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Papers by Serkan Öcal

Journal of gastrointestinal & digestive system, 2015

Gastrointestinal Endoscopy, Nov 1, 2022

Gastroenterology Nursing, 2019

Acute necrotizing pancreatitis after transarterial chemoembolization in candidates for a liver tr... more Acute necrotizing pancreatitis after transarterial chemoembolization in candidates for a liver transplant ଝ Pancreatitis aguda necrosante secundaria a quimioembolización transarterial en pacientes candidatos a trasplante hepático Dear Editor, Transarterial chemoembolization (TACE) is a procedure primarily applied to patients who are liver transplantation (LT) candidates who have liver lesions compatible with hepatocellular carcinoma (HCC) without indication of resection and who do not meet LT criteria. In case of reduction in size or number of lesions, the patient can be included in the list of LT due to meeting the Milan criteria, with TACE acting as a bridge treatment. TACE has been associated with complications such as acute cholecystitis, gastrointestinal mucosal lesions, pulmonary thromboembolism, or acute pancreatitis. 1 We describe 2 cases of LT candidates who developed necrotizing pancreatitis secondary to TACE for HCC. Case 1. 59-year-old male with alcoholic cirrhosis and HBV infection, Child-B9/MELD-10 functional grade and HCC in segment VIII (14 mm) and V (12 mm), evaluated as a candidate for LT. A selective TACE session was performed with adriamycin and lipiodol particles, without immediate complications. The patient was discharged on the second day, being readmitted through the Emergency Department after six days for abdominal pain and vomiting. Laboratory results highlighted: 11,000 white blood cells/mm 3 ; bilirubin 2.5 mg/dl; GOT 72 UI/l; GPT 80 UI/l and amylase 100 UI/l. A decreased uptake in the head of the pancreas was observed in the abdominal CT, mainly of the uncinate process, compatible with necrotizing pancreatitis. He entered the ICU with antibiotic treatment and TPN. The subsequent progression was favourable. 20 days after TACE, a new CT scan was performed, with improvement of pancreatic lesions, so his discharge was decided. Currently, the patient is pending re-evaluation for inclusion on the LT waiting list. Case 2. A 55-year-old male, diagnosed with HCV cirrhosis, Child-6/MELD-6, with portal hypertension and 3 HCC, included in the list of LT. 2 TACE had been previously performed due to SOL in segments II and IV. In the control CT scan, a lesion recurrence was observed in segment II and a new one, doubtful, in segments V-VI, so it was decided to perform a third TACE, with selective canalization of the left liver artery, injecting adriamycin and lipiodol. 20 days ଝ Please cite this article as: Nutu OA, Marcacuzco Quinto AA, Jiménez Romero LC. Pancreatitis aguda necrosante secundaria a quimioembolización transarterial en pacientes candidatos a trasplante hepático. Med Clin (Barc). 2017.

Journal of Hepatology, Jul 1, 2022

Transplantation, Jul 1, 2018

Introduction: Patients with chronic hepatitis C and end-stage renal disease (ESRD) have encounter... more Introduction: Patients with chronic hepatitis C and end-stage renal disease (ESRD) have encountered negative conditions not only liver-related complications, but also increased extra-hepatic comorbidities. Using of efficient, well-tolerated and safe direct-acting antivirals (DAAs) is major step forward in the treatment of these patients. This study aimed both to carry out the efficacy and tolerability of DAAs in patients with ESRD and also to analyze early viral response in the preparation of patients for kidney transplantation. Methods: We performed a prospective analysis of 15 patients with ESRD and HCV infection treated with ombitasvir-paritaprevir-ritonavir and dasabuvir combination with or without ribavirin based on genotype of HCV in our center. Results: The patients were predominantly male (n=10) and median age was Conclusion: Antiviral therapy with DAAs was highly efficacious in KT recipients with chronic hepatitis C. Nevertheless, drug interaction, revision of immunosuppressive dose and allograft dysfunction necessitate a close followup during therapy.

The Turkish journal of gastroenterology, Aug 18, 2014

Background/Aims: The purpose of this study was to evaluate the technical/hemodynamic success, com... more Background/Aims: The purpose of this study was to evaluate the technical/hemodynamic success, complications, and biochemical/ hematologic consequences of transjugular intrahepatic portosystemic shunt (TIPS) created with 10-mm bare stents in our patients. Materials and Methods: Data of 27 cirrhotic patients (18 men and 9 women; mean age, 39.7±18.7 years) with a median MELD score 14 (range 7-31) treated with TIPS between January 2000 and August 2010 were evaluated retrospectively. Results: The indications were refractory bleeding varices in 48.2%, refractory ascites in 22.2%, and Budd-Chiari syndrome in 29.6% of the patients. Technical and hemodynamic success rates were 96.3% and 92.3%, respectively. Mean portosystemic pressure gradient decreased from 21.5±5.3 mm Hg to 9±2.7 mm Hg (p<0.05). The rate of primary stent patency was 76.9% 1 year after the procedure. No statistically significant difference in shunt dysfunction was found between the groups of patients treated for Budd-Chiari syndrome and other indications (p>0.05). One patient (3.7%) had shunt dysfunction due to thrombosis within 24 hours. New and/or worsening hepatic encephalopathy occurred in 34.6% of patients. Increased age (≥40 years) was significantly related to hepatic encephalopathy in both univariate and multivariate analyses (p<0.05). Thirty-day mortality rate and 1-year transplant-free survival rate were 0% and 80.7%, respectively. Conclusion: Transjugular intrahepatic portosystemic shunt procedure is a safe treatment for many patients with cirrhosis, but post-procedure hepatic encephalopathy and shunt dysfunction are still problems. Especially, patient age should be taken into consideration in predicting hepatic encephalopathy risk.

Transplantation Proceedings, May 1, 2007

Patients with end-stage renal disease are at high risk for exposure to hepatitis C virus (HCV) in... more Patients with end-stage renal disease are at high risk for exposure to hepatitis C virus (HCV) infection. Although both viral replication and liver disease progression are accelerated after renal transplantation, the long-term impact of chronic HCV infection is unclear. Our aim was to analyze the course of HCV infection in renal transplant recipients and the effects of HCV reactivation on patient and graft survival. Methods. We retrospectively examined the 21-year (1985-2006) data of 1274 renal transplant recipients, 43 of whom were anti-HCV positive at the time of transplantation. Results. The mean posttransplant follow-up of 43 patients was 62.0 Ϯ 7.3 months. At the time of transplantation, HCV RNA was positive in 11 (25.6%) patients and negative in 32 (74.4%) patients. HCV reactivation was seen in 19 (45.2%) patients at a mean time of 20.8 Ϯ 5.7 months. In 31 (72%) patients, acute rejection occured, whereas graft loss occured in 10 (23%) patients. Three (7%) patients died. Among 43 patients, 22 (51.2%) were treated with interferon before transplantation. There was a statistically significant association between pretransplant interferon therapy and pretransplant HCVRNA level (P ϭ .024), but no significant association of HCV reactivation and graft rejection, mortality, or kidney survival. Conclusion. HCV reactivation occurred in nearly half of the renal transplant recipients, mostly in the second year. Patient survival and graft survival were not affected by HCV reactivation. Anti-HCV positivity should not preclude chronic renal failure patients from renal transplantation.

Research Square (Research Square), Apr 25, 2022

Background/aim: White matter lesions (WMLs) are more frequently observed in migraine patients tha... more Background/aim: White matter lesions (WMLs) are more frequently observed in migraine patients than in the average population. Associations between Helicobacter pylori (H. pylori) infection and different extraintestinal pathologies have been identi ed. Here, we aimed to examine the effect of H. pylori infection on WML in patients diagnosed with migraine. Materials and methods: A retrospective study was conducted with 526 subjects with a diagnosis of migraine. Hyperintensity of WML had been previously evaluated in these patients with brain magnetic resonance imaging (MRI) examinations. Previous endoscopic gastric biopsy histopathological examination of the same patients and reports on H. pylori ndings were recorded. The demographic characteristics of the patients, such as age, drugs, and gender, were recorded. Statistical evaluation was made. Results: Evaluation was made among 526 migraine patients who met the inclusion criteria, comprising 397 (75.5%) females and 129 (24.5%) males with a mean age of 45.57 ± 13.46 years (range, 18-69 years). Of the 211 (40.1%) subjects who were negative for H. pylori, WML was not detected in 140 (26.6%) and was detected in 71 (13.5%) on brain MRI. WML was not detected in 137 (26.0%) of 315 (59.9%) subjects who were positive for H. pylori and was detected in 178 (33.8%) on brain MRI (p <0.05). Subjects who are H. pylori-positive migraine were observed at a 2.5-fold higher incidence of brain MRI WML (odds ratio: 2.562, 95% CI 1.784-3.680). WML was found to be more signi cant in patients with hypertension and migraine than those without (p <0.001). Conclusion: It was concluded that H. pylori infection, a chronic infection, can be considered a risk factor in developing WML in subjects with migraine.

I have read the article titled, "A rare cause of gastric outlet obstruction," which was recently ... more I have read the article titled, "A rare cause of gastric outlet obstruction," which was recently published in this journal (1) with great interest. I have previously seen a similar case; however, this report particularly interested me (2). First, I would request the authors to provide more details regarding Figure 2. A part of the endoscope is visible in this picture. Is this a retroflexed view of the endoscope entering the stomach at the esophagogastric junction? Is there also an image of the gastric outlet obstructed by the polypoid tumor? Second, "combined right and left bile duct variations" are mentioned in this article (below Figure 3); however, no further description is provided. I would like to thank the authors for presenting this special case, and I would request them to provide the required details at the abovementioned instances.

G‹R‹fi Akut gastrointestinal sistem kanamalar› (G‹SK) morbidite ve mortalitesi yuksek ciddi bir k... more G‹R‹fi Akut gastrointestinal sistem kanamalar› (G‹SK) morbidite ve mortalitesi yuksek ciddi bir klinik durumdur. Endoskopik incelemelerin rutin kullan›ma girmesi ile G‹SK’n›n tan› ve tedavisinde ilerlemeler kaydedilmifltir. Endoskopik tedaviler icerisinde vazokonstruktor ajan enjeksiyonu, termal ablasyon ve mekanik tedaviler yer almaktad›r. Bu yontemlerin tek veya kombine kullan›lmas› tekrar kanama riskini, cerrahi mudahale ve kan transfuzyon ihtiyac›n› azaltarak hastane yat›fl suresini k›salt›r hatta mortaliteyi bile olumlu yonde etkileyebilir.

JOP : Journal of the pancreas, 2010

CONTEXT Drugs are related to the etiology of acute pancreatitis in approximately 1.4-2.0% of case... more CONTEXT Drugs are related to the etiology of acute pancreatitis in approximately 1.4-2.0% of cases. Although antibiotics constitute a small number of the drugs suspected, tetracycline is the most encountered antibiotic among those drugs. CASE REPORT A 33-year-old woman was admitted to the emergency room complaining of nausea and abdominal pain after the use of doxycycline 500 mg and ornidazole 500 mg twice daily for three days for a vaginal infection. She experienced epigastric pain, which worsened over time and radiated to her back. After a detailed evaluation, she was diagnosed as having mild acute pancreatitis which improved with medical treatment. All other possible causes of pancreatitis were eliminated. CONCLUSIONS Antibiotic-associated pancreatitis usually has a silent and mild course. To the best of our knowledge the literature reports only two cases of doxycycline-induced acute pancreatitis reported and there are no reports of pancreatitis associated with ornidazole. Our ca...

Primary anorectal lymphoma is a rare presentation of gastrointestinal lymphomas. Its clinical pre... more Primary anorectal lymphoma is a rare presentation of gastrointestinal lymphomas. Its clinical presentation is indistinguishable from that of anorectal carcinoma. Here, we report a case of primary anorectal non-Hodgkin's lymphoma (anaplastic large cell lymphoma) that was treated completely by standard chemotherapy. In addition, cytomegalovirus colitis was diagnosed and treated successfully during the immunosuppression phase.

Duodenal duplication cysts are rare congenital anomalies. Most symptomatic cases are diagnosed in... more Duodenal duplication cysts are rare congenital anomalies. Most symptomatic cases are diagnosed in childhood. In adults, they usually present with symptoms of recurrent pancreatitis, duodenal obstruction or gastrointestinal bleeding. Diagnosis is confirmed by histopathology. Diagnosis can also be achieved by endoscopic and/or radiologic imaging techniques. Symptomatic cases are treated by surgical resection or by using a variety of endoscopic techniques. Asymptomatic patients should be followed because of malignant degeneration risk. Here, we report an asymptomatic patient with duodenal duplication cyst diagnosed by endoscopic and radiologic imaging techniques.

Acta gastro-enterologica Belgica, 2020

BACKGROUND AND STUDY AIMS Gastric cancer (GC) is one of the major causes of cancer-related deaths... more BACKGROUND AND STUDY AIMS Gastric cancer (GC) is one of the major causes of cancer-related deaths worldwide. Helicobacter pylori (Hp) plays an important role in gastric carcinogenesis by inducing precancerous changes such as atrophic gastritis (AG) and intestinal metaplasia (IM). In our study, we aim to compare the grade of AG and IM before and after Hp eradication in patients who underwent esophagogastroduodenoscopy (EGD) in our center. PATIENTS AND METHODS The data of 40.060 patients who underwent EGD for various reasons in our Endoscopy Unit between June 2011 and November 2017 were retrospectively evaluated. The grade of AG and IM before and after Hp eradication of patients meeting the study criteria were compared with each other. In addition, these findings were compared using OLGA and OLGIM staging systems. RESULTS A total of 175 patients, 89 (50.9%) women and 86 (49.1%) men, were included in the study. The mean age was 55±12 years. The mean time between two EGD examinations wa...

Saudi Journal of Gastroenterology, 2016

Helicobacter pylori infection is a worldwide problem. Eighty percent of the population in develop... more Helicobacter pylori infection is a worldwide problem. Eighty percent of the population in developing countries and 20%-50% of the population in the developed countries are estimated to carry this pathogen. [1-3] The ultimate clinical manifestations of H. pylori infection include gastric and duodenal ulcer, gastric mucosa-associated lymphoid tissue lymphoma, and adenocarcinoma. [4,5] H. pylori eradication remains a challenge for the physicians, since no firstline regimen is able to cure the infection in all treated patients due to antibiotic resistance. The efficacy of standard triple therapy has decreased recently and is less than the 80% rate aimed for at the beginning. [5-8] The background rate of clarithromycin resistance is critically important as its presence negatively impacts the efficacy of standard triple therapy. [9] For this reason bismuth-containing quadruple therapies are recommended for firstline empirical treatment in areas of high clarithromycin resistance (>15%-20%) according to Maastricht IV consensus report. [8] It is known that resistance to metronidazole can be partially overcome by increased dose and duration of treatment. [10]

World Journal of Gastroenterology, 2015

AIM: To determine the association between the neutrophil to lymphocyte (N/L) ratio and the degree... more AIM: To determine the association between the neutrophil to lymphocyte (N/L) ratio and the degree of liver fibrosis in patients with chronic hepatitis B (CHB) infection. METHODS: Between December 2011 and February 2013, 129 consecutive CHB patients who were admitted to the study hospitals for histological evaluation of chronic hepatitis B-related liver fibrosis were included in this retrospective study. The patients were divided into two groups based on the fibrosis score: individuals with a fibrosis score of F0 or F1 were included in the "no/minimal liver fibrosis" group, whereas patients with a fibrosis score of F2, F3, or F4 were included in the "advanced liver fibrosis" group. The Statistical Package for Social Sciences 18.0 for Windows was used to analyze the data. A P value of < 0.05 was accepted as statistically significant. RESULTS: Three experienced and blinded pathologists evaluated the fibrotic status and inflammatory activity of 129 liver biopsy samples from the CHB patients. Following histopathological examination, the "no/ minimal fibrosis" group included 79 individuals, while the "advanced fibrosis" group included 50 individuals. Mean (N/L) ratio levels were notably lower in patients with advanced fibrosis when compared with patients with no/minimal fibrosis. The mean value of the aspartate aminotransferase-platelet ratio index was markedly higher in cases with advanced fibrosis compared to those with no/minimal fibrosis. CONCLUSION: Reduced levels of the peripheral blood N/L ratio were found to give high sensitivity, specificity and predictive values in CHB patients with significant fibrosis. The prominent finding of our research suggests that the N/L ratio can be used as a novel noninvasive marker of fibrosis in patients with CHB.

Journal of Gastrointestinal & Digestive System, 2015

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