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Dieulafoy lezyonunda endoskopik tedavi

Giris ve Amac: Calismamizda klinigimizde Dieulafoy Lezyonu tanisi konulan hastalari, yapilan endoskopik tedavileri ve bu tedavilerin basari oranlarini ortaya koymayi hedefledik. Gerec ve Yontem: Klinigimizde 2008-2016 tarihleri arasinda endoskopileri yapilan hastalar ‘Dieulafoy Lezyonu’ tanisi icin retrospektif olarak tarandi. Endoskopik tanisi Dieulafoy lezyonu olan hastalarin servis yatislari, laboratuvar degerleri, kac gun yattiklari, hastaliklarinin nihai sonucu tespit edildi. Bulgular: 18 hasta calismaya alindi. En sik basvuru sikayeti melenaydi. Hastalarin yedi tanesinde mortalite gerceklesti. Klips, tek basina veya kombine olmak uzere en sik basvurulan endoskopik tedavi yontemiydi. Klipsin tek basina uygulandigi hastalarla, klipsle beraber veya klips olmadan kombine tedavi uygulanan hastalar arasinda mortalite acisindan fark yoktu (p=0,9). Adrenalinle beraber heater yapilan olgular dislanarak yapilan subgrup analizinde klips uygulanan hastalarla klipsle beraber diger yontemlerin yapildigi hastalar arasinda mortalite karsilastirildi. Iki grup arasinda yine mortalite acisindan bir fark yoktu (p=0,6). Sonuc: Calismamiz klips tedavisine eklenecek adrenalin ve/veya heater koagu- lasyon gibi yontemlerle yapilan kombine tedavinin mortaliteyi azaltmada klips monoterapisine kiyasla herhangi bir ustunluklerinin olmadigini gostermistir.

Nazobiliyer drenaja bağlı akut böbrek yetmezliği gelişebilir mi

Nasobiliary drainage, an endoscopic drainage method, is used mainly for the treatment of symptoms such as acute suppurative cholangitis, hydatid cyst rupture into the bile duct, postoperative biliary drainage, and pruritus associated with cholestasis. In addition to its various benefits, nasobiliary drainage has disadvantages, including prolongation of the procedure, damage while passing from the oral cavity to nasal route, though rare, dislocation of the catheter in incompatible patients, and patient discomfort. However, there is no previous report in the literature indicating the occurrence of acute renal failure due to nasobiliary drainage. In this report, we present a case who was referred to surgery after nasobiliary drainage placement due to a preliminary diagnosis of malignant narrowing in the distal choledochus; however, acute renal failure developed during the procedure because of excessive biliary drainage.

Billroth II gastrektomili hastalarda koledok taşlarının temizlenmesi için kısmi biliyer sfinkterotomi ile birlikte "large" balon dilatasyonun etkinliği

Background/aims: Patients with Billroth II gastrectomy, who have modified anatomy of the gastrointestinal tract, present technical difficulties during endoscopic stone removal. Recently, a large balloon dilatation has been used especially for extraction of difficult bile duct stones after endoscopic sphincterotomy. The aim of this study was to evaluate the efficacy and safety of endoscopic papillary large balloon dilatation with limited endoscopic sphincterotomy for removal of bile duct stones in patients with Billroth II gastrectomy. Methods: Twelve patients (12 men; median age: 69 years) with bile duct stones and a history of Billroth II gastrectomy were enrolled. After cannulation, limited endoscopic sphincterotomy was performed. Then, a large balloon dilatation (balloon size, 12-18 mm) was performed and stones were removed conventionally or via mechanical lithotripsy. Successful stone removal and complications were evaluated. Results: In all cases, stones were removed successfully. The median number of sessions for complete stone removal was one (range 1-3). Stone removal by mechanical lithotripsy was achieved in three patients (11.5%). There were no significant complications such as bleeding, pancreatitis or perforation. Conclusions: Endoscopic papillary large balloon dilatation after endoscopic sphincterotomy appears to be an effective and safe method for removal of difficult bile duct stones in patients with Billroth II.

Bir taşla üç kuş: Perkütan ve endoskopik yolla aynı seansta biliyer ve enterik metalik stent uygulaması

Recurrent tumors following surgery for gastric cancer are largely inoperable and are not suitable for palliative surgery. Metallic stent placement as a palliative therapy is routinely used in patients with malignant intestinal and biliary obstructions. In this report, we present the case of a patient who developed a malignant intestinal and biliary obstruction due to the recurrence of gastric cancer; 3 metallic stents were placed in the same session using an endoscopic and percutaneous approach

Terapötik endoskopik retrograd kolanjiografide V-Skop sisteminin avantajları

Background and Aims: Fast and reliable biliary cannulation and therapeutic attempts can be problematic in endoscopic retrograde cholangiography, even in experienced hands. The V-system is a modified duodenoscope design, and was developed in order to simplify and improve the procedure and shorten the length of endoscopic retrograde cholangiography. The aim of this study was to evaluate the V-system advantages and compare the V-system with conventional duodenoscope. Materials and Methods: All patients admitted for biliary endoscopic retrograde cholangiography throughout January 2011 were assessed for the study. Patients were assigned to the V-system or conventional duodenoscope groups randomly. All parameters about the procedure were recorded by a chronometer. Results: Sixty-three patients were included, with 36 in the V-system group and 27 in the conventional duodenoscopy group. The most common diagnosis in the groups was cholelithiasis, and the most common attempt was implantation of biliary stent. Both total procedure time and fluoroscopy time were significantly shorter in the V-system group than conventional duodenoscope group. Loss of guide wire and necessity of guide wire repositioning occurred clearly less often in the V-system group. Conclusions: The V-system has shown some advantages in guide-wire control and procedure length, and provides convincing benefits in the performance of endoscopic retrograde cholangiography procedures.

Oddi tümörünü taklit eden bir biliyer fascioliasis olgusu

Fasciola hepatica is an infestation mainly affecting animals like sheep and cattle, whereas humans are infected as accidental hosts. Unlike most of the parasitoses, there are reports suggesting that Fasciola hepatica infection is also frequently seen in developed countries. In the liver phase (acute phase), the patients clinical picture and presence of peripheral eosinophilia may aid in the diagnosis, whereas in the biliary phase (chronic phase), flukes may be visualized via ultrasonography or ERCP. In the chronic phase, patients can present with cholangitis or obstructive jaundice. Herein, we present a 55-year-old female with the main complaint of abdominal pain and a presumed diagnosis of sphincter of Oddi tumor, who was later determined to have biliary fascioliasis after ERCP intervention.

Acil ERCP ile tedavi edilen papilla Vateri'ye sıkışmış taşın neden olduğu bir akut biliyer pankreatit vakası

Acute pancreatitis which is a serious disease can lead to mortality in a small group of patients. One of the main causes of acute pancreatitis is biliary stone (40-60%). Endoscopic Retrograde Cholangiopancreaticography can be a life saving procedure in some patients with obstructed stone clinic such as icterus, elevated cholestatic enzymes and biliary dilatation. In this report, emergent therapy of a biliary stone which is impacted at the papilla Vatery and caused acute pancreatitis has been presented.

Reflü özofajit ile Helikobakter pilori ve gastrit ilişkisi

Background and aim: The relation between gastroesophageal reflux disease and Helicobacter pylori infection is controversial. The aim of this study was to investigate the relation between the presence of Helicobacter pylori and the histological and topografical features of Helicobacter pylori gastritis, and the severity of esophagitis. Material and methods: 129 patients (84 male and 45 female) with esophagitis diagnosed during upper gastrointestinal endoscopy were enrolled into the study. Ages of patients, gender, alcohol abuse and symptoms of reflux disease, medical history of surgery were also recorded. Los Angles classification was used for reflux esophagitis. Biopsies from antrum and the body of stomach were obtained. Sydney classification was used for gastritis. Results: Grade A esophagitis was found in 44,2% of all patients, grade B esophagitis in 46,5%, grade C esophagitis in 8.5% and grade D esophagitis in 0.8%. Total Helicobacter pylori rate was 73%, 68,2% in antrum and 68,2% in the body of stomach. There was no significant association between the presence, severity and distribution of Helicobacter pylori in antrum and the body of stomach and the severity of esophagitis. There was no significant association the presence of activation, inflamation, atrophy and intestinal metaplasia in both location and the severity of esophagitis. The rates of inflamation was similar in antrum and the body of stomach (%95.3 and %92.2). The rate of activation was significantly higher in antrum (66.7%) than in the body of stomach (47.3%). The rate of atrophy was significantly higher in antrum (58.1%) than in the body of stomach (24%). Conclusion: The frequency of Helicobacter pylori in patients with esophagitis was similar to the frequency reported in our country. Chronic active gastritis and chronic atrophic gastritis was more frequent in the antrun than in the body of stomach. These findings indicate that the types of histological gastritis caused by Helicobacter pylori rather than the presence of Helicobacter pylori is associated with esophagitis.

Özgün Görüntüler ERCP'de pratik ipuçları -2 Distale migre olmuş plastik stentin çıkartılması: Önce içeri it, sonra çıkart

Bu yontem ozellikle distal darligi olan hastalarda basarili olmaktadir. Ozellikle darligin altina kay- missa, proksimal darliklarda stenti iceriye itmek mumkun olmayacagi icin basarili olamamakta- dir. Bu hastalarda baska yontemler tarif etmek gereklidir:)