2016; 33:108-11. [PMID: 27339642 DOI: 10.1016/j.ejim.2016.06.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Revised: 06/09/2016] [Accepted: 06/10/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND Double Balloon Enteroscopy (DBE) provides the opportunity not only to investigate but also apply endoscopic therapeutic interventions for small intestinal disturbances. The aim of this study is to assess the indications, diagnosis, therapeutic interventions, complications and safety in clinical practise of DBE procedures that have been performed in our clinic. MATERIAL-METHODS The data of patients who had undergone DBE procedure in our clinic between October 2007 and December 2014 were retrospectively investigated. All features including indications, findings, histopathological results, applied interventions and complications due to procedure were noted. RESULTS A total of 297 patients, 160 (53,9%) male and 137 (46,1%) female were enrolled in the study. Total number of procedures for these 297 patients were 372 [256 (68,8%) oral and 116 (31,2%) anal]. Mean age of the patients was 46,9 (14-94) years. The most common indications were; obscure gastrointestinal (GI) bleeding (28,3%), iron deficiency anaemia (17,5% ) and abnormal findings in a prior imaging study (13,8%), respectively. The rate of new diagnosis with DBE was 11.8%, where the rate for confirmation of a possible diagnosis was 16.2%, rate of endoscopic treatment with definite diagnosis was 11%, rate for ruling out possible diagnosis or showing normal findings was 34.7% and rate for insufficient or unsuccessful procedures was 26.3%. Ulcers, inflammation and erosions (13%), polyposis syndromes (9.8%) and vascular pathologies (7.4%) were the most common endoscopic findings. CONCLUSION Our study shows that DBE has high efficacy for diagnosis and ability to perform treatment of small intestinal disturbances with safety.
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Affiliation(s)
- Selçuk Dişibeyaz
- Turkiye Yuksek Ihtisas Education and Research Hospital, Department of Gastroenterology, M.D
| | - Nuretdin Suna
- Turkiye Yuksek Ihtisas Education and Research Hospital, Department of Gastroenterology, M.D
| | - Ufuk Barış Kuzu
- Turkiye Yuksek Ihtisas Education and Research Hospital, Department of Gastroenterology, M.D..
| | - Fatih Saygılı
- Turkiye Yuksek Ihtisas Education and Research Hospital, Department of Gastroenterology, M.D
| | - Erkin Öztaş
- Turkiye Yuksek Ihtisas Education and Research Hospital, Department of Gastroenterology, M.D
| | - Bülent Ödemiş
- Turkiye Yuksek Ihtisas Education and Research Hospital, Department of Gastroenterology, M.D
| | - İbrahim Koral Önal
- Turkiye Yuksek Ihtisas Education and Research Hospital, Department of Gastroenterology, M.D
| | - Zeki Mesut Yalın Kılıç
- Turkiye Yuksek Ihtisas Education and Research Hospital, Department of Gastroenterology, M.D
| | - Meral Akdoğan
- Turkiye Yuksek Ihtisas Education and Research Hospital, Department of Gastroenterology, M.D
| | - Ertuğrul Kayaçetin
- Turkiye Yuksek Ihtisas Education and Research Hospital, Department of Gastroenterology, M.D
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Kuzu UB, Öztaş E, Turhan N, Saygili F, Suna N, Yildiz H, Kaplan M, Akpinar MY, Akdoğan M, Kaçar S, Kiliç ZMY, Köksal AŞ, Ödemiş B, Kayaçetin E. Clinical and histological features of idiosyncratic liver injury: Dilemma in diagnosis of autoimmune hepatitis. Hepatol Res 2016; 46:277-91. [PMID: 25926402 DOI: 10.1111/hepr.12530] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 04/22/2015] [Accepted: 04/23/2015] [Indexed: 02/06/2023]
Abstract
AIM Drug-induced liver injury (DILI) is becoming a worldwide problem with its still unexplained properties. METHODS The data of patients who were diagnosed with DILI between January 2008 and December 2013 were assessed. RESULTS Five patients had been diagnosed with intrinsic and 82 patients with idiosyncratic DILI. The most common causative agents were antimicrobial drugs. The most common injury pattern was hepatocellular. When patients with bilirubin levels of more than 5 mg/dL were divided into two groups according to receiving steroid therapy (n = 11) or not (n = 40), there was not any significant difference according to their clinical results (P > 0.05). Five of the idiosyncratic DILI patients were diagnosed with drug-induced autoimmune hepatitis (DI-AIH). In histopathological examination, hepatic rosette formation and emperipolesis were observed to be more common among patients with DI-AIH when compared with ones without (P < 0.05). Interestingly, in the remaining patients with DILI (n = 77), three of them were diagnosed with classic autoimmune hepatitis during long-term follow up (range, 11-51 months). CONCLUSION The most common causes were antimicrobials, but any agents that have not been defined to cause DILI can induce DILI. The efficacy of steroids in DILI has not been observed but all deaths were observed in the steroid-free group. The association of DILI and AIH was observed in two different types in terms of diagnosis in our study. The first association was DI-AIH. The second one is the classical AIH which developed in three patients after a few months following spontaneous recovery of DILI.
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Affiliation(s)
| | - Erkin Öztaş
- Departments of Gastroenterology, Ankara, Turkey
| | - Nesrin Turhan
- Pathology, Turkiye Yuksek Ihtisas Education and Research Hospital, Ankara, Turkey
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Ödemiş B, Köksal AŞ, Torun S, Yurdakul M, Kayaçetin E. Complete biliary obstruction without jaundice due to an anatomic variation. Turk J Gastroenterol 2015; 25 Suppl 1:187-90. [PMID: 25910302 DOI: 10.5152/tjg.2014.4141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
An aberrant right posterior hepatic duct is present in 4.8-8.4% of the population. It is one of the causes of bile duct injury during laparascopic cholecystectomy. Herein we present a patient with complete transection of the common hepatic duct during laparascopic cholecystectomy (Stewart-Way class 3). Interestingly, the patient had an intact aberrant right posterior duct draining into the common hepatic duct distal to the obstruction site that prevented early diagnosis of the biliary injury because of drainage of the liver sufficient to prevent the development of jaundice.
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Affiliation(s)
- Bülent Ödemiş
- Department of Gastroenterology, Türkiye Yüksek İhtisas Hospital, Ankara, Turkey.
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Parlak E, Köksal AŞ, Dişibeyaz S, Çiçek B, Ödemiş B, Şaşmaz N, Şahin B. Retraction of the main papilla toward the biliary system in patients with primary sclerosing cholangitis. Turk J Gastroenterol 2015; 25 Suppl 1:203-5. [PMID: 25910307 DOI: 10.5152/tjg.2014.5238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND/AIMS Retraction of the main papilla toward the biliary system was observed in 70% of patients with primary sclerosing cholangitis (PSC). However, this observation was confounded by the fact that all of the patients with this finding had a prior history of sphincterotomy. The aim of the present study was to observe whether main papillary retraction can be seen in patients with naïve papillae and accompanies the progression of the disease. MATERIALS AND METHODS The study was conducted in a single tertiary reference center and included 4 patients with PSC. RESULTS Main papillary retraction was seen to emerge with progression of PSC after an initial presentation with intra and extrahepatic involvement in 2 patients and after progression from intrahepatic to extrahepatic bile ducts in 1 patient. Main papillary retraction was seen in 2 patients with naïve papillae and could be detected by magnetic resonance cholangiography in 1 patient. CONCLUSION Retraction of the main papilla can be seen in patients with PSC regardless of prior sphincterotomy history.
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Affiliation(s)
- Erkan Parlak
- Department of Gastroenterology, Türkiye Yüksek İhtisas Hospital, Ankara, Turkey.
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Parlak E, Köksal AŞ, Öztaş E, Dişibeyaz S, Ödemiş B, Yüksel M, Yıldız H, Şaşmaz N, Şahin B. Is there a safer electrosurgical current for endoscopic sphincterotomy in patients with liver cirrhosis? Wien Klin Wochenschr 2015; 128:573-8. [PMID: 25576330 DOI: 10.1007/s00508-014-0677-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2014] [Accepted: 11/08/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Endoscopic sphincterotomy has a higher risk of bleeding in patients with cirrhosis. Advanced Child stage and coagulopathy are well-known risk factors. We aimed to determine the role of electrosurgical currents in the development of endoscopic sphincterotomy bleeding in cirrhotic patients. METHODS The study was a retrospective observational study and included 19,642 patients who underwent endoscopic retrograde cholangiopancreatography between 2004 and 2013. The incidence of endoscopic sphincterotomy bleeding in cirrhotic patients who underwent sphincterotomy after 2009 with an electrosurgical generator applying alternating current in the pulse cut mode (Group 2) was compared with a historical control group who underwent endoscopic sphincterotomy between 2004 and 2009 via blended current (Group 1). RESULTS Group 1 included 15 patients (six women, nine men, mean age: 62.2 ± 12.9 years). Group 2 included 14 patients (six women, eight men, mean age: 63.6 ± 16.9 years). There was no statistically significant difference between the demographic and clinical characteristics of the two groups. Endoscopic sphincterotomy bleeding was observed in three patients in Group 1 (two endoscopic bleeding and one clinically significant bleeding) and none of the patients in Group 2 (p = 0.77). There were no cases of perforation or pancreatitis in both groups. One patient in Group 2 developed cholangitis. CONCLUSIONS Endoscopic sphincterotomy bleeding is less frequently observed in patients with cirrhosis who underwent sphincterotomy with alternating mixed current in the pulse cut mode compared with those with blended current.
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Affiliation(s)
- Erkan Parlak
- Department of Gastroenterology, Sakarya University, Sakarya, Turkey
| | - Aydın Şeref Köksal
- Department of Gastroenterology, Sakarya University, Sakarya, Turkey. .,Kızılırmak mahallesi, 1443. Cadde, 40/13, Çukurambar, Ankara, Turkey.
| | - Erkin Öztaş
- Department of Gastroenterology, Türkiye Yüksek İhtisas Hospital, Sıhhiye, Ankara, Turkey
| | - Selçuk Dişibeyaz
- Department of Gastroenterology, Türkiye Yüksek İhtisas Hospital, Sıhhiye, Ankara, Turkey
| | - Bülent Ödemiş
- Department of Gastroenterology, Türkiye Yüksek İhtisas Hospital, Sıhhiye, Ankara, Turkey
| | - Mahmut Yüksel
- Department of Gastroenterology, Türkiye Yüksek İhtisas Hospital, Sıhhiye, Ankara, Turkey
| | - Hakan Yıldız
- Department of Gastroenterology, Türkiye Yüksek İhtisas Hospital, Sıhhiye, Ankara, Turkey
| | - Nurgül Şaşmaz
- Department of Gastroenterology, Türkiye Yüksek İhtisas Hospital, Sıhhiye, Ankara, Turkey
| | - Burhan Şahin
- Department of Gastroenterology, Türkiye Yüksek İhtisas Hospital, Sıhhiye, Ankara, Turkey
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Üsküdar O, Parlak E, Dışıbeyaz S, Köksal AS, Cıçek B, Kılıç ZMY, Ödemiş B, Şaşmaz N. Major predictors for difficult common bile duct stone. Turk J Gastroenterol 2014; 24:423-9. [PMID: 24557966 DOI: 10.4318/tjg.2013.0511] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND/AIMS Endoscopic retrograde cholangiopancreatography has become the standard treatment for common bile duct stones worldwide. There are only a few reports with small number of patients concerning the factors that contribute to the technical difficulty of endoscopic retrograde cholangiopancreatography in these patients. In this study, we aimed to investigate these factors in a large group of patients. MATERIALS AND METHODS All patients with naive papilla (n=1850) who underwent endoscopic retrograde cholangiopancreatography during a study period of 2 years were prospectively evaluated. Among them, 757 patients with common bile duct stones were included in the study. Following successful cannulation, the patients who needed either more than one episode for stone extraction or mechanical lithotripsy, extracorporeal shock wave lithotripsy or in whom stone extraction could not be achieved endoscopically and underwent surgery were regarded as having "difficult stones". Age, sex, laboratory parameters, endoscopic and cholangiographic findings were recorded in all patients. Predictive factors for difficult stones were investigated in univariate and multivariate analysis. RESULTS The study group consisted of 432 women and 325 men with a mean age of 60±16 years (range, 4-96). Of the total 757 patients, 654 (86.4%) had easy and 103 (13.6%) had difficult stones. Endoscopic stone extraction was successful in 98.1% of patients. Stricture distal to the stone (OR: 8.248), smaller common bile duct/stone diameter ratio (OR: 0.348), stone diameter (OR: 1.187), stone impaction (OR: 1.117), and higher bilirubin levels (OR: 1.1) were found to be independent predictors of difficult stone in multivariate analysis. CONCLUSION Endoscopic retrograde cholangiopancreatography is a very effective method for the treatment of common bile duct stones. Besides strictures distal to the stone, smaller common bile duct/stone diameter ratio, stone diameter, impacted stone, and higher bilirubin levels are significant predictors of difficult stone.
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Affiliation(s)
- Oğuz Üsküdar
- Çukurova University, Balcalı Hospital, Department of Gastroenterology, Adana, Turkey
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Başar Ö, Ödemiş B, Tuna Y, Ekiz F, Erbiş H. Right Flank Pain in a Man: Renal Stone or Needle in the Liver? Electron J Gen Med 2014. [DOI: 10.15197/sabad.1.11.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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28
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Ödemiş B, Shorbagi A, Köksal AŞ, Özdemir E, Torun S, Yüksel M, Kayaçetin E. The "Lasso" technique: snare-assisted endoscopic-radiological rendezvous technique for the management of complete transection of the main bile duct. Gastrointest Endosc 2013; 78:554-6. [PMID: 23948203 DOI: 10.1016/j.gie.2013.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Accepted: 04/01/2013] [Indexed: 02/08/2023]
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Ödemiş B, Köksal AŞ, Torun S. An uncommon cause of abdominal pain after endoscopic retrograde cholangiopancreatography. Wien Klin Wochenschr 2013; 125:346-7. [PMID: 23681362 DOI: 10.1007/s00508-013-0368-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2013] [Accepted: 04/04/2013] [Indexed: 10/26/2022]
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Köksal AŞ, Kalkan IH, Torun S, Ödemiş B, Kiliç ZMY, Suvak B, Suna N, Ökten RS, Özoğul Y, Şaşmaz N. Superior mesenteric artery thrombosis related to double balloon enteroscopy in a patient with Crohn's disease. Clin Res Hepatol Gastroenterol 2013; 37:e40-1. [PMID: 23168229 DOI: 10.1016/j.clinre.2012.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Accepted: 09/12/2012] [Indexed: 02/04/2023]
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