Wafi Attaallah - Academia.edu (original) (raw)

Papers by Wafi Attaallah

Diseases of the Colon & Rectum, 2014

BACKGROUND: surgery is currently the sole treatment modality for anal fistulas. however, surgery ... more BACKGROUND: surgery is currently the sole treatment modality for anal fistulas. however, surgery is associated with complications such as permanent incontinence, which reduces quality of life. OBJECTIVE: to determine the rate of complete clinical healing of anal fistulas after irrigation of the fistula tract with silver nitrate solution as a nonsurgical treatment.

The Turkish Journal of Gastroenterology

World Journal of Surgery

Background Radiofrequency ablation (RFA) is a relatively novel procedure in the management of ben... more Background Radiofrequency ablation (RFA) is a relatively novel procedure in the management of benign nodular goiter. This study was conducted to evaluate the safety and efficacy of ultrasound (US)-guided percutaneous RFA for benign symptomatic thyroid nodules as an alternative to surgery. Methods The study involved patients for whom a fine needle aspiration biopsy had proved a diagnosis of benign nodular goiter and had nodule-related symptoms such as dysphagia, cosmetic problems, sensation of foreign body in the neck, hyperthyroidism due to autonomous nodules or fear of malignancy. Percutaneous RFA was performed as an outpatient procedure under local anesthesia. The primary outcome was an evaluation of the changes in symptom scores (0–10) for pain, dysphagia and foreign body sensation at the 1st, 3rd, and 6th months after the RFA procedure. Secondary outcomes were assessing volume changes in nodules, complication rates, and changes in thyroid function status. Results A total of 33 p...

Turkish Journal of Surgery, 2015

Tumor perforation is accepted as an important prognostic factor along with tumor size and mitotic... more Tumor perforation is accepted as an important prognostic factor along with tumor size and mitotic index in gastrointestinal stromal tumors (GIST). The prognosis is worse in patients with tumor perforation or rupture. A few case reports of small bowel GIST presenting with rupture have been published in the medical literature. We report an unusual case of a 7.5 cm GIST of the jejunum that presented with spontaneous rupture. A previously healthy 46-year-old male patient presented with sudden abdominal pain. Physical examination revealed overt peritonitis, and computed tomography showed a heterogeneous solid mass measuring approximately 6 cm x 5.5 cm arising from the jejunum and massive fluid in the peritoneum. The mass was diagnosed as a GIST originating from the gastrointestinal tract. Emergency laparotomy was performed and intraoperative findings showed massive hemoperitoneum and an outgrowing mass at the jejunum, 50 cm distal to the Treitz ligament. The tumor had ruptured near the wall of the small intestine and it was actively bleeding. Surgical resection of the tumor was performed and the patient was discharged home uneventfully on the third postoperative day. The immunohistochemical characteristics of the tumor revealed it to be a GIST.

Journal of Gastrointestinal Surgery, 2015

Soft pancreas is one of the most important risk factor for postoperative pancreatic fistula after... more Soft pancreas is one of the most important risk factor for postoperative pancreatic fistula after pancreatoduodenectomy. The aim of this study is to investigate whether pancreatic attenuation index utilized to assess the pancreatic texture with computed tomography can be used to predict the risk of developing a clinically relevant postoperative pancreatic fistula after pancreatoduodenectomy. We reviewed 76 consecutive patients undergoing pancreatoduodenectomy between 2012 and 2014. The pancreatic attenuation index is found by dividing the pancreas density by the spleen density achieved with non-enhanced computed tomography. The independent predictors of clinically relevant postoperative pancreatic fistula were investigated. Clinically relevant postoperative pancreatic fistula occurred in 13 patients (17.1 %). The group of patients with postoperative pancreatic fistula is compared with the group of patients without postoperative pancreatic fistula in terms of age, gender, body mass index, the American Society of Anesthesiologists (ASA) score, smoking, alcohol consumption, medical comorbidities, preoperative biliary drainage, type of anastomosis, and pancreatic duct size and pancreatic attenuation index. Univariate analyses have shown a significant difference in relation to chronic obstructive pulmonary disease and pancreatic attenuation index. The multivariate analyses showed that only pancreatic attenuation index was associated with a high postoperative pancreatic fistula rate (P = 0.012). A preoperative non-contrast computed tomography scan evaluating pancreatic attenuation index could help to predict the occurrence of clinically significant postoperative pancreatic fistula after pancreatoduodenectomy.

Turkish Journal of Surgery, 2015

The Turkish journal of gastroenterology : the official journal of Turkish Society of Gastroenterology, 2013

We report the case of a 30-year-old male patient who was admitted to the Emergency Department wit... more We report the case of a 30-year-old male patient who was admitted to the Emergency Department with symptoms and signs of intestinal obstruction. There was no history of abdominal surgery or trauma. Abdomen was distended. Abdominal plain X-ray showed intestinal loops with air-fluid levels in the middle area of the abdomen. Computed tomography showed small bowel dilatation and free fluid in the abdomen. A laparotomy was subsequently performed and the intraoperative findings revealed a band extending from the root of the mesentery to the antimesenteric wall of the jejunum. The band was resected; the postoperative course was uneventful. Congenital bands are extremely rare and usually observed in childhood. This case, therefore, represents an unusual surgical problem in an older individual in whom the diagnosis was clinically unexpected.

ABSTRACT Evidence that has accumulated for many years suggests that diet is an important environm... more ABSTRACT Evidence that has accumulated for many years suggests that diet is an important environmental factor in the etiology of colorectal cancers. Epidemiological data generally support the association between total energy intake, high fat diets, red meat intake and increased colon cancer risk. The Western-style diet and cooking techniques are risk factors for developing colon cancer. Further, oxidative stress caused by reactive oxygen species plays a significant role in a number of age-specific diseases such as cancer and neurodegenerative disorders. Dietary proteins including whey proteins have been reported to have the ability to scavenge reactive oxygen species. Animal studies have also shown that whey protein protects against the development of carcinogen induced colon tumors in rats. In addition to proteins, protein hydrolyzates have been found to exhibit antioxidant activity. During protein hydrolysis, overall antioxidant activity of protein is enhanced as its tertiary structure is disrupted and the solvent accessibility of released amino acids increases. In this review, we summarize the present knowledge on the etiopathogenesis of colorectal cancers and the potential use of whey proteins in its treatment.

Hernia, 2008

Background Parastomal hernia with a reported incidence of up to 50% is a major problem after osto... more Background Parastomal hernia with a reported incidence of up to 50% is a major problem after ostomy formation. Hernias at the closure site may be a problem after the closure of the enterostomy. In this study, in addition to physical examination, we used ultrasonography (USG) in order to Wnd the true incidence of ostomy closure site and laparotomy incisional hernias. Methods We examined patients with closed enterostomy sites by both physical examination and USG for the detection of hernias. Risk factors for hernia formation, such as age, gender, body mass index (BMI), ostomy type, and surgical site infections, were determined. Results The evaluation of 31 patients with ostomies resulted in a 32% incidence of closed ostomy site hernias when patient medical history, physical examination, and ultrasonographic examination were used together. With physical examination and USG, incisional hernias at the laparotomy incision were found in 58% of cases. USG was able to detect hernias which were not clinically evident at the ostomy closure site and the laparotomy wound. BMI, age, gender, ostomy type, and surgical site infection did not have a signiWcant eVect on hernia formation. Conclusion Ostomy closure site and laparotomy incisional hernias are important clinical problems with a high incidence after ostomies are closed. Closure of the enterostomy site should be regarded as a hernia repair rather than a simple fascial closure. USG is a valuable clinical tool in combination with physical examination for the detection of minor defects.

Pathology oncology research : POR, 2012

Recent studies have shown that whey protein has many useful effects including its anti-cancer eff... more Recent studies have shown that whey protein has many useful effects including its anti-cancer effect. In this study we have compared the protective effect of dietary whey protein with whey protein hydrolyzate against azoxymethane and dextran sodium sulfate induced colon cancer in rats. We used a rat model of the colon cancer induced by administration of azoxymethane followed by repeated dextran sodium sulfate ingestion which causes multiple tumor development. Colon tissues were analyzed histologically in addition to biochemical analyses performed by measuring lipid peroxidation, protein oxidation and glutathione levels in both of colon and liver tissues of rats after sacrification. Macroscopic and microscopic tumors were identified in all groups that received azoxymethane followed by repeated dextran sodium sulfate. Group fed with whey protein hydrolyzate showed significantly less macroscopic and microscopic tumor development compared with group fed with whey protein. The protocol a...

Diseases of the Colon & Rectum, 2014

Annals of Coloproctology, 2014

Ann Coloproctol 2014;30(5):210-215 http://dx.doi.org/10\. 3393/ac.2014.30.5.210 Purpose: Although ... more Ann Coloproctol 2014;30(5):210-215 http://dx.doi.org/10. 3393/ac.2014.30.5.210 Purpose: Although rectal cancer is a very common malignancy and has an improved cure rate in response to oncolog ical treatment, research on rectal-cancer survivors' sexual function remains limited. Sexual dysfunction (SD) after rectal cancer treatment was measured, and possible predisposing factors that may have an impact on the development of this disorder were identified. Methods: Patients undergoing curative rectal cancer surgery from January 2012 to September 2013 were surveyed using questionnaires. The female sexual function index or the International Index of Erectile Function was recorded. A multiple logistic regression was used to test associations of clinical factors with outcomes. Results: Fifty-six men (56%) and 28 women (44%) who completed the questionnaire were included in the study. A total of 76 patients of the 86 patients (90.5%) with the diagnosis of rectal cancer who were included in this study reported different levels of SD after radical surgery. A total of 64 patients (76%) from the whole cohort reported moderate to severe SD after treatment of rectal cancer. Gender (P = 0.011) was independently associated with SD. Female patients reported significantly higher rates of moderate to severe SD than male patients. Patients were rarely treated for dysfunction. Conclusion: Sexual problems after surgery for rectal cancer are common, but patients are rarely treated for SD. Female patients reported higher rates of SD than males. These results point out the importance of sexual (dys)function in survivors of rectal cancer. More attention should be drawn to this topic for clinical and research purposes.

Gastroenterology Research and Practice, 2013

Background. The association of gallstones with Helicobacter pylori has been investigated but not ... more Background. The association of gallstones with Helicobacter pylori has been investigated but not clearly demonstrated. In this study, the presence of H. pylori in the gallbladder mucosa of patients with symptomatic gallstones was investigated. Method. Ninety-four consecutive patients with symptomatic gallstone disease were enrolled for the study. Gastroscopy and gastric H. pylori urease test were done before cholecystectomy to all patients who accepted. After cholecystectomy, the gallbladder tissue was investigated in terms of H. pylori by urease test, Giemsa, and immunohistochemical stain. Results. Overall 35 patients (37%) gallbladder mucosa tested positive for H. pylori with any of the three tests. Correlation of the three tests Giemsa, IHC, and rapid urease test was significant ( : 0590, > 0.001). Rapid urease test was positive in the gastric mucosa in 47 (58.7%) patients, and it was positive in the gallbladder mucosa in 21 patients (22%). In 15 patients both gastric and gallbladder tested positive with the urease test. There was significant correlation of rapid urease test in both of gallbladder and gastric mucosa ( = 0.0001). Conclusion. Study demonstrates the presence of H. pylori in the gallbladders of 37% of patients with symptomatic gallstones.

Lymph-node metastasis is the most important predictor of survival in stage III rectal cancer. The... more Lymph-node metastasis is the most important predictor of survival in stage III rectal cancer. The number of metastatic lymph nodes may vary depending on the level of specimen dissection and the total number of lymph nodes harvested. The aim of this study was to evaluate whether the lymph node ratio (LNR) is a prognostic parameter for patients with rectal cancer. A retrospective review of a database of rectal cancer patients was performed to determine the effect of the LNR on the disease-free survival (DFS) and the overall survival. Of the total 228 patients with rectal cancer, 55 patients with stage III cancer were eligible for analysis. Survival curves were estimated using the Kaplan-Meier method. Cox regression analyses, after adjustments for potential confounders, were used to evaluate the relationship between the LNR and survival. According to the cutoff point 0.15 (15%), the 2-year DFS was 95.2% among patients with a LNR < 0.15 compared with 67.6% for those with LNR ≥ 0.15 (...

Surgical endoscopy, Jan 27, 2015

Endoscopically unextractable common bile duct stones may be challenging for the endoscopist. In t... more Endoscopically unextractable common bile duct stones may be challenging for the endoscopist. In this study, we investigated the rate of stone removal after the endoscopic insertion of a biliary stent in patients with common bile duct stones unextractable via ERCP. Records of patients with common bile duct stone/s who underwent ERCP at single center were retrospectively analyzed. Only patients with common bile duct stone/s who had a stent placed due to unyielding stone removal were eligible for inclusion into this study. Endoscopic biliary stents were placed in cases of unextractable stone. After a follow-up period, a second ERCP procedure was performed. Major outcomes were the rate of stent insertion because of unextractable bile duct stones, the rate of spontaneous stone passage and the rate of stone extraction after the endoscopic insertion of a biliary stent. A total of 66 (28 %) patients had a stent placed due to unyielding attempts for stone removal, and 43 patients were includ...

Diseases of the Colon & Rectum, 2014

BACKGROUND: surgery is currently the sole treatment modality for anal fistulas. however, surgery ... more BACKGROUND: surgery is currently the sole treatment modality for anal fistulas. however, surgery is associated with complications such as permanent incontinence, which reduces quality of life. OBJECTIVE: to determine the rate of complete clinical healing of anal fistulas after irrigation of the fistula tract with silver nitrate solution as a nonsurgical treatment.

The Turkish Journal of Gastroenterology

World Journal of Surgery

Background Radiofrequency ablation (RFA) is a relatively novel procedure in the management of ben... more Background Radiofrequency ablation (RFA) is a relatively novel procedure in the management of benign nodular goiter. This study was conducted to evaluate the safety and efficacy of ultrasound (US)-guided percutaneous RFA for benign symptomatic thyroid nodules as an alternative to surgery. Methods The study involved patients for whom a fine needle aspiration biopsy had proved a diagnosis of benign nodular goiter and had nodule-related symptoms such as dysphagia, cosmetic problems, sensation of foreign body in the neck, hyperthyroidism due to autonomous nodules or fear of malignancy. Percutaneous RFA was performed as an outpatient procedure under local anesthesia. The primary outcome was an evaluation of the changes in symptom scores (0–10) for pain, dysphagia and foreign body sensation at the 1st, 3rd, and 6th months after the RFA procedure. Secondary outcomes were assessing volume changes in nodules, complication rates, and changes in thyroid function status. Results A total of 33 p...

Turkish Journal of Surgery, 2015

Tumor perforation is accepted as an important prognostic factor along with tumor size and mitotic... more Tumor perforation is accepted as an important prognostic factor along with tumor size and mitotic index in gastrointestinal stromal tumors (GIST). The prognosis is worse in patients with tumor perforation or rupture. A few case reports of small bowel GIST presenting with rupture have been published in the medical literature. We report an unusual case of a 7.5 cm GIST of the jejunum that presented with spontaneous rupture. A previously healthy 46-year-old male patient presented with sudden abdominal pain. Physical examination revealed overt peritonitis, and computed tomography showed a heterogeneous solid mass measuring approximately 6 cm x 5.5 cm arising from the jejunum and massive fluid in the peritoneum. The mass was diagnosed as a GIST originating from the gastrointestinal tract. Emergency laparotomy was performed and intraoperative findings showed massive hemoperitoneum and an outgrowing mass at the jejunum, 50 cm distal to the Treitz ligament. The tumor had ruptured near the wall of the small intestine and it was actively bleeding. Surgical resection of the tumor was performed and the patient was discharged home uneventfully on the third postoperative day. The immunohistochemical characteristics of the tumor revealed it to be a GIST.

Journal of Gastrointestinal Surgery, 2015

Soft pancreas is one of the most important risk factor for postoperative pancreatic fistula after... more Soft pancreas is one of the most important risk factor for postoperative pancreatic fistula after pancreatoduodenectomy. The aim of this study is to investigate whether pancreatic attenuation index utilized to assess the pancreatic texture with computed tomography can be used to predict the risk of developing a clinically relevant postoperative pancreatic fistula after pancreatoduodenectomy. We reviewed 76 consecutive patients undergoing pancreatoduodenectomy between 2012 and 2014. The pancreatic attenuation index is found by dividing the pancreas density by the spleen density achieved with non-enhanced computed tomography. The independent predictors of clinically relevant postoperative pancreatic fistula were investigated. Clinically relevant postoperative pancreatic fistula occurred in 13 patients (17.1 %). The group of patients with postoperative pancreatic fistula is compared with the group of patients without postoperative pancreatic fistula in terms of age, gender, body mass index, the American Society of Anesthesiologists (ASA) score, smoking, alcohol consumption, medical comorbidities, preoperative biliary drainage, type of anastomosis, and pancreatic duct size and pancreatic attenuation index. Univariate analyses have shown a significant difference in relation to chronic obstructive pulmonary disease and pancreatic attenuation index. The multivariate analyses showed that only pancreatic attenuation index was associated with a high postoperative pancreatic fistula rate (P = 0.012). A preoperative non-contrast computed tomography scan evaluating pancreatic attenuation index could help to predict the occurrence of clinically significant postoperative pancreatic fistula after pancreatoduodenectomy.

Turkish Journal of Surgery, 2015

The Turkish journal of gastroenterology : the official journal of Turkish Society of Gastroenterology, 2013

We report the case of a 30-year-old male patient who was admitted to the Emergency Department wit... more We report the case of a 30-year-old male patient who was admitted to the Emergency Department with symptoms and signs of intestinal obstruction. There was no history of abdominal surgery or trauma. Abdomen was distended. Abdominal plain X-ray showed intestinal loops with air-fluid levels in the middle area of the abdomen. Computed tomography showed small bowel dilatation and free fluid in the abdomen. A laparotomy was subsequently performed and the intraoperative findings revealed a band extending from the root of the mesentery to the antimesenteric wall of the jejunum. The band was resected; the postoperative course was uneventful. Congenital bands are extremely rare and usually observed in childhood. This case, therefore, represents an unusual surgical problem in an older individual in whom the diagnosis was clinically unexpected.

ABSTRACT Evidence that has accumulated for many years suggests that diet is an important environm... more ABSTRACT Evidence that has accumulated for many years suggests that diet is an important environmental factor in the etiology of colorectal cancers. Epidemiological data generally support the association between total energy intake, high fat diets, red meat intake and increased colon cancer risk. The Western-style diet and cooking techniques are risk factors for developing colon cancer. Further, oxidative stress caused by reactive oxygen species plays a significant role in a number of age-specific diseases such as cancer and neurodegenerative disorders. Dietary proteins including whey proteins have been reported to have the ability to scavenge reactive oxygen species. Animal studies have also shown that whey protein protects against the development of carcinogen induced colon tumors in rats. In addition to proteins, protein hydrolyzates have been found to exhibit antioxidant activity. During protein hydrolysis, overall antioxidant activity of protein is enhanced as its tertiary structure is disrupted and the solvent accessibility of released amino acids increases. In this review, we summarize the present knowledge on the etiopathogenesis of colorectal cancers and the potential use of whey proteins in its treatment.

Hernia, 2008

Background Parastomal hernia with a reported incidence of up to 50% is a major problem after osto... more Background Parastomal hernia with a reported incidence of up to 50% is a major problem after ostomy formation. Hernias at the closure site may be a problem after the closure of the enterostomy. In this study, in addition to physical examination, we used ultrasonography (USG) in order to Wnd the true incidence of ostomy closure site and laparotomy incisional hernias. Methods We examined patients with closed enterostomy sites by both physical examination and USG for the detection of hernias. Risk factors for hernia formation, such as age, gender, body mass index (BMI), ostomy type, and surgical site infections, were determined. Results The evaluation of 31 patients with ostomies resulted in a 32% incidence of closed ostomy site hernias when patient medical history, physical examination, and ultrasonographic examination were used together. With physical examination and USG, incisional hernias at the laparotomy incision were found in 58% of cases. USG was able to detect hernias which were not clinically evident at the ostomy closure site and the laparotomy wound. BMI, age, gender, ostomy type, and surgical site infection did not have a signiWcant eVect on hernia formation. Conclusion Ostomy closure site and laparotomy incisional hernias are important clinical problems with a high incidence after ostomies are closed. Closure of the enterostomy site should be regarded as a hernia repair rather than a simple fascial closure. USG is a valuable clinical tool in combination with physical examination for the detection of minor defects.

Pathology oncology research : POR, 2012

Recent studies have shown that whey protein has many useful effects including its anti-cancer eff... more Recent studies have shown that whey protein has many useful effects including its anti-cancer effect. In this study we have compared the protective effect of dietary whey protein with whey protein hydrolyzate against azoxymethane and dextran sodium sulfate induced colon cancer in rats. We used a rat model of the colon cancer induced by administration of azoxymethane followed by repeated dextran sodium sulfate ingestion which causes multiple tumor development. Colon tissues were analyzed histologically in addition to biochemical analyses performed by measuring lipid peroxidation, protein oxidation and glutathione levels in both of colon and liver tissues of rats after sacrification. Macroscopic and microscopic tumors were identified in all groups that received azoxymethane followed by repeated dextran sodium sulfate. Group fed with whey protein hydrolyzate showed significantly less macroscopic and microscopic tumor development compared with group fed with whey protein. The protocol a...

Diseases of the Colon & Rectum, 2014

Annals of Coloproctology, 2014

Ann Coloproctol 2014;30(5):210-215 http://dx.doi.org/10\. 3393/ac.2014.30.5.210 Purpose: Although ... more Ann Coloproctol 2014;30(5):210-215 http://dx.doi.org/10. 3393/ac.2014.30.5.210 Purpose: Although rectal cancer is a very common malignancy and has an improved cure rate in response to oncolog ical treatment, research on rectal-cancer survivors' sexual function remains limited. Sexual dysfunction (SD) after rectal cancer treatment was measured, and possible predisposing factors that may have an impact on the development of this disorder were identified. Methods: Patients undergoing curative rectal cancer surgery from January 2012 to September 2013 were surveyed using questionnaires. The female sexual function index or the International Index of Erectile Function was recorded. A multiple logistic regression was used to test associations of clinical factors with outcomes. Results: Fifty-six men (56%) and 28 women (44%) who completed the questionnaire were included in the study. A total of 76 patients of the 86 patients (90.5%) with the diagnosis of rectal cancer who were included in this study reported different levels of SD after radical surgery. A total of 64 patients (76%) from the whole cohort reported moderate to severe SD after treatment of rectal cancer. Gender (P = 0.011) was independently associated with SD. Female patients reported significantly higher rates of moderate to severe SD than male patients. Patients were rarely treated for dysfunction. Conclusion: Sexual problems after surgery for rectal cancer are common, but patients are rarely treated for SD. Female patients reported higher rates of SD than males. These results point out the importance of sexual (dys)function in survivors of rectal cancer. More attention should be drawn to this topic for clinical and research purposes.

Gastroenterology Research and Practice, 2013

Background. The association of gallstones with Helicobacter pylori has been investigated but not ... more Background. The association of gallstones with Helicobacter pylori has been investigated but not clearly demonstrated. In this study, the presence of H. pylori in the gallbladder mucosa of patients with symptomatic gallstones was investigated. Method. Ninety-four consecutive patients with symptomatic gallstone disease were enrolled for the study. Gastroscopy and gastric H. pylori urease test were done before cholecystectomy to all patients who accepted. After cholecystectomy, the gallbladder tissue was investigated in terms of H. pylori by urease test, Giemsa, and immunohistochemical stain. Results. Overall 35 patients (37%) gallbladder mucosa tested positive for H. pylori with any of the three tests. Correlation of the three tests Giemsa, IHC, and rapid urease test was significant ( : 0590, > 0.001). Rapid urease test was positive in the gastric mucosa in 47 (58.7%) patients, and it was positive in the gallbladder mucosa in 21 patients (22%). In 15 patients both gastric and gallbladder tested positive with the urease test. There was significant correlation of rapid urease test in both of gallbladder and gastric mucosa ( = 0.0001). Conclusion. Study demonstrates the presence of H. pylori in the gallbladders of 37% of patients with symptomatic gallstones.

Lymph-node metastasis is the most important predictor of survival in stage III rectal cancer. The... more Lymph-node metastasis is the most important predictor of survival in stage III rectal cancer. The number of metastatic lymph nodes may vary depending on the level of specimen dissection and the total number of lymph nodes harvested. The aim of this study was to evaluate whether the lymph node ratio (LNR) is a prognostic parameter for patients with rectal cancer. A retrospective review of a database of rectal cancer patients was performed to determine the effect of the LNR on the disease-free survival (DFS) and the overall survival. Of the total 228 patients with rectal cancer, 55 patients with stage III cancer were eligible for analysis. Survival curves were estimated using the Kaplan-Meier method. Cox regression analyses, after adjustments for potential confounders, were used to evaluate the relationship between the LNR and survival. According to the cutoff point 0.15 (15%), the 2-year DFS was 95.2% among patients with a LNR < 0.15 compared with 67.6% for those with LNR ≥ 0.15 (...

Surgical endoscopy, Jan 27, 2015

Endoscopically unextractable common bile duct stones may be challenging for the endoscopist. In t... more Endoscopically unextractable common bile duct stones may be challenging for the endoscopist. In this study, we investigated the rate of stone removal after the endoscopic insertion of a biliary stent in patients with common bile duct stones unextractable via ERCP. Records of patients with common bile duct stone/s who underwent ERCP at single center were retrospectively analyzed. Only patients with common bile duct stone/s who had a stent placed due to unyielding stone removal were eligible for inclusion into this study. Endoscopic biliary stents were placed in cases of unextractable stone. After a follow-up period, a second ERCP procedure was performed. Major outcomes were the rate of stent insertion because of unextractable bile duct stones, the rate of spontaneous stone passage and the rate of stone extraction after the endoscopic insertion of a biliary stent. A total of 66 (28 %) patients had a stent placed due to unyielding attempts for stone removal, and 43 patients were includ...