Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 23
Filter
1.
Turk J Gastroenterol ; 33(8): 627-663, 2022 08.
Article in English | MEDLINE | ID: mdl-35993526

ABSTRACT

Colorectal cancer is the third most common cancer in Turkey. The current guidelines do not provide sufficient information to cover all aspects of the management of rectal cancer. Although treatment has been standardized in terms of the basic principles of neoadjuvant, surgical, and adjuvant therapy, uncertainties in the management of rectal cancer may lead to significant differences in clinical practice. In order to clarify these uncertainties, a consensus program was constructed with the participation of the physicians from the Acibadem Mehmet Ali Aydinlar and Koç Universities. This program included the physicians from the departments of general surgery, gastroenterology, pathology, radiology, nuclear medicine, medical oncology, radiation oncology, and medical genetics. The gray zones in the management of rectal cancer were determined by reviewing the evidence-based data and current guidelines before the meeting. Topics to be discussed consisted of diagnosis, staging, surgical treatment for the primary disease, use of neoadjuvant and adjuvant treatment, management of recurrent disease, screening, follow-up, and genetic counseling. All those topics were discussed under supervision of a presenter and a chair with active participation of related physicians. The consensus text was structured by centralizing the decisions based on the existing data.


Subject(s)
Rectal Neoplasms , Combined Modality Therapy , Consensus , Humans , Medical Oncology , Neoadjuvant Therapy , Neoplasm Staging , Rectal Neoplasms/pathology , Rectal Neoplasms/therapy
2.
ACG Case Rep J ; 7(6): e00405, 2020 Jun.
Article in English | MEDLINE | ID: mdl-33062780
3.
J Infect Dev Ctries ; 14(3): 298-303, 2020 03 31.
Article in English | MEDLINE | ID: mdl-32235091

ABSTRACT

INTRODUCTION: Socioeconomic factors play an important role in the prevalence of Helicobacter pylori (HP) infection. The aim of this study is to investigate HP prevalence among symptomatic patients in the upper socioeconomic segment of the population undergoing gastroscopy in an endemic urban region. METHODOLOGY: Over a 12-month period, data were collected from the first consecutive 1000 patients (500 from university hospital, 500 from community hospital) who had gastroscopy and HP evaluation. RESULTS: Overall, 211/1000 patients (21.1 %) were found to have HP in gastric biopsies. The specificity, sensitivity, positive predictive value, negative predictive value and diagnostic accuracy of rapid urease test were 87.5%, 99.7%, 99%, 96.5%, and 96.9% respectively. Atrophic gastritis, gastric and duodenal ulcers were significantly more common in HP positive patients. Age based distribution of HP prevalence: > 6 decades (15.5%), 3rd-5th decades (26.1%), < 3rd decades (10.4%). CONCLUSION: In an HP endemic country, the prevalence of HP infection among symptomatic patients belonging to the upper socioeconomic segment of the population appears to be markedly lower. The lowest prevalence in young patients is expected to result in future decrease in HP prevalence.


Subject(s)
Gastritis/epidemiology , Helicobacter Infections/epidemiology , Helicobacter pylori , Adult , Aged , Aged, 80 and over , Female , Gastritis/etiology , Gastroscopy , Helicobacter Infections/etiology , Hospitals, University , Humans , Male , Middle Aged , Prospective Studies , Social Class , Turkey/epidemiology , Young Adult
7.
Eur J Gastroenterol Hepatol ; 31(1): 1-9, 2019 01.
Article in English | MEDLINE | ID: mdl-30394944

ABSTRACT

Endoscopic ultrasound (EUS)-guided pancreatic cyst ablation with alcohol lavage or paclitaxel-based regimens are investigative modalities. To evaluate the safety and efficacy of EUS-guided pancreatic cyst ablation with alcohol lavage or paclitaxel-based regimens. A systematic review of computerized bibliographic databases was carried out for studies of EUS-guided pancreatic cyst ablation with alcohol lavage or paclitaxel-based regimens from January 1980 to February 2018. EUS-guided cyst ablation-related outcomes (cyst resolution) and complications. Data were extracted from six studies (N=207 patients) for EUS-guided cyst ablation with alcohol lavage and eight studies (N=347 patients) for EUS-guided cyst ablation with paclitaxel-based regimens. The pooled proportion of patients with complete cyst resolution was 68/207 (32.8%) for EUS-guided cyst ablation with alcohol lavage and 221/347 (63.6%) for EUS-guided cyst ablation with paclitaxel. Postablation adverse events with EUS-guided ablation with alcohol lavage were 44/207 (21.7%), and those with EUS-guided ablation with paclitaxel-based regimens were 52/347 (15%). Limitations of this study are because of the variability in study design and regimens tested, paucity of randomized trials, and differences in pancreatic cyst types receiving treatment. EUS-guided cyst ablation appears to be effective and safe. The effect on pancreatic cancer incidence is unknown; EUS-guided pancreatic cyst ablation modalities require further improvement and validation to determine their role in the treatment of patients with pancreatic cystic lesions.


Subject(s)
Ablation Techniques , Endosonography , Ethanol/administration & dosage , Paclitaxel/administration & dosage , Pancreatic Cyst/surgery , Ablation Techniques/adverse effects , Adult , Aged , Ethanol/adverse effects , Female , Humans , Male , Middle Aged , Paclitaxel/adverse effects , Pancreatic Cyst/diagnostic imaging , Pancreatic Cyst/pathology , Postoperative Complications/etiology , Predictive Value of Tests , Risk Factors , Treatment Outcome
8.
Turk J Gastroenterol ; 29(4): 436-441, 2018 07.
Article in English | MEDLINE | ID: mdl-30249558

ABSTRACT

BACKGROUND/AIMS: The aim of this study was to determine the diagnostic yield and factors influencing the diagnostic yield of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) for upper gastrointestinal (GI) subepithelial lesions (SELs) with rapid onsite cytopathologic evaluation. MATERIALS AND METHODS: This is a single-center, retrospective study. RESULTS: Among 22 patients who underwent EUS-FNA, a cytopathological diagnosis was reached in 16 (72.7%) patients. The EUS-FNA results were as follows: seven GISTs (31.8%), six leiomyomas (27.2%), four non-diagnostics (18%), two duplication cysts (9%), two spindle cell tumor (9%), and one ectopic pancreas (4.5%). The long-axis size was > 20 mm in 12 patients (average size: 31.3 ±9.3 mm) and < 20 mm (average size: 16.6 ±2.5 mm) in 10 patients. Diagnostic accuracy of EUS-FNA from lesions < 20 mm was 50% (5/10 lesions), and of lesions > 20 mm was 91.6% (11/12 lesions) (Fisher's exact test; p=0.028). Six patients underwent surgical resection. Surgical pathology results of five lesions (four GIST, one leiomyoma) were consistent with cytopathology results (83.3%). CONCLUSION: The diagnostic yield of EUS-FNA of the upper GI SELs with an onsite cytopathologic interpretation was 72.7%. Lesion size < 2 cm significantly reduces the diagnostic yield of EUS-FNA for the upper GI SELs.


Subject(s)
Endoscopic Ultrasound-Guided Fine Needle Aspiration/statistics & numerical data , Gastric Mucosa/pathology , Gastrointestinal Neoplasms/pathology , Intestinal Mucosa/pathology , Neoplasms, Glandular and Epithelial/pathology , Adult , Aged , Choristoma/diagnosis , Choristoma/pathology , Cysts/diagnosis , Cysts/pathology , Female , Gastrointestinal Diseases/diagnosis , Gastrointestinal Diseases/pathology , Gastrointestinal Neoplasms/diagnosis , Gastrointestinal Stromal Tumors/diagnosis , Gastrointestinal Stromal Tumors/pathology , Humans , Leiomyoma/diagnosis , Leiomyoma/pathology , Male , Middle Aged , Neoplasms, Glandular and Epithelial/diagnosis , Pancreas , Retrospective Studies , Sarcoma/diagnosis , Sarcoma/pathology , Tumor Burden
9.
Turk J Gastroenterol ; 29(3): 325-334, 2018 05.
Article in English | MEDLINE | ID: mdl-29755017

ABSTRACT

BACKGROUND/AIMS: Endoscopic papillectomy (EP) has emerged as an alternative to surgery in the management of ampullary lesions. The aim of this study is to evaluate feasibility, efficacy, safety, outcome, and impact of EP in the management of benign ampullary lesions. MATERIALS AND METHODS: This is a multicenter, retrospective study of 44 patients who had EP of benign ampullary lesions. RESULTS: Over the 11-year period, 44 (55.7%) of 79 patients underwent EP for benign ampullary lesions. Complete resection was achieved in 40 patients (91%). An underlying adenocarcinoma was the only risk factor for incomplete resection. Twenty-eight lesions (63.6%) were resected en-bloc and 16 lesions (36.4%) were resected in piecemeal fashion. Post-papillectomy histopathologic diagnoses were tubular adenoma in 14 patients (32%), invasive adenocarcinoma in 9 patients (20.5%), tubullovillous adenoma in 7 patients (16%), tubullovillous adenoma with carcinoma limited to the mucosal layer in 5 patients (11.3%), adenoma with high-grade dysplasia in 4 patients (9%), neuroendocrine tumor in 1 patient (2.3%), ganglioneuroma in 1 patient (2.3%), hamartomatous polyp in 1 patient (2.3%), adenofibroma in 1 patients (2.3%), and Brunner gland hyperplasia in 1 patient (2.3%). Seven (15.9%) procedure-related complications occurred: 3 (6.8%) bleeding, 2 (4.5%) pancreatitis, 1 (2.3%) abdominal pain, and 1 (2.3%) stent migration to the pancreatic duct. Seven patients (17%) had recurrence. CONCLUSION: Endoscopic papillectomy is a safe and effective method and can be considered as a first-line approach in patients with benign ampullary lesions with intent for cure. It also allows for correct histological diagnosis and staging.


Subject(s)
Ampulla of Vater/surgery , Common Bile Duct Neoplasms/surgery , Sphincterotomy, Endoscopic/methods , Adenocarcinoma/pathology , Adenocarcinoma/surgery , Adenoma/pathology , Adenoma/surgery , Adult , Aged , Aged, 80 and over , Ampulla of Vater/pathology , Carcinoma/pathology , Carcinoma/surgery , Common Bile Duct Neoplasms/pathology , Feasibility Studies , Female , Humans , Male , Middle Aged , Retrospective Studies , Treatment Outcome
10.
Turk J Gastroenterol ; 28(6): 514-517, 2017 Nov.
Article in English | MEDLINE | ID: mdl-29086719

ABSTRACT

We describe 2 patients with diabetes mellitus, presenting with upper abdominal pain. Although imaging findings were consistent with acute pancreatitis (AP), serum amylase and lipase levels were within normal limits. In both the cases, the only identifiable diagnostic culprit was vildagliptin. This is the first reported case of vildagliptin causing AP clinically and radiographically without elevated serum pancreatic enzymes. In conclusion, even when serum amylase and lipase levels are normal, AP should be kept in mind when making a differential diagnosis of patients with diabetes mellitus who present with abdominal pain and take dipeptidyl peptidase-4 (DPP-4) inhibitors.


Subject(s)
Abdominal Pain/diagnosis , Adamantane/analogs & derivatives , Diabetes Mellitus, Type 2/drug therapy , Dipeptidyl-Peptidase IV Inhibitors/adverse effects , Nitriles/adverse effects , Pancreatitis/diagnosis , Pyrrolidines/adverse effects , Abdominal Pain/blood , Abdominal Pain/chemically induced , Acute Disease , Adamantane/adverse effects , Aged , Amylases/blood , Diabetes Mellitus, Type 2/blood , Diagnosis, Differential , Female , Humans , Lipase/blood , Male , Middle Aged , Pancreatitis/blood , Pancreatitis/chemically induced , Vildagliptin
12.
Case Rep Gastroenterol ; 8(3): 377-80, 2014 Sep.
Article in English | MEDLINE | ID: mdl-25565932

ABSTRACT

Eosinophilic gastroenteritis is an uncommon disease characterized by eosinophilic infiltration of the gastrointestinal tract. The clinical manifestations are related to the layer(s) and extent of the bowel involved. In this paper, we present a case of intractable abdominal pain caused by jejunal submucosal eosinophilic infiltration without mucosal involvement, diagnosed by deep endoscopic biopsies. The patient was successfully treated with steroids without need for surgery for diagnosis or therapy.

13.
Dig Dis Sci ; 56(10): 3065-71, 2011 Oct.
Article in English | MEDLINE | ID: mdl-21735087

ABSTRACT

BACKGROUND: The data on the safety and utility of EUS in patients over 80 years of age is limited. OBJECTIVE: We investigated the indications, feasibility, safety, and clinical utility of EUS in the management of GI, pancreatobiliary, and mediastinal diseases. DESIGN: Retrospective study. SETTING: A tertiary referral university hospital. PATIENTS: Consecutive patients ≥80 years of age referred over a 9-year period for EUS evaluation. RESULTS: A total of 265 EUS scans were performed in 232 patients with a mean age of 83.8 years. The indications for pancreatobiliary EUS were to evaluate a pancreatic mass (n = 60), pancreatic cyst (n = 18), pancreatitis (n = 10), dilated CBD in the setting of jaundice and/or biliary stricture (n = 20), dilated CBD with no jaundice and/or biliary stricture (n = 20). The indications for luminal gastrointestinal EUS were esophageal lesions (n = 21), gastric lesions (n = 30), duodenal lesions (n = 14), rectal lesions (n = 22), and gastrointestinal subepithelial lesions (n = 28). The indications for mediastinal EUS were mass/lymphadenopathy (n = 14). EUS-guided FNA (EUS-FNA) was performed in 95 (35.8%) cases and results were consistent or suspicious for a malignancy in 62 cases (65.2%). Endoscopic mucosal resection (EMR) was performed in 17 cases (6.41%) on the same session following endosonographic evaluation. The procedure was successful in all patients with no complications related to sedation, EUS, or EUS-FNA encountered. One patient had perforation following EMR. LIMITATION: Retrospective study. CONCLUSIONS: EUS and EUS-FNA are feasible and safe and have a significant impact on the management of GI, pancreatobiliary and mediastinal diseases in extreme elderly.


Subject(s)
Endosonography/methods , Gastrointestinal Diseases/diagnostic imaging , Mediastinal Diseases/diagnostic imaging , Pancreatic Diseases/diagnostic imaging , Age Factors , Aged, 80 and over , Biopsy, Fine-Needle/adverse effects , Biopsy, Fine-Needle/methods , Endosonography/adverse effects , Feasibility Studies , Female , Humans , Male , Retrospective Studies , Sensitivity and Specificity
14.
World J Gastroenterol ; 17(13): 1701-9, 2011 Apr 07.
Article in English | MEDLINE | ID: mdl-21483630

ABSTRACT

AIM: To investigate the indication, feasibility, safety, and clinical utility of endoscopic submucosal dissection (ESD) in the management of various gastrointestinal pathologies. METHODS: The medical records of 60 consecutive patients (34 female, 26 male) who underwent ESD at the gastroenterology department of Kocaeli University from 2006-2010 were examined. Patients selected for ESD had premalignant lesions or non-invasive early cancers of the gastrointestinal tract and had endoscopic and histological diagnoses. Early cancers were considered to be confined to the submucosa, with no lymph node involvement by means of computed tomography and endosonography. RESULTS: Sixty ESD procedures were performed. The indications were epithelial lesions (n = 39) (33/39 adenoma with high grade dysplasia, 6/39 adenoma with low grade dysplasia), neuroendocrine tumor (n = 7), cancer (n = 7) (5/7 early colorectal cancer, 2/7 early gastric cancer), granular cell tumor (n = 3), gastrointestinal stromal tumor (n = 2), and leiomyoma (n = 2). En bloc and piecemeal resection rates were 91.6% (55/60) and 8.3% (5/60), respectively. Complete and incomplete resection rates were 96.6% (58/60) and 3.3% (2/60), respectively. Complications were major bleeding [n = 3 (5%)] and perforations [n = 5 (8.3%)] (4 colon, 1 stomach). Two patients with colonic perforations and two patients with submucosal lymphatic and microvasculature invasion (1 gastric carcinoid tumor, 1 colonic adenocarcinoma) were referred to surgery. During a mean follow-up of 12 mo, 1 patient with adenoma with high grade dysplasia underwent a second ESD procedure to resect a local recurrence. CONCLUSION: ESD is a feasible and safe method for treatment of premalignant lesions and early malignant gastrointestinal epithelial and subepithelial lesions. Successful en bloc and complete resection of lesions yield high cure rates with low recurrence.


Subject(s)
Dissection/methods , Endoscopy, Gastrointestinal/methods , Gastrointestinal Neoplasms/pathology , Gastrointestinal Neoplasms/surgery , Precancerous Conditions/pathology , Precancerous Conditions/surgery , Adult , Aged , Female , Humans , Male , Middle Aged , Postoperative Complications , Treatment Outcome
15.
Gastrointest Endosc ; 70(5): 892-8, 2009 Nov.
Article in English | MEDLINE | ID: mdl-19577744

ABSTRACT

BACKGROUND: The knowledge of EUS use in children is limited. OBJECTIVE: We investigated the indications, feasibility, safety, and clinical utility of EUS in the management of pediatric GI, pancreatobiliary, and mediastinal diseases. DESIGN: Retrospective study. SETTING: Two tertiary referral university hospitals. PATIENTS: Consecutive children age younger than 18 years referred over a 7-year period for EUS evaluation. RESULTS: Forty EUS scans were performed in 38 children with a mean age of 13.5 years. The indications for pancreatobiliary endosonography were pancreatitis (n = 10), solid pancreatic mass (n = 7), cystic pancreatic mass (n = 1), cyst in the setting of chronic pancreatitis (n = 1), suspected annular pancreas (n = 1), celiac plexus block (n = 1), suspected common bile duct stone (n = 1), abdominal pain and atrophic pancreas (n = 1), ampullary adenoma (n = 1), and abnormal MRCP in a patient with jaundice (n = 1). The indications for gastric EUS were mucosal lesions (n = 2) and subepithelial lesions (n = 4). The indications for mediastinal endosonography were mediastinal masses/lymph nodes (n = 5). The remaining evaluations were performed for esophageal stricture (n = 1), unexplained abdominal pain (n = 1), unexplained abdominal pain with celiac axis block (n = 1), and perirectal fluid collection (n = 1). EUS-guided FNA (EUS-FNA) was performed in 12 (30%) cases and established the correct diagnosis in 9 (75%). EUS-guided fine-needle injections for celiac axis block were performed in 2 (5%) cases. The procedure was successful in all patients, and no complications related to sedation, EUS, or EUS-FNA were encountered. LIMITATION: Retrospective study. CONCLUSION: EUS and EUS-FNA are feasible and safe and have a significant impact on the management of pediatric GI, pancreatobiliary, and mediastinal diseases.


Subject(s)
Biliary Tract Diseases/diagnostic imaging , Endosonography/statistics & numerical data , Gastrointestinal Diseases/diagnostic imaging , Mediastinal Diseases/diagnostic imaging , Pancreatic Diseases/diagnostic imaging , Adolescent , Biopsy, Fine-Needle/methods , Child , Child, Preschool , Diagnosis, Differential , Endosonography/methods , Feasibility Studies , Female , Follow-Up Studies , Humans , Male , Reproducibility of Results , Retrospective Studies
16.
Dis Esophagus ; 22(2): 104-12, 2009.
Article in English | MEDLINE | ID: mdl-19021687

ABSTRACT

The recent increase in the incidence of superficial esophageal cancer and promising developments in potentially curative endoscopic therapies have placed endoscopic ultrasound in a central position with regard to decision making. This is a review of the literature to determine the role of endoscopic ultrasound and high frequency probe ultrasonography in the assessment of superficial esophageal carcinomas.


Subject(s)
Endosonography , Esophageal Neoplasms/diagnostic imaging , Adenocarcinoma/diagnostic imaging , Algorithms , Carcinoma, Squamous Cell/diagnostic imaging , Esophageal Neoplasms/pathology , Humans , Neoplasm Invasiveness , Neoplasm Staging , Prognosis , Sensitivity and Specificity
17.
Can J Gastroenterol ; 22(8): 699-702, 2008 Aug.
Article in English | MEDLINE | ID: mdl-18701948

ABSTRACT

In a patient with a mid-common bile duct stone, the traction wires of a mechanical lithotriptor snapped, resulting in lithotriptor basket impaction. Simultaneous occurrence of these two potential complications of endoscopic stone extraction is very rarely reported. Extracorporeal shock wave lithotripsy failed to fragment the stone entrapped within the impacted basket. Endoscopic intracorporeal electrohydraulic shock wave lithotripsy successfully fragmented the stone under direct visualization through a cholangioscope. The entrapped stone within the basket could subsequently be pulled into the supra-ampullary bile duct for the final fragmentation with an extra-endoscopic mechanical lithotriptor cable. The present report is the first to describe a safe and effective use of endoscopic intracorporeal electrohydraulic shock wave lithotripsy followed by extra-endoscopic mechanical lithotripsy in the management of an impacted lithotriptor basket.


Subject(s)
Gallstones/therapy , Lithotripsy/adverse effects , Lithotripsy/methods , Aged , Cholangiopancreatography, Endoscopic Retrograde , Equipment Failure , Female , Fluoroscopy , Gallstones/diagnostic imaging , Humans , Lithotripsy/instrumentation , Retreatment
18.
Turk J Gastroenterol ; 19(4): 284-90, 2008 Dec.
Article in English | MEDLINE | ID: mdl-19119491

ABSTRACT

Duodenal varices are uncommon causes of gastrointestinal bleeding. In the literature, treatment of duodenal variceal bleeding is limited to case reports and case series. Treatment options are endoscopic, interventional radiologic and surgical modalities. In this article, we presented a case of a successful duodenal variceal bleeding treatment with transjugular intrahepatic portosystemic shunt. The other treatment modalities are also reviewed.


Subject(s)
Duodenum , Esophageal and Gastric Varices/surgery , Portasystemic Shunt, Transjugular Intrahepatic , Aged , Female , Humans
19.
J Clin Gastroenterol ; 41(7): 682-8, 2007 Aug.
Article in English | MEDLINE | ID: mdl-17667053

ABSTRACT

Azathioprine and 6-mercaptopurine (6-MP) are effective in inflammatory bowel disease (IBD). However, between 10% and 29% of patients treated with these drugs are forced to stop therapy due to side effects. Pulmonary toxicity due to azathioprine/6-MP has been reported infrequently. We describe 3 patients who developed severe, noninfectious pulmonary toxicity within 1 month after the initiation of azathioprine or 6-MP for the treatment of IBD colitis (2 Crohn's disease and 1 ulcerative colitis). All patients presented with dyspnea, cough, and fever after initiation of azathioprine/6-MP. Evaluation for infectious etiologies, including bronchoscopy (3/3 patients) and open-lung biopsy (2/3 patients) was negative. Histopathologic examination of the lung biopsies revealed bronchiolitis obliterans organizing pneumonia in one, and usual interstitial pneumonitis in another patient. Cessation of purine analog therapy resulted in clinical improvement in all 3 cases. Azathioprine/6-MP-related pulmonary toxicity is a rare but serious side effect, and it is important for clinicians to have a high index of suspicion for this adverse reaction which occurs within 1 month after initiation of treatment for IBD.


Subject(s)
Azathioprine/adverse effects , Crohn Disease/drug therapy , Immunosuppressive Agents/adverse effects , Lung Diseases/chemically induced , Mercaptopurine/adverse effects , Adult , Aged , Female , Humans , Male , Severity of Illness Index
20.
WMJ ; 106(1): 34-6, 2007 Feb.
Article in English | MEDLINE | ID: mdl-17393756

ABSTRACT

While the liver is a common site of metastasis, tumor metastases are not a common cause of portal hypertension. We report a case of a patient with symptomatic portal hypertension due to diffuse metastatic prostate carcinoma infiltration of liver parenchyma that was not appreciated with routine imaging.


Subject(s)
Hypertension, Portal/etiology , Prostatic Neoplasms/complications , Biopsy , Humans , Hypertension, Portal/diagnostic imaging , Hypertension, Portal/pathology , Male , Middle Aged , Neoplasm Metastasis , Prostatic Neoplasms/diagnostic imaging , Prostatic Neoplasms/pathology , Tomography, X-Ray Computed
SELECTION OF CITATIONS
SEARCH DETAIL
...