Emrah Alper - Academia.edu (original) (raw)

Papers by Emrah Alper

Research paper thumbnail of Irbesartan'ın indüklediği otoimmun hepatit

Akademik Gastroenteroloji Dergisi, Apr 1, 2012

Research paper thumbnail of The efficacy of endoscopic ultrasonography in local staging of rectal tumors

The Turkish Journal of Gastroenterology, 2012

Background/aims: The purpose of this study was to research the efficacy and reliability of endosc... more 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, ‹zmir 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.

Research paper thumbnail of Does presence of common bile duct stones in patients with acute biliary pancreatitis affect the severity of illness or laboratory findings?

The Turkish Journal of Gastroenterology, 2011

Akut biliyer pankreatitin fliddeti ile ilgili olarak ana safra kanal›ndaki tafllar›n etkisini tan... more Akut biliyer pankreatitin fliddeti ile ilgili olarak ana safra kanal›ndaki tafllar›n etkisini tan›mlamak. Yöntem: Bu tersiyer bir hastanede 103 hastal›k, prospektif ve cross sectional olarak yap›lm›fl bir çal›flmad›r. Baflvurunun ilk 12 ve 72. saatlerindeki serum biyokimyasal ve beyaz küre say›mlar› de¤erlendirildi. Hastalar, endoskopik ultrasonografi ve endoskopik retrograd kolanjiopankreatografide tan›mlanan ana safra kanal› tafllar›n›n varl›¤›na göre grupland›r›ld›. Bunun yan›nda hastalar bilgisayarl› tomografi ve kan örneklerinden derlenen verilerle (Baltazar skorlamas›na göre) hafif ve ciddi akut pankreatit olarak s›n›fland›. Bulgular: Akut biliyer pankreatitli 103 hasta aras›nda, 41 (%39,8) hastada endoskopik ultrasonografi ve endoskopik retrograd kolanjiopankreatografi ile ana safra kanal› veya ampullada tafl ve/veya çamur saptand›. Altm›fliki (%60,2) hastada ana safra ka-nal›nda tafl yoktu. Endoskopik ultrasonografi ve endoskopik retrograd kolanjiopankreatografide tafl saptanan 41 hastan›n 9'unda (%22), saptanmayan 62 hastan›n 13'ünde (%21) fliddetli pankreatit geliflti. Ana safra kanal›nda tafl olan ve olmayan hastalar ara-s›nda fliddetli akut biliyer pankreatite gidifl insidans›nda fark saptanmad› (p=0.45). Sonuç: Ana safra kanal› tafllar› varl›¤› akut biliyer pankreatit fliddeti ile iliflkili de¤ildir.

Research paper thumbnail of Combined use of endosonography and endoscopic retrograde cholangiopancreatography in the same session

The Turkish Journal of Gastroenterology, 2011

The diagnostic value of endoscopic ultrasound in common bile duct stones is high. In this investi... more 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. 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. 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. 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.

Research paper thumbnail of Simple non-invasive markers as a predictor of fibrosis and viral response in chronic hepatitis C patients

The Turkish Journal of Gastroenterology, 2012

Kronik hepatit C'nin prevalans› yüksek olup, sirozis ve hepatosellüler karsinom geliflmesine nede... more Kronik hepatit C'nin prevalans› yüksek olup, sirozis ve hepatosellüler karsinom geliflmesine neden olur. Kronik hepatit C ta-fl›y›c›lar›nda tedavi karar›n› etkileyen esas faktörlerden biri karaci¤er fibrozisinin derecesidir. Kronik hepatit C hastalar›nda hepatik fibrozisi non-invaziv olarak öngörmede, bir kaç basit laboratuvar test, skor ve indeks önerilmektedir. Bu çal›flman›n amac›, kronik hepatit C hastalar›nda tedaviye cevaps›zl›¤› (relaps/non-responder) ve fibrozisi öngörmede non-invaziv karaci¤er fibrozis testlerini de¤erlendirmekti. Gereç ve Yöntem: ‹zmir Atatürk E¤itim ve Araflt›rma Hastanesinde Temmuz 2008 ile A¤ustos 2008 tarihleri aras›nda naiv kronik hepatit C hastalar›nda platelet say›s›, aspartat aminotransferaz/alanin aminotransferaz oran›, yafl platelet indeksi ve aspartat aminotransferaz/platelet oran› gibi, non-invaziv karaci¤er fibrozis testleri kaydedilerek retrospektif vaka kontrol çal›flmas› yap›ld›. Bulgular: Non-invaziv karaci¤er fibrozis testlerini tedaviye cevaps›z hastalar› öngörmede, özellikle yafl-platelet indeksi olmak üzere, oldukça etkin saptad›k (Do¤ruluk=73%, OR=6.93, 95% CI, 2.41-19.8). Yap›lan çoklu analizde tedaviye cevaps›zl›k ve viral yük, yafl-platelet indeksi gibi baz› non-invaziv karaci¤er fibrozis testleri aras›nda güçlü bir iliflki sapta-d›k. Sonuç: Non-invaziv testler yafl, cinsiyet, ›rk, vücut kitle indeksi ve fibrozise gore bireysellefltirilebilirse, histolojik sonuçlarla tama yak›n korelasyon sa¤lanabilir, fibrozisin derecesi bafllang›çta öngörülebilir, tedaviye cevap/cevaps›zl›k tahmin edilebilir ve tekrarlayan biyopsi ihtiyac› ortadan kalkabilir. Anahtar kelimeler: Kronik hepatit C, fibrozis, non-invaziv testler, non-SVR Background/aims: Chronic hepatitis C has a high prevalence and leads to development of cirrhosis and hepatocellular carcinoma. Liver fibrosis staging is one of the main factors that influence the decision to indicate therapy for chronic hepatitis C carriers. Several simple laboratory tests, scores and indices have been proposed for the non-invasive prediction of hepatic fibrosis in patients with chronic hepatitis C. The purpose of this study was to evaluate non-invasive liver fibrosis tests as a predictive factor of fibrosis and non-sustained viral response (relapse/non-responder) in chronic hepatitis C naive patients. Materials and Methods: We performed a retrospective case-control study with utilization of non-invasive liver fibrosis test, platelet count, aspartate aminotransferase/alanine aminotransferase ratio, age-platelet index and aspartate aminotransferase to platelet ratio index, as a predictor of non-sustained viral response in chronic hepatitis C naive patients between July 2008 and August 2010 in ‹zmir Atatürk Training and Research Hospital. Results: We observed non-invasive liver fibrosis test to be highly effective in predicting non-sustained viral response patients, especially with age-platelet index (Accuracy=73%, OR=6.93, 95% CI, 2.41-19.8). A strong relationship was shown with multivariate analysis between non-sustained viral response and some non-invasive liver fibrosis tests such as viral load (OR=4.51, 95% CI, 1.16-17.6, p=0.03) and age-platelet index (OR=11.8, 95% CI, 2.25-62.15, p=0.004). Conclusions: If non-invasive tests could be standardized according to age, gender, race, and body mass index and individualized according to the fibrosis, then a nearly full correlation of non-invasive liver fibrosis test with histologic results could be obtained, stage of fibrosis could be predicted initially, sustained viral response/non-sustained viral response could be estimated, and the need for a repeat biopsy could be eliminated.

Research paper thumbnail of A rare cause of cholangitis: Fasciola hepatica

The Turkish Journal of Gastroenterology, 2010

... LETTERS TO THE EDITOR A rare cause of cholangitis: Fasciola hepatica. Fatih ASLAN, Emrah ALPE... more ... LETTERS TO THE EDITOR A rare cause of cholangitis: Fasciola hepatica. Fatih ASLAN, Emrah ALPER, Zehra AKPINAR, Behlül BAYDAR, Mehmet Kadir AKSÖZ, Zafer BUYRAÇ, Cem ÇEKİÇ, Belkis ÜNSAL. ... Infez Med 2006; 14: 208-12. 4. Sezgin O, Altintas E, Disibeyaz S, et al. ...

Research paper thumbnail of Radial EUS Examination Can be Helpful in Predicting the Severity of Acute Biliary Pancreatitis

Medicine, 2016

We investigated the utility of noncontrast enhanced endosonography (EUS) in predicting the severi... more 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.

Research paper thumbnail of The Use of Radial Endosonography Findings in the Prediction of Cholangiocarcinoma in Cases with Distal Bile Duct Obstructions

Hepato-gastroenterology

We retrospectively collected the data of radial endosonographic (EUS) imaging findings of the pat... more 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. We gathered the data of 192 cases with distal biliary stricture due to various causes which all were diagnosed. 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 segme...

Research paper thumbnail of Evaluation of Factors Associated With Response to Hepatitis B Vaccination in Patients With Inflammatory Bowel Disease

Medicine, 2015

It is recommended to investigate the serology of hepatitis B virus (HBV) and vaccinate seronegati... more 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 mg 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 ¼ 0.011, P < 0.001, P ¼ 0.003, and P < 0.001, respectively). With multivariate analysis, age < 45 years (OR 3.1, 95% CI 1.2-8.3, P ¼ 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 ¼ 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.

Research paper thumbnail of The last innovation in achalasia treatment; per-oral endoscopic myotomy

The Turkish Journal of Gastroenterology, 2015

Background/Aims: Per-oral endoscopic myotomy (POEM) is a minimally invasive endoscopic treatment ... more Background/Aims: Per-oral endoscopic myotomy (POEM) is a minimally invasive endoscopic treatment option for patients with achalasia and has been performed since 2010. It is less invasive than Heller myotomy and its use is spreading rapidly worldwide. We present our results of POEM that, to the best of our knowledge, are the first cases in Turkey. Materials and Methods: We enrolled patients between May 2014 and September 2014; 8 patients with achalasia whose complaints recurred after pneumatic balloon dilatation underwent POEM. The procedure was performed under general anesthesia at the endoscopy unit of the gastroenterology clinic. Demographic data was recorded before the procedure, and the results of the procedure were recorded prospectively. Results: The median age of the patients was 42.5 (30-72) years. Preoperative and postoperative median Eckardt scores were 10 (8-12) and 1 (0-2), respectively. The median total duration of the procedure was 101 (71-158) min, and the median myotomy length was 13.5 (10-16) cm. Postoperative oral intake started on median day 1 (1-2) and the length of hospital stay was 4 (3-6) days. In 2 patients, capnoperitoneum developed during the procedure and was treated with a Veress needle. Conclusion: POEM is a safe endoscopic treatment modality for patients with achalasia in centers that are experienced in advanced endoscopic techniques.

Research paper thumbnail of What is the most accurate method for the treatment of diminutive colonic polyps?: standard versus jumbo forceps polypectomy

Medicine, 2015

Different methods such as standard, hot, and jumbo forceps are used in endoscopic treatment of di... more 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 rat...

Research paper thumbnail of The impact of periampullary diverticula on the endoscopic treatment of choledocholithiasis

Gastroenterology Review, 2012

I In nt tr ro od du uc ct ti io on n: : Periampullary diverticula (PD) are generally asymptomatic... more I In nt tr ro od du uc ct ti io on n: : Periampullary diverticula (PD) are generally asymptomatic and frequently diagnosed coincidentally during endoscopic retrograde cholangiopancreatography (ERCP). A Ai im m: : To investigate the impact of PD on procedural success in ERCP for common bile duct (CBD) stones, and possible complications. M Ma at te er ri ia al l a an nd d m me et th ho od ds s: : Five hundred and eighty-six patients diagnosed with CBD stones by diagnostic techniques and treated by ERCP were prospectively included in the study. Periampullary diverticula presence (patients with PD were allocated to group A, and those without PD to group B), size of the diverticulum (< 2 cm or ≥ 2 cm), papillary association with the diverticulum, size and number of CBD stones, were prospectively recorded for each patient. Total extraction of CBD stones by ERCP was considered successful treatment, and inability to remove the stone(s) was defined as lack of success. R Re es su ul lt ts s: : Group A consisted of 478 (82%), and group B 108 patients (18%). Cannulation success at first try was 97.7% in group A, and 95.4% in group B patients (p > 0.05). The prevalence of stone impaction was 3.1% in group A, and 10.2% in group B (p < 0.01). 86.8% of group A and 81.5% of group B patients were treated endoscopically. C Co on nc cl lu us si io on ns s: : Periampullary diverticula is a contributing factor in the formation of choledocholithiasis, and in the increase in size or impaction of existing stones. However, the presence of PD does not necessarily affect the success of ERCP or the prevalence of procedure-related complications in patients with CBD stones.

Research paper thumbnail of Hepcidin as a predictor of disease severity in acute pancreatitis: a single center prospective study

Hepato-gastroenterology, 2013

Predicting the severity of acute pancreatitis is limited to clinical, laboratory and radiological... more 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. 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. 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). In this study, hepcidin was found to be superior to CRP in predicting the severity of pancreatitis.

Research paper thumbnail of The effect of biliary stenting on difficult common bile duct stones

Przegla̜d gastroenterologiczny, 2014

If common bile duct (CBD) stones (choledocholithiasis) are left untreated, they may cause increas... more If common bile duct (CBD) stones (choledocholithiasis) are left untreated, they may cause increases in morbidity and mortality due to several conditions. In this study, using transient biliary stenting following the failure of an initial endoscopic retrograde cholangiopancreatography (ERCP) session, we aimed to show the effects of making the CBD stones smaller and easier to remove in the following session. In 156 of 1300 (12%) patients with CBD stones, who underwent balloon screening and/or basket lithotripsy following ERCP and CBD cannulation, it was not possible to remove the stones in the first session. Of these 156 patients, 64 (4.9%) were further followed and tested following transient biliary stenting. In the last ERCP following biliary stenting, the maximum stone sizes and stone indices were decreased in 54 (83%) patients and stone fragmentation was observed in 46 (72%) patients. Complete and incomplete removal was obtained in 40 (62.5%) and 24 (37.5%) patients, respectively....

Research paper thumbnail of The relationship between chronic HCV infection and the level of plasma adiponectin

The Turkish journal of gastroenterology : the official journal of Turkish Society of Gastroenterology, 2008

Metabolic products (TNFalpha, adiponectin, resistin, etc.), which are effective in insulin sensit... more 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. 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 level...

Research paper thumbnail of Endoscopic submucosal dissection in gastric lesions: the 100 cases experience from a tertiary reference center in West

Scandinavian Journal of Gastroenterology, 2015

Endoscopic submucosal dissection (ESD) is an endoscopic treatment method widely used in premalign... more 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. 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. 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 &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001, p = 0.003, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001, p = 0.009, and p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001, respectively). No significant difference was detected in the en-bloc and complete resection rates and complications between the groups. 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.

Research paper thumbnail of The Effect of Intravenous Iron Treatment on Quality of Life in Inflammatory Bowel Disease Patients with Nonanemic Iron Deficiency

Gastroenterology Research and Practice, 2015

Background.Iron deficiency is the prevalent complication of inflammatory bowel disease (IBD). Her... more Background.Iron deficiency is the prevalent complication of inflammatory bowel disease (IBD). Herein, we investigated the effect of intravenous iron treatment on quality of life (QoL) in nonanemic and iron deficient IBD patients.Methods.Eighty-five IBD patients were recruited for this study. The patients were intravenously administered 500 mg iron sucrose in the first week of the study. Hematologic parameters and QoL were evaluated before to iron treatment and during the 12th week of treatment. The Inflammatory Bowel Disease Questionnaire (IBDQ) and the Short Form-36 (SF-36) Health Survey were used to assess QoL.Results.Prior to intravenous iron administration, the IBDQ, SF-36 Physical Component Summary (PCS) and Mental Component Summary (MCS) scores were152.3±30.6,46.7±7.3, and45.7±9.8, respectively. In the 12th week of iron administration, those scores were162.3±25.5(P<0.001),49.3±6.4(P<0.001), and47.6±8.9(P=0.024), respectively, which were all significantly different from t...

Research paper thumbnail of The prevalence of IgG4-positive plasma cell infiltrates in inflammatory bowel disease patients without autoimmune pancreatitis

The Turkish Journal of Gastroenterology, 2014

Background/Aims: IgG4-related autoimmune disease can exist in other organs even when there is no ... more Background/Aims: IgG4-related autoimmune disease can exist in other organs even when there is no evidence of autoimmune pancreatitis. The aim of our study was to determine the prevalence of IgG4-positive plasma cells in the histopathological evaluations of colon biopsy specimens in IBD patients. Materials and Methods: The number of IgG4-positive plasma cells with strong cytoplasmic immunoreactivity was counted in each colon biopsy from inflammatory bowel disease patients who had no evidence of autoimmune pancreatitis. Five high power fields (HPFs) in the highest density plasma cell infiltration area were counted and were then averaged. An average >10 cells/HPF was considered significant for IgG4-related disease. Results: We detected IgG4-positive plasma cell staining in the colon of 21 of 119 patients (17.6%). Of these 21 patients, 5 had elevated serum IgG4 levels (>140 mg/dL). Of the total, 4.2% (5/119) had both IgG4-immunstaining and elevated IgG4 serum levels. The demographic features, disease type and activity, and response to treatment (especially to steroid treatment) were similar between the IgG4-negative and IgG4-positive groups. Conclusion: In our study, 4.2% of patients with the diagnosis of IBD had elevated IgG4 serum levels and significant IGg4 immunostaining. Together, these two parameters indicate the possible diagnosis of an IgG4-related systemic disease.

Research paper thumbnail of Sa1581 The Usage of Overtube Has a Favorable Effect on Endoscopic Submucosal Dissection

Gastrointestinal Endoscopy, 2014

ABSTRACT Endoscopic submucosal dissection (ESD) may be very time consuming, and depending on the ... more ABSTRACT Endoscopic submucosal dissection (ESD) may be very time consuming, and depending on the anesthesia, the contents of the stomach may reflux to the esophagus and cause the patient to aspirate. To prevent these situations, many practitioners suggest using an overtube, but no study has been done to evaluate the effect of the use of an overtube while performing the ESD procedure. Our aim was to investigate the effects of performing an upper gastrointestinal ESD with and without overtube. Records of patients who underwent ESD were evaluated for histopathological results, complications, speed of dissection, dosages of anesthetic medications, and number of suctions performed during the procedure. The patients were classified into two depending on whether an overtube was used or not. There were a total of 58 patients on which 63 upper gastrointestinal ESD procedures were performed. Regarding age, gender, localization of the lesions, duration of the procedures, dosage of propofol, histopathological results, rate of complete resection, and rate of en-bloc resection, there was no difference between the two groups (p &gt; 0,05). But the size of the lesions, the size of the resected specimen, and the speed of dissection were statistically different in two groups (p = 0.018, p &lt; 0.001, p &lt; 0.001, respectively).The need for suction during the procedure was much lower in the overtube group than those with no overtube (p &lt; 0.001). We conclude that using an overtube during an upper gastrointestinal ESD decreases the need for suction, favors the speed of dissection, and eases the comfort of the procedure.

Research paper thumbnail of Artykuły oryginalne Impact of video information before unsedated upper gastrointestinal endoscopy on patient satisfaction and anxiety: a prospective randomized trial

Gastroenterology Review, 2013

I In nt tr ro od du uc ct ti io on n: : Anxiety and stress are common problems in patients underg... more I In nt tr ro od du uc ct ti io on n: : Anxiety and stress are common problems in patients undergoing invasive medical procedures. Anxiety before upper gastrointestinal endoscopy may have adverse consequences and can sometimes hamper successful completion of the procedure. A Ai im m: : To investigate the effects of adding an information video or detailed verbal information to our usual preprocedural information. M Ma at te er ri ia al l a an nd d m me et th ho od ds s: : Four hundred and forty gastrointestinal endoscopy patients were randomly assigned to video (226) or verbal information (214) groups. Patients in the video group watched a 10-minute-long video about the necessity of the endoscopic procedure, doctor and patient cooperation, and possible complications, emphasizing the possible feelings the patients might experience. The patients' situational anxiety was measured using the State-Trait Anxiety Inventory's two scales (STAI-State and STAI-Trait). Patients rated pain and overall satisfaction related to the procedure. R Re es su ul lt ts s: : There was a significant difference between the patient groups after endoscopy, in favor of the video group, when the answers to the STAI-S questions "the procedure was similar to what was explained" and "it was worse than what was explained" were evaluated (p = 0.003, p < 0.001 and p < 0.001, respectively). C Co on nc cl lu us si io on ns s: : It can be concluded that information by video helps reduce the anxiety of the patient, increases patient satisfaction and the patient is much more readily convinced to undergo another procedure, in cases where a control is needed.

Research paper thumbnail of Irbesartan'ın indüklediği otoimmun hepatit

Akademik Gastroenteroloji Dergisi, Apr 1, 2012

Research paper thumbnail of The efficacy of endoscopic ultrasonography in local staging of rectal tumors

The Turkish Journal of Gastroenterology, 2012

Background/aims: The purpose of this study was to research the efficacy and reliability of endosc... more 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, ‹zmir 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.

Research paper thumbnail of Does presence of common bile duct stones in patients with acute biliary pancreatitis affect the severity of illness or laboratory findings?

The Turkish Journal of Gastroenterology, 2011

Akut biliyer pankreatitin fliddeti ile ilgili olarak ana safra kanal›ndaki tafllar›n etkisini tan... more Akut biliyer pankreatitin fliddeti ile ilgili olarak ana safra kanal›ndaki tafllar›n etkisini tan›mlamak. Yöntem: Bu tersiyer bir hastanede 103 hastal›k, prospektif ve cross sectional olarak yap›lm›fl bir çal›flmad›r. Baflvurunun ilk 12 ve 72. saatlerindeki serum biyokimyasal ve beyaz küre say›mlar› de¤erlendirildi. Hastalar, endoskopik ultrasonografi ve endoskopik retrograd kolanjiopankreatografide tan›mlanan ana safra kanal› tafllar›n›n varl›¤›na göre grupland›r›ld›. Bunun yan›nda hastalar bilgisayarl› tomografi ve kan örneklerinden derlenen verilerle (Baltazar skorlamas›na göre) hafif ve ciddi akut pankreatit olarak s›n›fland›. Bulgular: Akut biliyer pankreatitli 103 hasta aras›nda, 41 (%39,8) hastada endoskopik ultrasonografi ve endoskopik retrograd kolanjiopankreatografi ile ana safra kanal› veya ampullada tafl ve/veya çamur saptand›. Altm›fliki (%60,2) hastada ana safra ka-nal›nda tafl yoktu. Endoskopik ultrasonografi ve endoskopik retrograd kolanjiopankreatografide tafl saptanan 41 hastan›n 9'unda (%22), saptanmayan 62 hastan›n 13'ünde (%21) fliddetli pankreatit geliflti. Ana safra kanal›nda tafl olan ve olmayan hastalar ara-s›nda fliddetli akut biliyer pankreatite gidifl insidans›nda fark saptanmad› (p=0.45). Sonuç: Ana safra kanal› tafllar› varl›¤› akut biliyer pankreatit fliddeti ile iliflkili de¤ildir.

Research paper thumbnail of Combined use of endosonography and endoscopic retrograde cholangiopancreatography in the same session

The Turkish Journal of Gastroenterology, 2011

The diagnostic value of endoscopic ultrasound in common bile duct stones is high. In this investi... more 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. 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. 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. 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.

Research paper thumbnail of Simple non-invasive markers as a predictor of fibrosis and viral response in chronic hepatitis C patients

The Turkish Journal of Gastroenterology, 2012

Kronik hepatit C'nin prevalans› yüksek olup, sirozis ve hepatosellüler karsinom geliflmesine nede... more Kronik hepatit C'nin prevalans› yüksek olup, sirozis ve hepatosellüler karsinom geliflmesine neden olur. Kronik hepatit C ta-fl›y›c›lar›nda tedavi karar›n› etkileyen esas faktörlerden biri karaci¤er fibrozisinin derecesidir. Kronik hepatit C hastalar›nda hepatik fibrozisi non-invaziv olarak öngörmede, bir kaç basit laboratuvar test, skor ve indeks önerilmektedir. Bu çal›flman›n amac›, kronik hepatit C hastalar›nda tedaviye cevaps›zl›¤› (relaps/non-responder) ve fibrozisi öngörmede non-invaziv karaci¤er fibrozis testlerini de¤erlendirmekti. Gereç ve Yöntem: ‹zmir Atatürk E¤itim ve Araflt›rma Hastanesinde Temmuz 2008 ile A¤ustos 2008 tarihleri aras›nda naiv kronik hepatit C hastalar›nda platelet say›s›, aspartat aminotransferaz/alanin aminotransferaz oran›, yafl platelet indeksi ve aspartat aminotransferaz/platelet oran› gibi, non-invaziv karaci¤er fibrozis testleri kaydedilerek retrospektif vaka kontrol çal›flmas› yap›ld›. Bulgular: Non-invaziv karaci¤er fibrozis testlerini tedaviye cevaps›z hastalar› öngörmede, özellikle yafl-platelet indeksi olmak üzere, oldukça etkin saptad›k (Do¤ruluk=73%, OR=6.93, 95% CI, 2.41-19.8). Yap›lan çoklu analizde tedaviye cevaps›zl›k ve viral yük, yafl-platelet indeksi gibi baz› non-invaziv karaci¤er fibrozis testleri aras›nda güçlü bir iliflki sapta-d›k. Sonuç: Non-invaziv testler yafl, cinsiyet, ›rk, vücut kitle indeksi ve fibrozise gore bireysellefltirilebilirse, histolojik sonuçlarla tama yak›n korelasyon sa¤lanabilir, fibrozisin derecesi bafllang›çta öngörülebilir, tedaviye cevap/cevaps›zl›k tahmin edilebilir ve tekrarlayan biyopsi ihtiyac› ortadan kalkabilir. Anahtar kelimeler: Kronik hepatit C, fibrozis, non-invaziv testler, non-SVR Background/aims: Chronic hepatitis C has a high prevalence and leads to development of cirrhosis and hepatocellular carcinoma. Liver fibrosis staging is one of the main factors that influence the decision to indicate therapy for chronic hepatitis C carriers. Several simple laboratory tests, scores and indices have been proposed for the non-invasive prediction of hepatic fibrosis in patients with chronic hepatitis C. The purpose of this study was to evaluate non-invasive liver fibrosis tests as a predictive factor of fibrosis and non-sustained viral response (relapse/non-responder) in chronic hepatitis C naive patients. Materials and Methods: We performed a retrospective case-control study with utilization of non-invasive liver fibrosis test, platelet count, aspartate aminotransferase/alanine aminotransferase ratio, age-platelet index and aspartate aminotransferase to platelet ratio index, as a predictor of non-sustained viral response in chronic hepatitis C naive patients between July 2008 and August 2010 in ‹zmir Atatürk Training and Research Hospital. Results: We observed non-invasive liver fibrosis test to be highly effective in predicting non-sustained viral response patients, especially with age-platelet index (Accuracy=73%, OR=6.93, 95% CI, 2.41-19.8). A strong relationship was shown with multivariate analysis between non-sustained viral response and some non-invasive liver fibrosis tests such as viral load (OR=4.51, 95% CI, 1.16-17.6, p=0.03) and age-platelet index (OR=11.8, 95% CI, 2.25-62.15, p=0.004). Conclusions: If non-invasive tests could be standardized according to age, gender, race, and body mass index and individualized according to the fibrosis, then a nearly full correlation of non-invasive liver fibrosis test with histologic results could be obtained, stage of fibrosis could be predicted initially, sustained viral response/non-sustained viral response could be estimated, and the need for a repeat biopsy could be eliminated.

Research paper thumbnail of A rare cause of cholangitis: Fasciola hepatica

The Turkish Journal of Gastroenterology, 2010

... LETTERS TO THE EDITOR A rare cause of cholangitis: Fasciola hepatica. Fatih ASLAN, Emrah ALPE... more ... LETTERS TO THE EDITOR A rare cause of cholangitis: Fasciola hepatica. Fatih ASLAN, Emrah ALPER, Zehra AKPINAR, Behlül BAYDAR, Mehmet Kadir AKSÖZ, Zafer BUYRAÇ, Cem ÇEKİÇ, Belkis ÜNSAL. ... Infez Med 2006; 14: 208-12. 4. Sezgin O, Altintas E, Disibeyaz S, et al. ...

Research paper thumbnail of Radial EUS Examination Can be Helpful in Predicting the Severity of Acute Biliary Pancreatitis

Medicine, 2016

We investigated the utility of noncontrast enhanced endosonography (EUS) in predicting the severi... more 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.

Research paper thumbnail of The Use of Radial Endosonography Findings in the Prediction of Cholangiocarcinoma in Cases with Distal Bile Duct Obstructions

Hepato-gastroenterology

We retrospectively collected the data of radial endosonographic (EUS) imaging findings of the pat... more 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. We gathered the data of 192 cases with distal biliary stricture due to various causes which all were diagnosed. 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 segme...

Research paper thumbnail of Evaluation of Factors Associated With Response to Hepatitis B Vaccination in Patients With Inflammatory Bowel Disease

Medicine, 2015

It is recommended to investigate the serology of hepatitis B virus (HBV) and vaccinate seronegati... more 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 mg 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 ¼ 0.011, P < 0.001, P ¼ 0.003, and P < 0.001, respectively). With multivariate analysis, age < 45 years (OR 3.1, 95% CI 1.2-8.3, P ¼ 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 ¼ 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.

Research paper thumbnail of The last innovation in achalasia treatment; per-oral endoscopic myotomy

The Turkish Journal of Gastroenterology, 2015

Background/Aims: Per-oral endoscopic myotomy (POEM) is a minimally invasive endoscopic treatment ... more Background/Aims: Per-oral endoscopic myotomy (POEM) is a minimally invasive endoscopic treatment option for patients with achalasia and has been performed since 2010. It is less invasive than Heller myotomy and its use is spreading rapidly worldwide. We present our results of POEM that, to the best of our knowledge, are the first cases in Turkey. Materials and Methods: We enrolled patients between May 2014 and September 2014; 8 patients with achalasia whose complaints recurred after pneumatic balloon dilatation underwent POEM. The procedure was performed under general anesthesia at the endoscopy unit of the gastroenterology clinic. Demographic data was recorded before the procedure, and the results of the procedure were recorded prospectively. Results: The median age of the patients was 42.5 (30-72) years. Preoperative and postoperative median Eckardt scores were 10 (8-12) and 1 (0-2), respectively. The median total duration of the procedure was 101 (71-158) min, and the median myotomy length was 13.5 (10-16) cm. Postoperative oral intake started on median day 1 (1-2) and the length of hospital stay was 4 (3-6) days. In 2 patients, capnoperitoneum developed during the procedure and was treated with a Veress needle. Conclusion: POEM is a safe endoscopic treatment modality for patients with achalasia in centers that are experienced in advanced endoscopic techniques.

Research paper thumbnail of What is the most accurate method for the treatment of diminutive colonic polyps?: standard versus jumbo forceps polypectomy

Medicine, 2015

Different methods such as standard, hot, and jumbo forceps are used in endoscopic treatment of di... more 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 rat...

Research paper thumbnail of The impact of periampullary diverticula on the endoscopic treatment of choledocholithiasis

Gastroenterology Review, 2012

I In nt tr ro od du uc ct ti io on n: : Periampullary diverticula (PD) are generally asymptomatic... more I In nt tr ro od du uc ct ti io on n: : Periampullary diverticula (PD) are generally asymptomatic and frequently diagnosed coincidentally during endoscopic retrograde cholangiopancreatography (ERCP). A Ai im m: : To investigate the impact of PD on procedural success in ERCP for common bile duct (CBD) stones, and possible complications. M Ma at te er ri ia al l a an nd d m me et th ho od ds s: : Five hundred and eighty-six patients diagnosed with CBD stones by diagnostic techniques and treated by ERCP were prospectively included in the study. Periampullary diverticula presence (patients with PD were allocated to group A, and those without PD to group B), size of the diverticulum (< 2 cm or ≥ 2 cm), papillary association with the diverticulum, size and number of CBD stones, were prospectively recorded for each patient. Total extraction of CBD stones by ERCP was considered successful treatment, and inability to remove the stone(s) was defined as lack of success. R Re es su ul lt ts s: : Group A consisted of 478 (82%), and group B 108 patients (18%). Cannulation success at first try was 97.7% in group A, and 95.4% in group B patients (p > 0.05). The prevalence of stone impaction was 3.1% in group A, and 10.2% in group B (p < 0.01). 86.8% of group A and 81.5% of group B patients were treated endoscopically. C Co on nc cl lu us si io on ns s: : Periampullary diverticula is a contributing factor in the formation of choledocholithiasis, and in the increase in size or impaction of existing stones. However, the presence of PD does not necessarily affect the success of ERCP or the prevalence of procedure-related complications in patients with CBD stones.

Research paper thumbnail of Hepcidin as a predictor of disease severity in acute pancreatitis: a single center prospective study

Hepato-gastroenterology, 2013

Predicting the severity of acute pancreatitis is limited to clinical, laboratory and radiological... more 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. 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. 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). In this study, hepcidin was found to be superior to CRP in predicting the severity of pancreatitis.

Research paper thumbnail of The effect of biliary stenting on difficult common bile duct stones

Przegla̜d gastroenterologiczny, 2014

If common bile duct (CBD) stones (choledocholithiasis) are left untreated, they may cause increas... more If common bile duct (CBD) stones (choledocholithiasis) are left untreated, they may cause increases in morbidity and mortality due to several conditions. In this study, using transient biliary stenting following the failure of an initial endoscopic retrograde cholangiopancreatography (ERCP) session, we aimed to show the effects of making the CBD stones smaller and easier to remove in the following session. In 156 of 1300 (12%) patients with CBD stones, who underwent balloon screening and/or basket lithotripsy following ERCP and CBD cannulation, it was not possible to remove the stones in the first session. Of these 156 patients, 64 (4.9%) were further followed and tested following transient biliary stenting. In the last ERCP following biliary stenting, the maximum stone sizes and stone indices were decreased in 54 (83%) patients and stone fragmentation was observed in 46 (72%) patients. Complete and incomplete removal was obtained in 40 (62.5%) and 24 (37.5%) patients, respectively....

Research paper thumbnail of The relationship between chronic HCV infection and the level of plasma adiponectin

The Turkish journal of gastroenterology : the official journal of Turkish Society of Gastroenterology, 2008

Metabolic products (TNFalpha, adiponectin, resistin, etc.), which are effective in insulin sensit... more 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. 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 level...

Research paper thumbnail of Endoscopic submucosal dissection in gastric lesions: the 100 cases experience from a tertiary reference center in West

Scandinavian Journal of Gastroenterology, 2015

Endoscopic submucosal dissection (ESD) is an endoscopic treatment method widely used in premalign... more 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. 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. 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 &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001, p = 0.003, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001, p = 0.009, and p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001, respectively). No significant difference was detected in the en-bloc and complete resection rates and complications between the groups. 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.

Research paper thumbnail of The Effect of Intravenous Iron Treatment on Quality of Life in Inflammatory Bowel Disease Patients with Nonanemic Iron Deficiency

Gastroenterology Research and Practice, 2015

Background.Iron deficiency is the prevalent complication of inflammatory bowel disease (IBD). Her... more Background.Iron deficiency is the prevalent complication of inflammatory bowel disease (IBD). Herein, we investigated the effect of intravenous iron treatment on quality of life (QoL) in nonanemic and iron deficient IBD patients.Methods.Eighty-five IBD patients were recruited for this study. The patients were intravenously administered 500 mg iron sucrose in the first week of the study. Hematologic parameters and QoL were evaluated before to iron treatment and during the 12th week of treatment. The Inflammatory Bowel Disease Questionnaire (IBDQ) and the Short Form-36 (SF-36) Health Survey were used to assess QoL.Results.Prior to intravenous iron administration, the IBDQ, SF-36 Physical Component Summary (PCS) and Mental Component Summary (MCS) scores were152.3±30.6,46.7±7.3, and45.7±9.8, respectively. In the 12th week of iron administration, those scores were162.3±25.5(P<0.001),49.3±6.4(P<0.001), and47.6±8.9(P=0.024), respectively, which were all significantly different from t...

Research paper thumbnail of The prevalence of IgG4-positive plasma cell infiltrates in inflammatory bowel disease patients without autoimmune pancreatitis

The Turkish Journal of Gastroenterology, 2014

Background/Aims: IgG4-related autoimmune disease can exist in other organs even when there is no ... more Background/Aims: IgG4-related autoimmune disease can exist in other organs even when there is no evidence of autoimmune pancreatitis. The aim of our study was to determine the prevalence of IgG4-positive plasma cells in the histopathological evaluations of colon biopsy specimens in IBD patients. Materials and Methods: The number of IgG4-positive plasma cells with strong cytoplasmic immunoreactivity was counted in each colon biopsy from inflammatory bowel disease patients who had no evidence of autoimmune pancreatitis. Five high power fields (HPFs) in the highest density plasma cell infiltration area were counted and were then averaged. An average >10 cells/HPF was considered significant for IgG4-related disease. Results: We detected IgG4-positive plasma cell staining in the colon of 21 of 119 patients (17.6%). Of these 21 patients, 5 had elevated serum IgG4 levels (>140 mg/dL). Of the total, 4.2% (5/119) had both IgG4-immunstaining and elevated IgG4 serum levels. The demographic features, disease type and activity, and response to treatment (especially to steroid treatment) were similar between the IgG4-negative and IgG4-positive groups. Conclusion: In our study, 4.2% of patients with the diagnosis of IBD had elevated IgG4 serum levels and significant IGg4 immunostaining. Together, these two parameters indicate the possible diagnosis of an IgG4-related systemic disease.

Research paper thumbnail of Sa1581 The Usage of Overtube Has a Favorable Effect on Endoscopic Submucosal Dissection

Gastrointestinal Endoscopy, 2014

ABSTRACT Endoscopic submucosal dissection (ESD) may be very time consuming, and depending on the ... more ABSTRACT Endoscopic submucosal dissection (ESD) may be very time consuming, and depending on the anesthesia, the contents of the stomach may reflux to the esophagus and cause the patient to aspirate. To prevent these situations, many practitioners suggest using an overtube, but no study has been done to evaluate the effect of the use of an overtube while performing the ESD procedure. Our aim was to investigate the effects of performing an upper gastrointestinal ESD with and without overtube. Records of patients who underwent ESD were evaluated for histopathological results, complications, speed of dissection, dosages of anesthetic medications, and number of suctions performed during the procedure. The patients were classified into two depending on whether an overtube was used or not. There were a total of 58 patients on which 63 upper gastrointestinal ESD procedures were performed. Regarding age, gender, localization of the lesions, duration of the procedures, dosage of propofol, histopathological results, rate of complete resection, and rate of en-bloc resection, there was no difference between the two groups (p &gt; 0,05). But the size of the lesions, the size of the resected specimen, and the speed of dissection were statistically different in two groups (p = 0.018, p &lt; 0.001, p &lt; 0.001, respectively).The need for suction during the procedure was much lower in the overtube group than those with no overtube (p &lt; 0.001). We conclude that using an overtube during an upper gastrointestinal ESD decreases the need for suction, favors the speed of dissection, and eases the comfort of the procedure.

Research paper thumbnail of Artykuły oryginalne Impact of video information before unsedated upper gastrointestinal endoscopy on patient satisfaction and anxiety: a prospective randomized trial

Gastroenterology Review, 2013

I In nt tr ro od du uc ct ti io on n: : Anxiety and stress are common problems in patients underg... more I In nt tr ro od du uc ct ti io on n: : Anxiety and stress are common problems in patients undergoing invasive medical procedures. Anxiety before upper gastrointestinal endoscopy may have adverse consequences and can sometimes hamper successful completion of the procedure. A Ai im m: : To investigate the effects of adding an information video or detailed verbal information to our usual preprocedural information. M Ma at te er ri ia al l a an nd d m me et th ho od ds s: : Four hundred and forty gastrointestinal endoscopy patients were randomly assigned to video (226) or verbal information (214) groups. Patients in the video group watched a 10-minute-long video about the necessity of the endoscopic procedure, doctor and patient cooperation, and possible complications, emphasizing the possible feelings the patients might experience. The patients' situational anxiety was measured using the State-Trait Anxiety Inventory's two scales (STAI-State and STAI-Trait). Patients rated pain and overall satisfaction related to the procedure. R Re es su ul lt ts s: : There was a significant difference between the patient groups after endoscopy, in favor of the video group, when the answers to the STAI-S questions "the procedure was similar to what was explained" and "it was worse than what was explained" were evaluated (p = 0.003, p < 0.001 and p < 0.001, respectively). C Co on nc cl lu us si io on ns s: : It can be concluded that information by video helps reduce the anxiety of the patient, increases patient satisfaction and the patient is much more readily convinced to undergo another procedure, in cases where a control is needed.