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Günay S, Paköz B, Çekiç C, Çamyar H, Alper E, Yüksel ES, Topal F, Binicier ÖB. Evaluation of hydrogen peroxide-assisted endoscopic ultrasonography-guided necrosectomy in walled-off pancreatic necrosis: A single-center experience. Medicine (Baltimore) 2021; 100:e23175. [PMID: 33545925 PMCID: PMC7837928 DOI: 10.1097/md.0000000000023175] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 10/07/2020] [Indexed: 12/11/2022] Open
Abstract
Hydrogen peroxide is a liquid that functions in mechanical removal of the necrotic tissue via the elimination of tissue debris.In this study, we aimed to evaluate the effectiveness of the use of hydrogen peroxide in necrosectomy treatment of walled-off pancreatic necrosis.Records of 24 patients who were diagnosed with pancreatic necrosis or walled-off pancreatic necrosis and underwent endoscopic necrosectomy (EN) were retrospectively assessed. Patients were divided into 2 groups; hydrogen peroxide used for treatment or not used, and these 2 groups were compared.A total of 24 patients underwent endoscopic intervention for walled-off pancreatic necrosis. Procedural success was comparable between the 2 groups. During the post-procedural follow-up, the duration of the hospital stay, recurrence, and complication rates were found to be similar in both groups. The mean number of the endoscopic interventions was significantly lower in the hydrogen peroxide group (4.2 ± 1.4 vs 6.1 ± 4.2; P = .01).The use of hydrogen peroxide for EN in walled-off pancreatic necrosis patients seems to have similar efficiency and safety. However, it can be said that the use of hydrogen peroxide could reduce the number of endoscopic procedures.
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Affiliation(s)
- Süleyman Günay
- Department of Gastroenterology, Katip Çelebi University, Atatürk Training and Research Hospital, Izmir
| | - Betül Paköz
- Department of Gastroenterology, Katip Çelebi University, Atatürk Training and Research Hospital, Izmir
| | - Cem Çekiç
- Department of Gastroenterology, Katip Çelebi University, Atatürk Training and Research Hospital, Izmir
| | - Hakan Çamyar
- Department of Gastroenterology, Katip Çelebi University, Atatürk Training and Research Hospital, Izmir
| | - Emrah Alper
- Department of Gastroenterology, Koc Universitesi, Istanbul
| | - Elif Saritaş Yüksel
- Department of Gastroenterology, Katip Çelebi University, Atatürk Training and Research Hospital, Izmir
| | - Firdevs Topal
- Department of Gastroenterology, Katip Çelebi University, Atatürk Training and Research Hospital, Izmir
| | - Ömer Burcak Binicier
- Tepecik Education and Research Hospital, Department of Gastroenterology, Yenisehir-Izmir, Turkey
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Attila T, Zeybel M, Yigit YE, Baran B, Ahishali E, Alper E, Aslan F, Ergonul O, Mungan Z. Upper socioeconomic status is associated with lower Helicobacter pylori infection rate among patients undergoing gastroscopy. J Infect Dev Ctries 2020; 14:298-303. [PMID: 32235091 DOI: 10.3855/jidc.11877] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 07/26/2019] [Accepted: 01/22/2020] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Socioeconomic factors play an important role in the prevalence of Helicobacter pylori (HP) infection. The aim of this study is to investigate HP prevalence among symptomatic patients in the upper socioeconomic segment of the population undergoing gastroscopy in an endemic urban region. METHODOLOGY Over a 12-month period, data were collected from the first consecutive 1000 patients (500 from university hospital, 500 from community hospital) who had gastroscopy and HP evaluation. RESULTS Overall, 211/1000 patients (21.1 %) were found to have HP in gastric biopsies. The specificity, sensitivity, positive predictive value, negative predictive value and diagnostic accuracy of rapid urease test were 87.5%, 99.7%, 99%, 96.5%, and 96.9% respectively. Atrophic gastritis, gastric and duodenal ulcers were significantly more common in HP positive patients. Age based distribution of HP prevalence: > 6 decades (15.5%), 3rd-5th decades (26.1%), < 3rd decades (10.4%). CONCLUSION In an HP endemic country, the prevalence of HP infection among symptomatic patients belonging to the upper socioeconomic segment of the population appears to be markedly lower. The lowest prevalence in young patients is expected to result in future decrease in HP prevalence.
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Affiliation(s)
- Tan Attila
- Division of Gastroenterology and Hepatology, Koc University School of Medicine, Istanbul, Turkey.
| | - Mujdat Zeybel
- Division of Gastroenterology and Hepatology, Koc University School of Medicine, Istanbul, Turkey.
| | - Yesim Esen Yigit
- School of Medicine, Rumelifeneri, Koc University, Istanbul, Turkey.
| | - Bulent Baran
- Division of Gastroenterology and Hepatology, Koc University School of Medicine, Istanbul, Turkey.
| | - Emel Ahishali
- Division of Gastroenterology and Hepatology, Koc University School of Medicine, Istanbul, Turkey.
| | - Emrah Alper
- Division of Gastroenterology and Hepatology, Koc University School of Medicine, Istanbul, Turkey.
| | - Fatih Aslan
- Division of Gastroenterology and Hepatology, Koc University School of Medicine, Istanbul, Turkey.
| | - Onder Ergonul
- Division of Infectious Diseases, Koc University, Istanbul, Turkey.
| | - Zeynel Mungan
- Division of Gastroenterology and Hepatology, American Hospital, Istanbul, Turkey.
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Sezer H, Yazıcı D, Deyneli O, Meriçöz Ç, Esin A, Alper E. Empagliflozin-induced ketoacidosis in a patient presenting with new-onset type 2 diabetes mellitus due to indolent pancreatic cancer. Endokrynol Pol 2020; 71:283-284. [PMID: 32154575 DOI: 10.5603/ep.a2020.0012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 02/16/2020] [Accepted: 02/21/2020] [Indexed: 11/25/2022]
Abstract
Not required for Clinical Vignette.
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Affiliation(s)
- Havva Sezer
- Koç University School of Medicine, İstanbul, Turkey.
| | - Dilek Yazıcı
- Koç University School of Medicine, İstanbul, Turkey
| | | | | | - Ayla Esin
- Koç University School of Medicine, İstanbul, Turkey
| | - Emrah Alper
- Koç University School of Medicine, İstanbul, Turkey
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Kayar Dogan E, Abaci Gunyar O, Topal F, Alper E, Ekinci N. Bacterial species and total bacterial load in the distal oesophagus in patients with and without clinical gastric reflux. J Appl Microbiol 2019; 126:1891-1898. [PMID: 30873693 DOI: 10.1111/jam.14250] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 02/25/2019] [Accepted: 03/11/2019] [Indexed: 12/01/2022]
Abstract
AIMS The purpose of this study is to compare distal oesophagus of persons with and without gastric reflux in terms of bacterial load and presence of certain bacterial species. METHODS AND RESULTS Two biopsy specimens were obtained from the distal oesophagus at 5 cm above the gastroesophageal junction of each of the 50 patients (20 with normal oesophagus and 30 with reflux oesophagitis) under endoscopic examination and used for histological examination and DNA isolation. We used a real-time PCR-based assay to quantify the bacterial load and the presence of certain bacterial species from one of the biopsy samples. The biopsy specimens taken from the patients with reflux oesophagitis were consistent with gastroesophageal reflux disease (GERD). The bacterial load did not significantly differ between the groups (P < 0·005). CONCLUSION While there was no difference between the bacterial load in the two groups, variation was observed in bacterial species. Most of the bacteria identified in distal oesophagus of the patients with gastroesophageal reflux were Gram negative. SIGNIFICANCE AND IMPACT OF THE STUDY The human oesophagus was considered sterile until quite recently. Molecular techniques displayed the presence of a diverse bacterial species in the oesophagus. Although it is known that dysbiosis in the oesophagus causes GERD, and that Barrett's oesophagus can trigger the development of oesophageal adenocarcinoma, its etiopathogenesis is not clear. A limited number of published studies support the importance of the present study.
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Affiliation(s)
- E Kayar Dogan
- Basic and Industrial Microbiology Section, Biology Department, Science Faculty, Ege University, İzmir, Turkey
| | - O Abaci Gunyar
- Basic and Industrial Microbiology Section, Biology Department, Science Faculty, Ege University, İzmir, Turkey
| | - F Topal
- Department of Gastroenterology, Atatürk Research and Teaching Hospital, İzmir Katip Çelebi University, İzmir, Turkey
| | - E Alper
- Department of Gastroenterology, İstanbul Koç University Hospital, İzmir, Turkey
| | - N Ekinci
- Department of Pathology, Atatürk Research and Teaching Hospital, İzmir Katip Çelebi University, İzmir, 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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Tavusbay C, Alper E, Gökova M, Kamer E, Kar H, Atahan K, Özşay O, Gür Ö, Cin N, Çapkınoğlu E, Durak E. Management of perforation after endoscopic retrograde cholangiopancreatography. ULUS TRAVMA ACIL CER 2017; 22:441-448. [PMID: 27849320 DOI: 10.5505/tjtes.2016.42247] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Endoscopic retrograde cholangiopancreatography (ERCP)-related perforation is an infrequent complication. It is associated with significant morbidity and mortality. The present study is an evaluation of experience with management and outcomes of ERCP-related perforations and a review of relevant literature. METHODS Between January 2008 and January 2015, a total of 9383 ERCPs were performed in endoscopy unit. A total of 29 perforations (0.33%) were identified and retrospectively reviewed. RESULTS Of the 29 patients, 18 were female and 11 patients were male, with mean age of 70.5 years (range 33-99 years). According to Stapfer's classification, the 29 patients with ERCP related perforations included 5 type 1 perforations, 14 type 2 perforations, 7 type 3 perforations, and 3 cases of type 4 perforation. In total, 15 of 29 patients with ERCP perforation were operated on. Nine (60%) of those who underwent surgery were discharged uneventful, but 6 (40%) patients died due to postoperative complications and/or associated comorbidities. Seven (24.1%) of 29 patients had undergone endoscopic treatment and 5 of the 7 were discharged from the hospital without any problems; however, peritonitis occurred in 2 patients whose initial endoscopic treatment failed. The first of these 2 patients underwent surgery and was discharged uneventfully, but second patient, who refused surgery, died due to sepsis. Six patients were successfully treated with conservative management. Surgery could not be performed in the remaining 2 patients, who died of sepsis following peritonitis; 1 refused surgery, the other had sudden cardiopulmonary arrest during induction of general anesthesia. Mean hospital stay was 13.2 days (range: 2-57 days). In all, 9 (31%) patients died during period of the study. CONCLUSION ERCP-related perforation is uncommon complication, but an extremely serious condition. Early diagnosis and prompt management are most important to reduce associated significant morbidity and mortality rates. The most appropriate treatment course should be determined on case-by-case basis.
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Affiliation(s)
- Cengiz Tavusbay
- Department of General Surgery, İzmir Katip Çelebi University Atatürk Training and Researh Hospital, İzmir-Turkey.
| | - Emrah Alper
- Department of Gastroenterology, İzmir Katip Çelebi University Atatürk Training and Researh Hospital, İzmir-Turkey
| | - Melek Gökova
- Department of General Surgery, İzmir Katip Çelebi University Atatürk Training and Researh Hospital, İzmir-Turkey
| | - Erdinç Kamer
- Department of General Surgery, İzmir Katip Çelebi University Atatürk Training and Researh Hospital, İzmir-Turkey
| | - Haldun Kar
- Department of General Surgery, İzmir Katip Çelebi University Atatürk Training and Researh Hospital, İzmir-Turkey
| | - Kemal Atahan
- Department of General Surgery, İzmir Katip Çelebi University Atatürk Training and Researh Hospital, İzmir-Turkey
| | - Oğuzhan Özşay
- Department of General Surgery, İzmir Katip Çelebi University Atatürk Training and Researh Hospital, İzmir-Turkey
| | - Özlem Gür
- Department of General Surgery, İzmir Katip Çelebi University Atatürk Training and Researh Hospital, İzmir-Turkey
| | - Necat Cin
- Department of General Surgery, İzmir Katip Çelebi University Atatürk Training and Researh Hospital, İzmir-Turkey
| | - Emir Çapkınoğlu
- Department of General Surgery, İzmir Katip Çelebi University Atatürk Training and Researh Hospital, İzmir-Turkey
| | - Evren Durak
- Department of General Surgery, İzmir Katip Çelebi University Atatürk Training and Researh Hospital, İzmir-Turkey
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Uygun A, Ozturk K, Demirci H, Oztuna A, Eren F, Kozan S, Yilmaz Y, Kurt O, Turker T, Vatansever S, Alper E, Unsal B. The association of nonalcoholic fatty liver disease with genetic polymorphisms: a multicenter study. Eur J Gastroenterol Hepatol 2017; 29:441-447. [PMID: 28253210 DOI: 10.1097/meg.0000000000000813] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Growing evidence suggests that multiple factors, such as insulin resistance, nutritional factors, gut microbiota, and hormones released from the adipose tissue, act together on genetically predisposed individuals. We aimed to investigate whether various single-nucleotide polymorphisms (SNPs) play a role in the development of nonalcoholic fatty liver disease (NAFLD) and severity of liver damage in the Anatolian population. METHODS Two hundred and sixteen patients with biopsy-proven NAFLD and 150 control participants, aged 18-70 years, were consecutively enrolled in this multicenter study. Blood samples were genotyped for the PNPLA3 (rs738409), IL28B (rs12979860, rs12980275, rs8099917), PPAR-α 227 ALA, PPAR-γ pro 12 ALA, SOD2 C47T, and LOX-1 IVS4-14 polymorphisms using the custom-made LightSNiP assays on a LightCycler 480 II instrument. RESULTS Genotypic distributions of PNPLA3 rs738409 SNPs were different between NAFLD and control participants, but not for other SNPs. The PNPLA3 rs738409 GG polymorphism was associated with a 27-fold increased risk of development of NAFLD (odds ratio=27.8, 95% confidence interval: 3.5-218.4; P=0.002). Patients with the PNPLA3 GG genotype had higher nonalcoholic fatty liver disease activity score levels compared with patients with the PNPLA3 CC genotype (P<0.005). NAFLD patients without fibrosis had a higher frequency of IL28B rs12979860 TT and rs12980275 GG genotypes compared with NAFLD patients with fibrosis (P<0.005). CONCLUSION The present study proposes that polymorphisms in the PNPLA3 gene have highly predictive value in the development of NAFLD and are independently associated with the severity of liver histology in patients with NAFLD. The results of this study suggest that IL28B rs12979860 TT or rs12980275 GG may play an important protective role against the development of advanced fibrosis and even cirrhosis.
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Affiliation(s)
- Ahmet Uygun
- Departments of aGastroenterologybGeneticscHealth Public and Epidemiology, Gulhane School of Medicine, AnkaradDepartment of Gastroenterology, Marmara University, IstanbuleDepartment of Gastroenterology, Katip Çelebi University, Izmir, Turkey
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Abstract
Endoscopic ultrasound (EUS) enables a gastroenterologist to sample the masses of the middle and inferior mediastinum, which are adjacent to the esophagus; cystic or solid lesions of the pancreas, which are adjacent to the stomach and duodenum; and perirectal lesions. Needles used for EUS sampling include aspiration (19, 20, and 22 Gauge) or core biopsy needles (ProCore and Trucut) (19, 20, and 22 Gauge). The type and size of EUS needles do not alter the diagnostic results. Rapid on-site cytopathological evaluation will increase the diagnostic efficacy to 100% without prolonging the procedure time. Diagnostic efficacy of EUS-guided fine-needle aspiration or core biopsy depends on the experience of an endoscopist and a cytopathologist. In the presence of an experienced endoscopist and cytopathologist, the size of the needle does not have any significant impact on the diagnostic success.
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Affiliation(s)
- Emrah Alper
- Department of Gastroenterology, Katip Çelebi University, İzmir Atatürk Training and Research Hospital, İzmir, Turkey.
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Abstract
We investigated the utility of noncontrast enhanced endosonography (EUS) in predicting the severity of acute pancreatitis (AP) during the first 72 to 96 h of admission.In total, 187 patients with acute biliary pancreatitis were included. The patients were classified into 2 groups as having severe and mild AP according to the Modified Glasgow scoring and computerized tomography severity index (SI). The 158 cases with mild and 29 cases with severe AP had a similar age and sex distribution.Although none of the cases with mild AP developed morbidity and death, of the cases with severe AP, 16 developed serious morbidities and 5 died. On EUS examination, we looked for parenchymal findings, peripancreatic inflammatory signs, free or loculated fluid collections, and abnormalities of the common bile duct and the pancreatic channel. Statistical analysis indicated a significant relationship between the severity of AP with diffuse parenchymal edema, periparenchymal plastering, and/or diffuse retroperitoneal free fluid accumulation, and peri-pancreatic edema. We also defined an EUSSI and found that the EUSSI had sensitivity of 89.7%, specificity of 84.2%, positive predictivity value (PPV) of 88.9%, negative predictivity value (NPV) of 91.2%, and an accuracy of 87.9% in the differentiation of mild and severe AP. We found that the EUSSI had an accuracy of 72.4%, sensitivity of 75.4%, specificity of 65.1%, PPV of 69.3%, and NPV of 73.1% for determining mortality.Our data suggest that EUS allowed us to accurately predict the severity and mortality in nearly 90% of cases with AP.
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Affiliation(s)
- Emrah Alper
- From the Department of Gastroenterology, Izmir Katip Çelebi University, İzmir, Turkey
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Bildik G, Akin N, Guzel Y, Yakin K, Alper E, Ata AS, Balaban B, Urman B, Oktem O. Gonadotropin stimulation alters the expression of local growth factors in the granulosa cells involved in paracrine communication, dominant follicle selection and luteinization. Fertil Steril 2015. [DOI: 10.1016/j.fertnstert.2015.07.1011] [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: 11/16/2022]
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Ipek S, Cekic C, Alper E, Coban E, Eliacik E, Arabul M, Aslan F, Vatansever S, Yalcin H, Unsal B. Can red cell distribution width be a marker of disease activity in ulcerative colitis? Int J Clin Exp Med 2015; 8:13848-13853. [PMID: 26550336 PMCID: PMC4613021] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 07/21/2015] [Indexed: 06/05/2023]
Abstract
AIM The current study aimed to investigate the association between disease activity and red cell distribution width (RDW) levels in ulcerative colitis and to determine whether RDW can be used as a marker of disease activity in non-anemic ulcerative colitis. METHODS The RDW levels of 310 ulcerative colitis patients who underwent colonoscopy were analyzed retrospectively. The patients were divided into two groups (active disease and remission) according to the endoscopic activity index. In addition, the accuracy of RDW in determining disease activity in non-anemic patients was assessed. The efficacy of RDW in determining disease activity was compared to that of white blood cell count, platelet count, C-reactive protein, and erythrocyte sedimentation rate. RESULTS Two hundred and six (66.5%) patients had active disease, and 104 (33.5%) were in remission. The mean RDW levels in patients with active ulcerative colitis and in those in remission were 16.8±2.9 and 15.5±1.4, respectively (P<0.001). Ninety-six (46.6%) patients in the active disease group and 89 (85.6%) in the remission group were non-anemic, and their respective RDW levels were 15.4±1.2 and 15.3±1.1 (P=0.267). The sensitivity and specificity of RDW in determining inflammation were 41% and 91%, respectively (AUC 0.65, P<0.001). CONCLUSIONS This study demonstrated that RDW can be used as a marker for disease activity in ulcerative colitis, but it did not have the same efficacy in the non-anemic group.
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Affiliation(s)
- Serkan Ipek
- Department of Gastroenterology, Izmir Katip Celebi University, Atatürk Training and Research HospitalIzmir, Turkey
| | - Cem Cekic
- Department of Gastroenterology, Izmir Katip Celebi University, Atatürk Training and Research HospitalIzmir, Turkey
| | - Emrah Alper
- Department of Gastroenterology, Izmir Katip Celebi University, Atatürk Training and Research HospitalIzmir, Turkey
| | - Eyup Coban
- Department of Gastroenterology, Izmir Katip Celebi University, Atatürk Training and Research HospitalIzmir, Turkey
| | - Eylem Eliacik
- Department of Hematology, Hacettepe UniversityAnkara, Turkey
| | - Mahmut Arabul
- Department of Gastroenterology, Izmir Katip Celebi University, Atatürk Training and Research HospitalIzmir, Turkey
| | - Fatih Aslan
- Department of Gastroenterology, Izmir Katip Celebi University, Atatürk Training and Research HospitalIzmir, Turkey
| | - Sezgin Vatansever
- Department of Gastroenterology, Izmir Katip Celebi University, Atatürk Training and Research HospitalIzmir, Turkey
| | - Hulya Yalcin
- Department of Biochemistry, Tepecik Training and Research HospitalIzmir, Turkey
| | - Belkis Unsal
- Department of Gastroenterology, Izmir Katip Celebi University, Atatürk Training and Research HospitalIzmir, Turkey
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Aslan F, Camcı M, Alper E, Akpınar Z, Arabul M, Celik M, Unsal B. Cold snare polypectomy versus hot snare polypectomy in endoscopic treatment of small polyps. Turk J Gastroenterol 2015; 25:279-83. [PMID: 25141316 DOI: 10.5152/tjg.2014.5085] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [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 The removal of small colon polyps by hot snare polypectomy (HP) is a commonly used method. Polypectomy with a cold snare (CP) has been increasingly utilized in recent years. Each method has its own advantages and disadvantages. Herein, we explored the efficacy and safety of each method. MATERIALS AND METHODS Between January 1, 2012 and June 30, 2012, 97 consecutive patients with small colorectal polyps ranging from 5-9 mm in size were separated into either the CP or HP group. Demographic data, the duration of polypectomy, and pathology reports were recorded. RESULTS Seventy-seven polyps were removed from 49 patients in the CP group, and 71 polyps were removed from 48 patients in the HP group. There was no significant difference between the groups with respect to gender, age distribution, number of polyps, or indications for colonoscopy. The mean polyp size was 7.21±1.4 mm in the CP group and 7.56±1.45 mm in the HP group (p=0.111). There was a significant difference in the mean procedure time between the two groups (CP, 25.71±4.3 sec; HP, 70.28±11.3 sec, p<0.001). One patient (1.3/1.4%) from each group developed post-polypectomy bleeding that required treatment. Histological evaluation revealed that 10 of the polyps (6.75%) were advanced adenomas. Pathological examination showed that the polyps were not completely removed in 4 patients (5.13%) in the CP group and 4 patients (5.63%) in the HP group (p=0.89). CONCLUSION CP is an effective and safe method that shortens the polypectomy duration in small polyps (≤9 mm) compared to HP.
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Affiliation(s)
- Fatih Aslan
- Department of Gastroenterology, Katip Çelebi University Atatürk Research and Training Hospital, İzmir, Turkey.
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Cekic C, Aslan F, Kirci A, Gümüs ZZ, Arabul M, Yüksel ES, Vatansever S, Yurtsever SG, Alper E, Ünsal B. Evaluation of factors associated with response to hepatitis B vaccination in patients with inflammatory bowel disease. Medicine (Baltimore) 2015; 94:e940. [PMID: 26039133 PMCID: PMC4616368 DOI: 10.1097/md.0000000000000940] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
It is recommended to investigate the serology of hepatitis B virus (HBV) and vaccinate seronegative patients at the time of diagnosis in inflammatory bowel diseases (IBD). This study aimed to investigate the efficacy of HBV vaccine and factors affecting the response.In this retrospective, observational study, HBV-seronegative IBD patients were administered 3 doses (at months 0, 1, and 6) recombinant 20 μg HbsAg. Patients' demographics, IBD attributes, and treatment methods were investigated as the factors with potential impacts on vaccination outcomes.One hundred twenty-five patients with IBD were evaluated. The number of patients with Anti-HBs >10 IU/L was 71 (56.8%), and the number of patients with anti-HBs >100 IU/L was 50 (40%). Age, disease activity, Crohn disease subtype, and immunosuppressive treatment (IST) were found to have significant effects on immune response (P = 0.011, P < 0.001, P = 0.003, and P < 0.001, respectively). With multivariate analysis, age < 45 years (OR 3.1, 95% CI 1.2-8.3, P = 0.020), vaccination during remission (OR 5.6, 95% CI 2.3-14, P < 0.001), and non-IST (OR 11.1, 95% CI 2.9-43.2, P = 0.001) had favorable effects on the occurrence of adequate vaccine response.The likelihood of achieving adequate immune response with standard HBV vaccination protocol in IBD is low. Selecting vaccination protocols with more potent immunogenicity is a better approach to achieve effective vaccine response in patients with multiple unfavorable factors.
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Affiliation(s)
- Cem Cekic
- From the Department of Gastroenterology, Katip Celebi University, Atatürk Training and Research Hospital (CC, FA, MA, ESY, SV, SG, EA, BÜ); Department of Gastroenterology, Şifa University, Faculty of Medicine (AK); Department of Internal Medicine (ZZG); and Department of Medical Microbiology, Katip Celebi University, Atatürk Training and Research Hospital, İzmir, Turkey (SGY)
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Aslan F, Akpinar Z, Alper E, Atay A, Aslan Yurtlu D, Cekic C, Bor S, Unsal B. The last innovation in achalasia treatment; per-oral endoscopic myotomy. Turk J Gastroenterol 2015; 26:218-23. [DOI: 10.5152/tjg.2015.0150] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Aslan F, Cekiç C, Camci M, Alper E, Ekinci N, Akpinar Z, Alpek S, Arabul M, Unsal B. What is the most accurate method for the treatment of diminutive colonic polyps?: Standard versus jumbo forceps polypectomy. Medicine (Baltimore) 2015; 94:e621. [PMID: 25881835 PMCID: PMC4602498 DOI: 10.1097/md.0000000000000621] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Different methods such as standard, hot, and jumbo forceps are used in endoscopic treatment of diminutive colon polyps. In the current study, it was aimed to compare efficacy and safety of standard and jumbo forceps polypectomy methods in treatment of diminutive colon polyps of ≤5 mm. Polyps with ≤5 mm which were excised during colonoscopy by using standard or jumbo forceps were evaluated. Standard and jumbo forceps polypectomy methods were randomly performed in 212 consecutive patients with diminutive colorectal polyp. One-bite polypectomy and complete resection rates were also determined among polypectomy methods. Results of 161 standard forceps polypectomy and 102 jumbo forceps polypectomy were retrospectively evaluated. Both one-bite polypectomy and complete resection rates were significantly higher in the jumbo forceps polypectomy group than the standard forceps polypectomy group (P < 0.001). In the subgroup analysis performed according to polyp sizes, complete resection rate among polyps with 3-mm diameter was determined as 100%. However, numbers of bites in 4-mm and 5-mm polyps were higher in the standard forceps polypectomy group, and complete resection rate was lower than in the jumbo forceps polypectomy group (P < 0.001). Both endoscopic treatment methods may be employed in treatment of diminutive colon polyps with ≤5 mm. However, jumbo forceps polypectomy is a more effective treatment method in 4- to 5-mm polyps with high one-bite polypectomy and complete resection rate.
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Affiliation(s)
- Fatih Aslan
- From the Department of Gastroenterology, KatipCelebi University Ataturk Training and Research Hospital, Izmir, Turkey
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Vatansever S, Akpinar Z, Alper E, Ipek S, Yazicioglu N, Ekinci N, Unsal B. Gastric polyps and polypoid lesions: Retrospective analysis of 36650 endoscopic procedures in 29940 patients. Turk J Gastroenterol 2015; 26:117-22. [DOI: 10.5152/tjg.2015.7720] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Aslan F, Alper E, Cekıc C, Yurtlu DA, Ekıncı N, Arabul M, Unsal B, Mıura Y, Yamamoto H. Endoscopic submucosal dissection in gastric lesions: the 100 cases experience from a tertiary reference center in West. Scand J Gastroenterol 2015; 50:368-75. [PMID: 25582554 DOI: 10.3109/00365521.2014.999253] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [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] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Endoscopic submucosal dissection (ESD) is an endoscopic treatment method widely used in premalignant and malignant lesions in countries of the Far East. This method, which is difficult technically and has a high complication risk rate, has rarely been performed in the West, because of the fewer number of upper gastrointestinal lesions. In the present study, we aimed to present our results of gastric ESD procedures in respect to the learning curve. METHODS A total of 100 ESD procedures, which were performed in the stomach between April 2012 and September 2014, were recorded prospectively before and after the procedure. Patient data were analyzed retrospectively. ESD procedures were numbered chronologically; the first 30 patients constituted group 1, whereas the rest were classified as the group 2. ESD results were compared between the groups. RESULTS In a total of 95 patients, 100 gastric ESDs were performed. The overall en-bloc and complete resection rates were 93% and 92%, respectively. In respect of the learning curve, there were significant differences in the sizes of lesions and tissues obtained, procedure duration and dissection rate, snare use and knife preferences between groups (p = 0.002, p < 0.001, p = 0.003, p < 0.001, p = 0.009, and p < 0.001, respectively). No significant difference was detected in the en-bloc and complete resection rates and complications between the groups. CONCLUSION According to guideline recommendations and masters for ESD, if ESD training is initiated and continued, successful ESD may be performed in localized lesions in the stomach.
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Affiliation(s)
- Fatih Aslan
- Department of Gastroenterology, Ataturk Training and Research Hospital, Katip Celebi University , Izmir , Turkey
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Ustundag Y, Alper E, Fusaroli P. EUS-FNA versus ERCP-guided sampling for suspected malignant biliary obstruction: which to choose? Gastrointest Endosc 2015; 81:241-2. [PMID: 25527061 DOI: 10.1016/j.gie.2014.07.059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Accepted: 07/24/2014] [Indexed: 02/08/2023]
Affiliation(s)
- Yucel Ustundag
- Department of Internal Medicine, Gastroenterology Clinics, Bulent Ecevit University, Zonguldak, Turkey
| | - Emrah Alper
- Katip Celebi University Hospital, Izmir, Turkey
| | - Pietro Fusaroli
- Gastroenterology Unit, Imola Hospital, Bologna University, Bologna, Italy
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Aslan F, Akpinar Z, Cekic C, Alper E. En bloc resection of a 9 cm giant gastro-duodenal lipoma by endoscopic submucosal dissection. Dig Liver Dis 2015; 47:88-9. [PMID: 25304152 DOI: 10.1016/j.dld.2014.09.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 08/19/2014] [Accepted: 09/10/2014] [Indexed: 12/11/2022]
Affiliation(s)
- Fatih Aslan
- Gastroenterology, Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey.
| | - Zehra Akpinar
- Gastroenterology, Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey.
| | - Cem Cekic
- Gastroenterology, Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey.
| | - Emrah Alper
- Gastroenterology, Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey.
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Çekiç C, Aslan F, Vatansever S, Topal F, Yüksel ES, Alper E, Dallı A, Ünsal B. Latent tuberculosis screening tests and active tuberculosis infection rates in Turkish inflammatory bowel disease patients under anti-tumor necrosis factor therapy. Ann Gastroenterol 2015; 28:241-246. [PMID: 25831138 PMCID: PMC4367214] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 09/21/2014] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Tumor necrosis factor (TNF)-α inhibitors increase the risk of tuberculosis (TB). The objective of the present study was to determine the rate of active TB infection in inflammatory bowel disease (IBD) patients receiving anti-TNF therapy and to determine the results of their latent TB infection (LTBI) screening tests during the follow up. METHODS This is a retrospective observational study of IBD patients receiving anti-TNF therapy. Tuberculin skin test (TST), interferon-γ release assay (IGRA), and chest radiography were used to determine LTBI. Active TB infection rate during anti-TNF treatment was determined. RESULTS Seventy-six IBD patients (25 with ulcerative colitis, 51 with Crohn's disease; 53 male; mean age 42.0±12.4 years) were included. Forty-four (57.9%) patients received infliximab and 32 (42.1%) adalimumab. Their median duration of anti-TNF therapy was 15 months. Forty-five (59.2%) patients had LTBI and received isoniazid (INH) prophylaxis. During the follow-up period, active TB was identified in 3 (4.7%) patients who were not receiving INH prophylaxis. There was a moderate concordance between the TST and the IGRA (kappa coefficient 0.44, 95% CI 0.24-0.76). Patients with or without immunosuppressive therapy did not differ significantly with respect to TST (P=0.318) and IGRA (P=0.157). CONCLUSION IBD patients receiving anti-TNF therapy and prophylactic INH have a decreased risk of developing active TB infection. However, despite LTBI screening, the risk of developing active TB infection persists.
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Affiliation(s)
- Cem Çekiç
- Department of Gastroenterology (Cem Çekiç, Fatih Aslan, Sezgin Vatansever, Firdevs Topal, Elif Sarıtaş Yüksel, Emrah Alper, Belkıs Ünsal), Katip Çelebi University, Atatürk Training and Research Hospital, İzmir, Turkey,
Correspondence to: Cem Çekiç, Katip Çelebi Üniversitesi, Atatürk Eğitim ve Araştırma Hastanesi, Gastroenteroloji Kliniği, 35360, Basınsitesi, İzmir, Turkey, Tel.: +90 505 832 36 52, Fax: +90 232 243 15 30, e-mail:
| | - Fatih Aslan
- Department of Gastroenterology (Cem Çekiç, Fatih Aslan, Sezgin Vatansever, Firdevs Topal, Elif Sarıtaş Yüksel, Emrah Alper, Belkıs Ünsal), Katip Çelebi University, Atatürk Training and Research Hospital, İzmir, Turkey
| | - Sezgin Vatansever
- Department of Gastroenterology (Cem Çekiç, Fatih Aslan, Sezgin Vatansever, Firdevs Topal, Elif Sarıtaş Yüksel, Emrah Alper, Belkıs Ünsal), Katip Çelebi University, Atatürk Training and Research Hospital, İzmir, Turkey
| | - Firdevs Topal
- Department of Gastroenterology (Cem Çekiç, Fatih Aslan, Sezgin Vatansever, Firdevs Topal, Elif Sarıtaş Yüksel, Emrah Alper, Belkıs Ünsal), Katip Çelebi University, Atatürk Training and Research Hospital, İzmir, Turkey
| | - Elif Sarıtaş Yüksel
- Department of Gastroenterology (Cem Çekiç, Fatih Aslan, Sezgin Vatansever, Firdevs Topal, Elif Sarıtaş Yüksel, Emrah Alper, Belkıs Ünsal), Katip Çelebi University, Atatürk Training and Research Hospital, İzmir, Turkey
| | - Emrah Alper
- Department of Gastroenterology (Cem Çekiç, Fatih Aslan, Sezgin Vatansever, Firdevs Topal, Elif Sarıtaş Yüksel, Emrah Alper, Belkıs Ünsal), Katip Çelebi University, Atatürk Training and Research Hospital, İzmir, Turkey
| | - Ayşe Dallı
- Department of Chest Disease (Ayşe Dallı), Katip Çelebi University, Atatürk Training and Research Hospital, İzmir, Turkey
| | - Belkıs Ünsal
- Department of Gastroenterology (Cem Çekiç, Fatih Aslan, Sezgin Vatansever, Firdevs Topal, Elif Sarıtaş Yüksel, Emrah Alper, Belkıs Ünsal), Katip Çelebi University, Atatürk Training and Research Hospital, İzmir, Turkey
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Cekiç C, Gümüş ZZ, Aslan F, Alper E, Sarıtaş Yüksel E, Akay S, Unsal B. An unusual case of ulcerative colitis with Behçet's disease. Turk J Gastroenterol 2014; 25:586-7. [PMID: 25417628 DOI: 10.5152/tjg.2014.5367] [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] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Cem Cekiç
- Department of Gastroenterology, Atatürk Training and Research Hospital, İzmir, Turkey.
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Aslan F, Akpinar Z, Seren AR, Alper E, Cekic C, Ekinci N, Vatansever S, Unsal B. Are endoscopic mucosal resection and endoscopic submucosal dissection risky for patients with cirrhosis? Endoscopy 2014; 46 Suppl 1 UCTN:E149-50. [PMID: 24756268 DOI: 10.1055/s-0034-1364946] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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)
- Fatih Aslan
- Department of Gastroenterology, Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - Zehra Akpinar
- Department of Gastroenterology, Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - Ali Riza Seren
- Department of Anesthesiology and Reanimation, Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - Emrah Alper
- Department of Gastroenterology, Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - Cem Cekic
- Department of Gastroenterology, Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - Nese Ekinci
- Department of Pathology, Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - Sezgin Vatansever
- Department of Gastroenterology, Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - Belkis Unsal
- Department of Gastroenterology, Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
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Baydar B, Cantürk F, Alper E, Aslan F, Akpınar Z, Cengız O, Kandemır A, Ünsal B. Intrahepatic localization of pancreatic pseudocyst: a case report. Turk J Gastroenterol 2014; 24:447-9. [PMID: 24557971 DOI: 10.4318/tjg.2013.0805] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The location of a pseudocyst in the liver is an exceptional event. We report here a case developing right and left intrahepatic pseudocyst following acute biliary pancreatitis. Ultrasound and computed tomography scan revealed a 13-cm right and two 4-cm left intrahepatic collections. Percutaneous puncture permitted us to detect a high level of amylase in the collection, confirming the diagnosis of intrahepatic pseudocyst. Percutaneous drainage resulted in 3000 mL of fluid discharge. The mechanism involved in this patient was rupture of the pancreatic pseudocyst in the retroperitoneal cavity and erosion reaching the right hepatic parenchyma retroperitoneally posterior to the hepatoduodenal ligament and the left hepatic parenchyma via the hepatogastric ligament. Besides, endoscopic sphincterotomy was performed with endoscopic retrograde cholangiopancreatography for cholangitis. After performing endoscopic sphincterotomy, the cysts in the left lobe resolved dramatically. Intrahepatic pseudocyst should be kept in mind when an intrahepatic collection is found in a patients with chronic or recent episode of acute pancreatitis. Computed tomography and high level of amylase in the collection plays an important role for diagnosing this complication. In case of abdominal pain and large intrahepatic pseudocyst, percutaneous drainage can be performed.
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Affiliation(s)
- Behlül Baydar
- Atatürk Eğitim ve Arafltırma Hastanesi,İzmir, Gastroenteroloji Kliniği, İzmir, Turkey
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Topal F, Saritas Yuksel E, Ekinci N, Pekdiker M, Cakalagaoglu F, Alper E, Unal B. The prevalence of IgG4-positive plasma cell infiltrates in inflammatory bowel disease patients without autoimmune pancreatitis. Turk J Gastroenterol 2014; 25:558-62. [DOI: 10.5152/tjg.2014.5714] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Alper E, Arabul M. Serum myeloperoxidase, CPK, CK-MB, and cTnI levels in early diagnosis of myocardial ischemia during ERCP; Once or repeated once? Turk J Gastroenterol 2014; 25:452-3. [DOI: 10.5152/tjg.2014.0020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Cekic C, Arabul M, Alper E, Pakoz ZBK, Saritas E, Ünsal B. Evaluation of the relationship between serum ghrelin, C-reactive protein and interleukin-6 levels, and disease activity in inflammatory bowel diseases. Hepatogastroenterology 2014; 61:1196-1200. [PMID: 25436282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND/AIMS Ghrelin is a 28 aminoasid peptide hormone, have generally focused upon this peptide’s role upon growth and energy metabolism. Recently, studies investigating ghrelin’s effect upon inflammation and immune response have gained importance. We aimed to compare the effectiveness of ghrelin levels, Creactive protein and interleukin-6 levels in establishing disease activity. METHODOLOGY 52 cases with ulcerative colitis and 33 with Crohn’s disease, total 85 patients, were included in this study. The serum ghrelin levels of the patients in remission and of those with active disease were compared. RESULTS The mean serum ghrelin level in active patients (1243 ± 648 pg/ml), was found to be higher than those in remission (466 ± 214 pg/ml) (p<0.001). In establishing the disease activity, CRP is a the most effective marker compared to the other two inflammatory markers. AUC values were established as; CRP: 0.947 (95% CI,0.903-0.992),ghrelin:0.934(95% CI, 0.884-0.984) and interleukin-6: 0.756 (95% CI, 0.648- 0.864). DISCUSSION Serum ghrelin level can be used with CRP as an important marker in establishing the mucosal damage in inflammatory bowel diseases.
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Arabul M, Celik M, Aslan O, Torun S, Beyazit Y, Alper E, Kandemir A, Ünsal B. Hepcidin as a predictor of disease severity in acute pancreatitis: a single center prospective study. Hepatogastroenterology 2013; 60:595-600. [PMID: 23665668 DOI: 10.5754/hge12770] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND/AIMS Predicting the severity of acute pancreatitis is limited to clinical, laboratory and radiological risk factors. Hepcidin levels increase in acute inflammation. We aimed to assess the relationship between hepcidin and C-reactive protein (CRP), white blood cells (WBC) and multi-detector computerized tomography (MDCT) in predicting the severity of pancreatitis. METHODOLOGY We undertook a prospective review of 59 consecutive patients with acute pancreatitis admitted to our clinic. Biochemical values were measured from blood samples taken within 2 hours of admission and from between 2 and 72 hours related to the time of symptom onset. RESULTS In predicting severe acute pancreatitis, hepcidin was superior to CRP and WBC (Area Under the Curve (AUC)=0.79, p=0.003; AUC=0.69, p=NS; AUC=0.53, p=NS, respectively). CONCLUSIONS In this study, hepcidin was found to be superior to CRP in predicting the severity of pancreatitis.
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Affiliation(s)
- Mahmut Arabul
- Department of Gastroenterology, Izmir Katip Celebi University, Atatürk Training and Research Hospital, Izmir, Turkey.
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Alper E, Arabul M, Buyrac Z, Baydar B, Ustundag Y, Celik M, Ünsal B. The use of radial endosonography findings in the prediction of cholangiocarcinoma in cases with distal bile duct obstructions. Hepatogastroenterology 2013; 60:678-683. [PMID: 24046829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND/AIMS We retrospectively collected the data of radial endosonographic (EUS) imaging findings of the patients with the distal bile duct obstructions due to different benign and malignant conditions. We aimed to assess and analyze the EUS findings in the distal bile duct obstruction which can predict or detect the existence of cholangiocarcinoma originating from the distal bile duct wall. METHODOLOGY We gathered the data of 192 cases with distal biliary stricture due to various causes which all were diagnosed. RESULTS With EUS, The sensitivity and specificity for diagnosis of cholangiocarcinoma in lesions were respectively as following: Firstly, small hypoechoic mass which interrupts to see lumen and choledoch wall with total occlusion at distal choledoch: 75.8%, 88.1%. Secondly, hypoechoic and irregular thickening than surrounding regions at distal choledoch wall: 68.1%, 87.3%. Thirdly, appearance of lumen prompt termination at distal choledoch: 57.1%, 87.6%. Lastly, appearance where lumen narrows short segment: 13.6 %, 59.3 %. CONCLUSIONS EUS findings including hypoechoic mass appearance completely occluding the lumen or heterogeneously increased irregular wall-thickness in the distal bile duct were found to be highly predictive and sensitive for detecting malignancy originating from the distal bile duct.
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Arabul M, Kandemır A, Çelık M, Alper E, Akpinar Z, Aslan F, Vatansever S, Ünsal B. Impact of an information video before colonoscopy on patient satisfaction and anxiety. Turk J Gastroenterol 2013; 23:523-9. [PMID: 23161296 DOI: 10.4318/tjg.2012.0416] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND/AIMS Anxiety is a common problem in patients undergoing invasive medical procedures. Colonoscopy is a demanding procedure and requires a patient's good cooperation for successful results. We aimed to examine the effects of adding an information video to our usual preprocedural information. MATERIALS AND METHODS A total of 227 patients were assessed in this study (120 male, 107 female). The patients were divided into two groups as video (n=124) or verbal (n=103). When the patients in the polyclinic with indications for colonoscopy were selected, a text about the procedure and related complications was given to them. A colonoscopy appointment was scheduled for the patients 3-4 weeks following the procedure. On the appointment day, the patients selected randomly in groups of 10 as either verbal or video sections were taken into the communication room 1-5 hours before the procedure. The patients' anxiety was measured afterwards using the Spielberger State-Trait Anxiety Inventory questionnaire. In addition, patients answered individual questions. After the colonoscopy, the patients were asked if they would undergo colonoscopy again for health reasons and whether the procedure was similar to, better, or worse than they had expected (following the information sessions). RESULTS It was noted in univariate and multiple logistic regression analyses that low State-Trait Anxiety Inventory-State levels (p≤0.001 and p=0.016, respectively) and communication by video (p<0.001, p=0.007, respectively) had a significant impact on communication success. CONCLUSIONS An information video shown to patients preparing for colonoscopy had an impact on the success of the procedure and on anxiety.
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Affiliation(s)
- Mahmut Arabul
- İzmir Atatürk Training and Research Hospital, Department of Gastroenterology, İzmir, Turkey.
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Ünsal B, Alper E, Baydar B, Arabul M, Aslan F, Çelık M, Buyraç Z, Akça S. The efficacy of endoscopic ultrasonography in local staging of rectal tumors. Turk J Gastroenterol 2013; 23:530-4. [PMID: 23161297 DOI: 10.4318/tjg.2012.0359] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND/AIMS The purpose of this study was to research the efficacy and reliability of endoscopic rectal ultrasonography in local staging (T and N stages) of rectal tumors. MATERIALS AND METHODS This retrospective study was carried out by the Department of Gastroenterology, İzmir Atatürk Training and Research Hospital, which is tertiary level. Thirty-one patients with adenocarcinoma were included in the study. The patients found operable according to computed tomography underwent preoperative local staging by endoscopic ultrasonography. Radial endoscopic ultrasonography and T and N stages were evaluated. RESULTS It was observed that endoscopic rectal ultrasonography had 80.6% accuracy, 93.4% sensitivity, and 96.5% specificity in T stage; 70% accuracy, 70% sensitivity, and 86% specificity in the detection of presence of lymph node; and 76% accuracy, 100% sensitivity, and 22% specificity in the detection of the nature of lymph node. CONCLUSIONS In this study, it was observed that endoscopic rectal ultrasonography is an efficient and reliable method in the detection of local lymph node and the depth of invasion of rectal tumors (T staging), although it is not reliable enough to determine the characteristics of lymph nodes.
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Affiliation(s)
- Belkıs Ünsal
- Department of General Surgery, Atatürk Research and Training Hospital, İzmir, Turkey
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Öztürk MÇ, Ume CS, Alper E. Reaction Mechanism and Kinetics of 1,8-Diazabicyclo[5.4.0]undec-7-ene and Carbon Dioxide in Alkanol Solutions. Chem Eng Technol 2012. [DOI: 10.1002/ceat.201200341] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Arabul M, Karakus F, Alper E, Kandemir A, Celik M, Karakus V, Yucel K, Unsal B. Comparison of multidetector CT and endoscopic ultrasonography in malignant pancreatic mass lesions. ACTA ACUST UNITED AC 2012; 59:1599-603. [PMID: 22155849 DOI: 10.5754/hge11608] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND/AIMS Endoscopic ultrasonography (EUS) has been shown to be superior to conventional CT in detecting and staging pancreatic cancer. We conducted a prospective trial to compare EUS and MDCT, in discriminating benign/malignant, in determining local and vascular invasion of a suspected pancreatic cancer and deciding its resectability. METHODOLOGY The study was performed at the Gastroenterology Department of Izmir Ataturk Training and Research Hospital, from June 2009 to June 2010, all patients with suspected pancreatic and periampullary tumors referred to our department were enrolled. A total of 56 patients were evaluated at the beginning. Five patients having distal CBD tumor (n=2), gallbladder tumor (n=1) and papillary tumor (n=2) were excluded from the study. Analysis was done for the remaining 51 patients. RESULTS For the diagnosis of resectability/unresectability, EUS alone demonstrated a definite role in 4 (9%) of the 43 patients in confirming surgical and pathologic results and MDCT alone demonstrated a definite role in 6 (14%) of the 43 patients in confirming their results. An accurate diagnostic decision regarding resectability/unresectability was accomplished in 27 (63%) patients with EUS and MDCT. CONCLUSIONS While MDCT is clinically quite effective, in terms of a correct resectability/unresectability decision, EUS should also be used.
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Affiliation(s)
- Mahmut Arabul
- Department of Gastroenterology, Izmir Ataturk Training and Research Hospital, Izmir, Turkey.
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Aslan F, Alper E, Cantürk F, Baydar B, Cın N, Iflazoğlu N, Buyraç Z, Akder Sari A, Oyar I, Unsal B. Gastrointestinal stromal tumor perforation in a case with neurofibromatosis presenting with abdominal pain. Turk J Gastroenterol 2012; 23:83-4. [PMID: 22505388 DOI: 10.4318/tjg.2012.0329] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Ustundag Y, Alper E, Parlak E. EUS-guided rendezvous instead of precut techniques as a rescue measure when selective biliary cannulation fails: is it replacement or misplacement? Gastrointest Endosc 2012; 76:466-7; author reply 467. [PMID: 22817802 DOI: 10.1016/j.gie.2012.02.013] [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: 02/10/2012] [Accepted: 02/13/2012] [Indexed: 02/08/2023]
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Alper E, Baydar B, Vatansever S, Buyraç Z, Aslan F, Akpinar Z, Aksöz MK, Akça S, Ünsal B. Does presence of common bile duct stones in patients with acute biliary pancreatitis affect the severity of illness or laboratory findings? Turk J Gastroenterol 2012; 22:517-22. [PMID: 22234760 DOI: 10.4318/tjg.2011.0242] [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: 11/08/2022]
Abstract
BACKGROUND/AIMS To determine the effect of stone within the common bile duct, on the severity of acute biliary pancreatitis. MATERIAL AND METHODS This is a prospective and cross sectional study which was conducted at a tertiary care hospital including 103 patients. Serum biochemical values and white blood cell counts at the first 12th and 72nd hours of presentation were evaluated. The patients were grouped according to the presence or absence of common bile duct stones which were diagnosed by endoscopic ultrasonography and endoscopic retrograde cholangiopancreatography. Besides, the patients were classified as mild and severe acute pancreatitis according to the data provided by computed tomography (Balthazar scoring) and clinical assessment and blood samples. RESULTS Among the 103 patients with acute biliary patients, radial endoscopic ultrasonography and endoscopic retrograde cholangiopancreatography revealed stones and/or sludge within the common bile duct or ampulla in 41 (39.8%) patients. There was not any persistent common bile duct stone in 62 (60.2%) patients. Severe pancreatitis developed in 9 (22%) of 41 patients who were determined to have stones by endoscopic ultrasonography and endoscopic retrograde cholangiopancreatography, and in 13 (21%) of 62 patients who were not. There was no difference in the incidence of progressing to severe acute biliary patients between patients with and without common bile duct stones (p=0.45). CONCLUSION Presence of common bile duct stones do not correlate with the severity of acute biliary pancreatitis.
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Affiliation(s)
- Emrah Alper
- Department of Gastroenterology, Atatürk Research and Education Hospital, İzmir
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Nesbitt-Hawes E, Campbell N, Won H, Maley P, Henry A, Abbott J, Potdar N, Mason-Birks S, Elson CJ, Gelbaya TA, Nardo LG, Stavroulis A, Nnoaham K, Hummelshoj L, Zondervan K, Saridogan E, GSWH Consortium WERF, Chamie LP, Soares ACP, Kimati CT, Gomes C, Fettback P, Riboldi M, Serafini P, Lalitkumar S, Menezes J, Evdokia D, Gemzell-Danielsson K, Lalitkumar PGL, Bailey J, Newman TA, Johnston A, Zisimopoulou K, White M, Sadek K, Shreeve N, Macklon N, Cheong Y, Al-Akoum M, Akoum A, Giles J, Garrido N, Vidal C, Mondion M, Gallo C, Ramirez J, Pellicer A, Remohi J, Ghosh S, Chattopadhyay R, Jana S, Goswami SK, Bose G, Chakravarty M, Chowdhuri K, Chakravarty BN, Kendirci Ceviren A, Ozcelik Tanriverdi N, Urfan A, Donmez L, Isikoglu M, Romano A, Schreinemacher MH, Backes WH, Slenter JM, Xanthoulea SA, Delvoux B, van Winden L, Beets-Tan RG, Evers JLH, Dunselman GAJ, Jana SK, Chaudhury K, Chattopadhyay R, Chakravarty BN, Maruyama T, Yamasaki A, Miyazaki K, Arase T, Uchida H, Yoshimura Y, Kaser D, Ginsburg E, Missmer S, Correia K, Racowsky C, Streuli I, Chouzenoux S, de Ziegler D, Chereau C, Weill B, Chapron C, Batteux F, Arianmanesh M, Fowler PA, Al-Gubory KH, Urata Y, Osuga Y, Izumi G, Nagai M, Takamura M, Yamamoto N, Saito A, Hasegawa A, Takemura Y, Harada M, Hirata T, Hirota Y, Yoshino O, Koga K, Taketani Y, Mohebbi A, Janan A, Nasri S, Lakpour MR, Ramazanali F, Moini A, Aflatoonian R, Germeyer A, Novak O, Renke T, Jung M, Jackus J, Toth B, Strowitzki T, Bhattacharya J, Mitra A, Kundu S, Pal M, Kundu A, Gumusel A, Basar M, Yaprak E, Aslan E, Arda O, Ilvan S, Kayisli U, Guzel E, Haouzi D, Monzo C, Lehmann S, Hirtz C, Tiers L, Hamamah S, Choi D, Choi J, Jo M, Lee E, Shen X, Wang BIN, Li X, Tamura I, Maekawa R, Asada H, Tamura H, Sugino N, Tamura H, Tamura I, Maekawa R, Asada H, Sugino N, Liu H, Jiang Y, Chen J, Zhu L, Shen X, Wang B, Yan G, Sun H, Coughlan C, Sinagra M, Ledger W, Li TC, Laird SM, Dafopoulos K, Vrekoussis T, Chalvatzas N, Messini CI, Kalantaridou S, Georgoulias P, Messinis IE, Makrigiannakis A, Xue Q, Xu Y, Zuo WL, Zhang L, Shang J, Zhu SN, Bulun SE, Tomassetti C, Geysenbergh B, Meuleman C, Fieuws S, D'Hooghe T, Suginami K, Sato Y, Horie A, Matsumoto H, Fujiwara H, Konishi I, Jung Y, Cho S, Choi Y, Lee B, Seo S, Urman B, Yakin K, Oktem O, Alper E, Taskiran C, Aksoy S, Takeuchi K, Kurematsu T, Yu-ki Y, Fukumoto Y, Homan Y, Sata Y, Kuroki Y, Takeuchi M, Awata S, Muneyyirci-Delale O, Charles C, Anopa J, Osei-Tutu N, Dalloul M, Weedon J, Muney A, Stratton P, Yilmaz B, Kilic S, Aksakal O, Kelekci S, Aksoy Y, Lordlar N, Sut N, Gungor T, Chan J, Tan CW, Lee YH, Tan HH, Choolani M, Griffith L, Oldeweme J, Barcena de Arellano ML, Reichelt U, Schneider A, Mechsner S, Barcena de Arellano ML, Munch S, Vercellino GF, Chiantera V, Schneider A, Mechsner S, Santoro L, D'Onofrio F, Campo S, Ferraro PM, Tondi P, Gasbarrini A, Santoliquido A, Jung MH, Kim HY, Barcena de Arellano ML, Arnold J, Vercellino GF, Chiantera V, Schneider A, Mechsner S, Arnold J, Barcena de Arellano ML, Buttner A, Vercellino GF, Chiantera V, Schneider A, Mechsner S, Karaer A, Celik O, Bay Karabulut A, Celik E, Kiran TR, Simsek OY, Yilmaz E, Turkcuoglu I, Tanrikut E, Alieva K, Kulakova E, Ipatova M, Smolnikova V, Kalinina E. ENDOMETRIOSIS, ENDOMETRIUM, IMPLANTATION AND FALLOPIAN TUBE. Hum Reprod 2012. [DOI: 10.1093/humrep/27.s2.78] [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: 11/12/2022] Open
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van Mello NM, Mol F, Horne AW, Abidin HBZ, Adin ZEHA, Boswell L, Brown JK, Burgess S, Lee KF, Duncan WC, Akhtar M, Oktem O, Mercan R, Alper E, Salar Z, Balaban B, Urman B. SESSION 50: EARLY PREGNANCY - NEW EVIDENCE. Hum Reprod 2012. [DOI: 10.1093/humrep/27.s2.49] [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: 11/13/2022] Open
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Alper E, Üstün Dao Y, Akca S, Arabul M, Buyrac Z, Baydar B. The utility of radial endosonographic features in the diagnosis of cholangio-carcinoma arising from the distal common bile duct. MINERVA GASTROENTERO 2011; 57:434-435. [PMID: 22105733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Unsal B, Alper E, Baydar B, Aslan F, Akpinar Z, Buyraç Z, Aksöz MK. Combined use of endosonography and endoscopic retrograde cholangiopancreatography in the same session. Turk J Gastroenterol 2011; 22:54-9. [PMID: 21480112 DOI: 10.4318/tjg.2011.0157] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND/AIMS The diagnostic value of endoscopic ultrasound in common bile duct stones is high. In this investigation, we evaluated the feasibility of endoscopic ultrasound preceding endoscopic retrograde cholangiography in the same session and the potential benefits in increasing the therapeutic endoscopic retrograde cholangiography ratio in the treatment of choledocholithiasis. METHODS One hundred and sixty-five consecutive patients who presented with elevated ALP and bilirubin levels and were referred for endoscopic retrograde cholangiography of biliary stones diagnosed with magnetic resonance cholangiopancreatography were evaluated. During the evaluation period (mean: 2 weeks), 50 patients with reductions in ALP and bilirubin by at least half relative to baseline values were enrolled into the study. Endoscopic ultrasound was performed prior to endoscopic retrograde cholangiography. Time spent to perform endoscopic ultrasound was noted. For the presence of common bile duct stone, we used retrograde cholangiography findings as the standard of reference. RESULTS Median endoscopic ultrasound time was 10.66 minutes (SD±1.52). Bile duct stones were revealed with retrograde cholangiography in 34 patients (68%). Sensitivity, specificity (with 95% confidence intervals [CIs]), positive predictive value and negative predictive value of endoscopic ultrasound were calculated. In identifying common bile duct stones on endoscopic ultrasound, sensitivity, specificity, positive predictive value, and negative predictive value were statistically determined as 91.2% (95% CI), 88.3% (95% CI), 91%, and 81.3%, respectively. CONCLUSIONS Our results indicate that in the presence of local experience and availability of endoscopic ultrasound, it is feasible to perform endoscopic ultrasound prior to endoscopic retrograde cholangiography. The sensitivity, specificity, positive predictive value, and negative predictive value for detecting choledocholithiasis in suspected cases are high. Endoscopic ultrasound preceding endoscopic retrograde cholangiography in the same session has the potential to decrease diagnostic endoscopic retrograde cholangiography and increase therapeutic endoscopic retrograde cholangiography. Need to perform magnetic resonance cholangiopancreatography in the presence of easily accessible endoscopic ultrasound should be questioned.
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Affiliation(s)
- Belkıs Unsal
- Department of, Gastroenterology, Atatürk Training and Research Hospital, İzmir
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Alper E, Unsal B, Buyrac Z, Baydar B, Akca S, Arslan F, Ustundag Y. Role of radial endosonography in the diagnosis of acute cholangitis. Dig Dis Sci 2011; 56:2191-6. [PMID: 21221785 DOI: 10.1007/s10620-010-1552-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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: 10/08/2010] [Accepted: 12/22/2010] [Indexed: 01/15/2023]
Abstract
BACKGROUND AND STUDY AIM We aimed to assess radial endoscopic ultrasound (EUS) features of the bile duct wall as well as biliary luminal liquid characteristics in cases with acute cholangitis. PATIENTS AND METHODS This prospective study was performed during the period from January 2009 to February 2010 in a tertiary referral center. Twenty-eight patients with acute cholangitis and 60 patients without acute cholangitis but with cholestasis due to gallstone disease were enrolled in the study. During radial EUS examination, sonographic features of the common bile duct wall, the intraductal luminal content, and nearby periductal structures were investigated. Mild hyperechogenic-heterogenic appearances with waving-type movements without acoustic shadowing enclosing one-third of the common bile duct were noted as purulent materials. RESULTS EUS indicated an increased focal and/or diffuse concentric bile duct wall thickness (>1.5 mm) in 68 and 27% of the cases with and without acute cholangitis, respectively. The mean bile duct wall thickness was 1.9 mm (0.9-2.9 mm) and 1.1 mm (0.6-2.1 mm) in the study and control groups, respectively (P < 0.05). On EUS, a pericholedochal hypoechoic strand more than 1.5 cm in length was present in 13 of 28 patients with acute cholangitis (46%). It was less than 1 cm long in 11 cases without acute cholangitis (18%). Bile duct content with heterogenous dense echogenicity without acoustic shadowing was present in 18 patients (64%) with acute cholangitis and in two patients (3%) without cholangitis. Those 20 patients were successfully drained with a same-day endoscopic retrograde cholangiography (ERCP) procedure which confirmed purulent biliary content after sphincterotomy. Same-day ERCP revealed no purulent material drainage from the bile duct in the other eight patients without cholangitis. The accuracy and positive and negative predictivity of diffuse concentric wall thickening and a peribiliary hypoechoic strand of greater than 1.5 cm in length for a diagnosis of acute cholangitis were 91, 86.3, and 67.1%, and 76, 72, and 54%, respectively. For purulent material, the accuracy and positive and negative predictive values of EUS for acute cholangitis were noted to be 87, 93.3, and 82%, respectively. CONCLUSION Through this study, it was concluded that EUS findings such as diffuse and/or concentric wall thickening of more than 1.5 mm and intraductal heterogenous echogenicity without acoustic shadowing are highly accurate and predictive for diagnosing acute cholangitis.
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Affiliation(s)
- Emrah Alper
- İzmir Atatürk Training and Research Hospital, 35041, Karabaglar, Izmir, Turkey
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Alper E, Buyraç Z, Baydar B, Cengiz O, Vatansever S, Aslan F, Akça S, Ünsal B. Evaluation of flow and structure abnormalities of splanchnic system veins in cirrhotic patients without portal hypertension. MINERVA GASTROENTERO 2011; 57:123-127. [PMID: 21587151] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
AIM The aim of this study was to evaluate hemodynamic and anatomic alterations of the splanchnic venous system and the efficiency and safety of color Doppler radial endosonography in the assessment of cirrhotic patients by comparing Child A cirrhotic patients without portal hypertension findings versus a non-cirrhotic group. METHODS The study was carried out between January 2009 and February 2010; the study population was 38 cirrhotic patients without portal hypertension and 140 control patients. RESULTS Hepatopedal flow was monophasic in all the control patients; the flow pattern was chaotic and irregular in 8% of the cirrhotic patients; in the cirrhotic patients the portal vein diameter was increased and the flow velocity reduced; no differences in flow volume were observed between the two groups. Splenic vein diameter and flow velocity were normal. In the majority of the Child A cirrhotic patients without portal hypertension, no changes were seen in portal vein diameter or flow volume; in some patients no significant increase portal vein diameter was observed and showed the flow volumes were unchanged. CONCLUSION Radial Doppler endosonography may be efficient and safe for assessing the splanchnic system.
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Affiliation(s)
- E Alper
- Atatürk Research and Training Hospital, Izmir, Turkey
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Ceken N, Yurtsever SG, Baran N, Alper E, Buyrac Z, Unsal B. Comparison of Helicobacter pylori antibody detection in stool with other diagnostic tests for infection. Asian Pac J Cancer Prev 2011; 12:1077-1081. [PMID: 21790255] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
For detection of Helicobacter pylori, bacterial culture and histopathological examination are invasive in nature, whereas the fast urease test and urea breath test are non-invasive and indirect methods of detection. Stool antibody tests and polymerase chain reaction (PCR) to detect genomic DNA are serological methods, which are preferred to invasive examinations. Our aim was to assess diagnostic specifity and sensitivity of stool antibody tests, with histopathological examination as the golden standard and to compare results with fast urease test findings. Biopsy samples of patients in the study were evaluated as examples of invasive methods, and also stool antibody screening were made (HpSA). When urease and HpSA test results were compared with histopathological results, sensitivity and specificity of urease test were 62.2% and 100%, respectively, and 68.9% and 100% for the HpSA test. General accuracy was 80% and 81%, respectively , positive predictive value 100% with each and negative predictive values 66.1% and 67.2% . The differences were not statistically significant, and the confidence intervals were approximately in the same range. Thus results obtained with biopsy urease and HpSA tests were generally similar to those obtained by histopathological examination. A review of national and international literature showed similar findings.
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Affiliation(s)
- Nihan Ceken
- Microbiology and Clinical Microbiology Department, Izmir Ataturk Training and Research Hospital, Karabaglar/Izmir, Turkey.
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Aslan F, Alper E, Akpinar Z, Baydar B, Aksöz MK, Buyraç Z, Çekıç C, Ünsal B. A rare cause of cholangitis: Fasciola hepatica. Turk J Gastroenterol 2010; 21:329-30. [PMID: 20931447 DOI: 10.4318/tjg.2010.0115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Bican A, Bora İ, Algın O, Hakyemez B, Özkol V, Alper E. Neuroimaging in narcolepsy. Sleep Med 2010; 11:225-6. [DOI: 10.1016/j.sleep.2009.05.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2009] [Revised: 05/10/2009] [Accepted: 05/15/2009] [Indexed: 10/20/2022]
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Alper E, Oktem O, Palaoglu E, Peker K, Yakin K, Urman B. The impact of laparoscopic ovarian cystectomy on ovarian reserve as assessed by antral follicle count and serum AMH levels. Fertil Steril 2009. [DOI: 10.1016/j.fertnstert.2009.07.230] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Aksoz K, Unsal B, Yoruk G, Buyrac Z, Haciyanli M, Akpinar Z, Alper E. Endoscopic sphincterotomy alone in the management of low-grade biliary leaks due to cholecystectomy. Dig Endosc 2009; 21:158-61. [PMID: 19691762 DOI: 10.1111/j.1443-1661.2009.00878.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [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] [Indexed: 02/08/2023]
Abstract
AIM Endoscopic retrograde cholangiopancreatography (ERCP) is important in the diagnosis and management of postoperative bile leaks. Endoscopic sphincterotomy (ES) alone, ES with stent or nasobiliary drain (NBD) placement and stent or NBD without ES are the methods of choice. In the present study, we aimed to show the efficacy of ES alone in the management of low-grade (LGL) cystic duct stump (CDS) leaks due to cholecystectomy. METHODS Between September 2005 and January 2008, ES was carried out on 31 patients with LGL from the CDS due to cholecystectomy who were referred to the endoscopy unit of Izmir Ataturk Training and Research Hospital. Biliary leakage was detected by biliary discharge from a tube drain inserted during the operation. In cases of retaining common bile duct stones, balloon extraction was carried out. If bile discharge continued, a stent was introduced for cessation of the leak as a second procedure. RESULTS The success rate of ES alone was 87.1% (27 of 31 patients). In four patients (12.9%), ES alone was inadequate, therefore a stent was placed. The biliary leak ceased gradually and stopped in all patients at a mean of 11 (7-21) days. Balloon extraction of retained stones was carried out in six patients (19.6%). In two (6.5%) patients, mild hemorrhage and in two patients self-limited pancreatitis was seen (6.5%) as complications. CONCLUSION Endoscopic retrograde cholangiopancreatography is essential in the management of postoperative biliary leaks. Endoscopic sphincterotomy alone can be the initial procedure in the treatment of LGL from the CDS due to cholecystectomy.
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Affiliation(s)
- Kadir Aksoz
- Izmir Ataturk Training and Research Hospital, Izmir, Turkey.
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Aksõz K, Unsal B, Kirci A, Alper E, Buyraç Z, Aslan F, Cekiç C, Cengiz O, Ozcan Ari F, Akpinar Z. The relationship between chronic HCV infection and the level of plasma adiponectin. Turk J Gastroenterol 2008; 19:254-257. [PMID: 19119485] [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] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND/AIMS Metabolic products (TNFalpha, adiponectin, resistin, etc.), which are effective in insulin sensitivity and in the regulation of inflammation, play an important role in the development of metabolic disorders and fatty liver disease. The aim of this study was to evaluate the effect of HCV infection alone on plasma adiponectin levels and insulin sensitivity when metabolic factors are minimized and to determine whether chronic HCV infection causes hepatosteatosis through its effect on these factors. METHODS This study was carried out between 2006-2007, at the Gastroenterology Clinic of Izmir Atatürk Training and Research Hospital, in 30 non-diabetic patients with chronic HCV infection and 30 healthy subjects as controls. BMI (<26 kg/m2), fasting plasma glucose level, and ultrasonography were normal in both groups. In the patient group, HCV RNA was > or =1.90 x 10(3) IU/ml, ALT and AST were two times normal, and histological fibrosis scores were 1-2 in liver biopsy. Serum adiponectin levels and HOMA-IR were compared. RESULTS Fasting blood glucose levels, body mass index and HOMA-IR of the two groups were similar and normal. The mean ALT value was significantly higher in the patient group [61.8 U/L vs 28.17 U/L (p<0.05)]. The mean viral load was determined as 5.6 x 10(5) IU/ml in the chronic HCV patient group. The mean plasma adiponectin concentrations were 71.07 microg/ml in chronic HCV patients and 82.07 microg/ml in the control group, and the difference was statistically insignificant (p>0.05). CONCLUSIONS In the absence of metabolic disorders such as obesity, diabetes mellitus and hepatosteatosis, chronic HCV infection does not affect insulin sensitivity or adiponectin concentration.
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Affiliation(s)
- Kadir Aksõz
- Department of Gastroenterology, Izmir Atatürk Training and Research Hospital, Izmir.
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Rzaev ZMO, Yilmazbayhan A, Alper E. A one-step preparation of compatibilized polypropylene-nanocomposites by reactive extrusion processing. Adv Polym Technol 2007. [DOI: 10.1002/adv.20082] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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