Zehra Akpinar

Endoscopic sphincterotomy alone in the management of low-grade biliary leaks due to cholecystectomy.

Aim:u2002 Endoscopic retrograde cholangiopancreatography (ERCP) is important in the diagnosis and management of postoperative bile leaks. Endoscopic sphincterotomy (ES) alone, ES with stent or nasobiliary drain (NBD) placement and stent or NBD without ES are the methods of choice. In the present study, we aimed to show the efficacy of ES alone in the management of low‐grade (LGL) cystic duct stump (CDS) leaks due to cholecystectomy.

Cold snare polypectomy versus hot snare polypectomy in endoscopic treatment of small polyps

BACKGROUND/AIMSnThe removal of small colon polyps by hot snare polypectomy (HP) is a commonly used method. Polypectomy with a cold snare (CP) has been increasingly utilized in recent years. Each method has its own advantages and disadvantages. Herein, we explored the efficacy and safety of each method.nnnMATERIALS AND METHODSnBetween January 1, 2012 and June 30, 2012, 97 consecutive patients with small colorectal polyps ranging from 5-9 mm in size were separated into either the CP or HP group. Demographic data, the duration of polypectomy, and pathology reports were recorded.nnnRESULTSnSeventy-seven polyps were removed from 49 patients in the CP group, and 71 polyps were removed from 48 patients in the HP group. There was no significant difference between the groups with respect to gender, age distribution, number of polyps, or indications for colonoscopy. The mean polyp size was 7.21±1.4 mm in the CP group and 7.56±1.45 mm in the HP group (p=0.111). There was a significant difference in the mean procedure time between the two groups (CP, 25.71±4.3 sec; HP, 70.28±11.3 sec, p<0.001). One patient (1.3/1.4%) from each group developed post-polypectomy bleeding that required treatment. Histological evaluation revealed that 10 of the polyps (6.75%) were advanced adenomas. Pathological examination showed that the polyps were not completely removed in 4 patients (5.13%) in the CP group and 4 patients (5.63%) in the HP group (p=0.89).nnnCONCLUSIONnCP is an effective and safe method that shortens the polypectomy duration in small polyps (≤9 mm) compared to HP.

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

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 500u2009mg 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 were 152.3 ± 30.6, 46.7 ± 7.3, and 45.7 ± 9.8, respectively. In the 12th week of iron administration, those scores were 162.3 ± 25.5 (P < 0.001), 49.3 ± 6.4 (P < 0.001), and 47.6 ± 8.9 (P = 0.024), respectively, which were all significantly different from the scores prior to iron administration. The mean changes in the IBDQ scores for ulcerative colitis and Crohns disease were 8.7% and 3.0% (P = 0.029), were 6.4% and 4.7% (P = 0.562) for the SF-36 PCS, and were 4.6% and 3.2% (P = 0.482) for the SF-36 MCS, respectively. Conclusion. Intravenous iron treatment may improve QoL in nonanemic, but iron deficient, IBD patients.

Assessment of presence and grade of activity in ileal Crohn's disease.

BACKGROUND/AIMSnTo assess the sensitivity of magnetic resonance enterography (MRE) in the diagnosis of Crohns disease (CD) activity and correlation between endoscopic and MRE scores in predicting the activity grade.nnnMATERIALS AND METHODSnTwenty-five ileal CD patients with clinical and biochemical evidence of activation underwent ileocolonoscopy and MRE within 7 days of their application. Simplified endoscopic scoring of CD (SES-CD) and MRE scores was done and compared with each other and other parameters of activation (CRP, leukocyte count, platelet count).nnnRESULTSnThe sensitivity of MRE scoring was found to be 92%; however, the statistical correlation with SES-CD was not significant (p=0.83) for the grading of the activity.nnnCONCLUSIONnMRE scoring is sensitive enough to use in CD activity evaluation; however, it can not be used alone, and it is rather a complementary technique to endoscopy and is especially valuable for patients with extraluminal disease.

Gastric polyps and polypoid lesions: Retrospective analysis of 36650 endoscopic procedures in 29940 patients

BACKGROUND/AIMSnThe frequency of gastric polyps increases with the widespread use of endoscopy for diagnosis and treatment. As gastric polyps can be malignant or premalignant, histopathological evaluation is needed. The aim of this study is to determine the prevalence and characteristics of gastric polyps in patients undergoing endoscopy.nnnMATERIALS AND METHODSnThis study consisted of a retrospective analysis of 36650 consecutive endoscopy and associated pathology reports of 29940 patients between December 2005 and February 2012 in a tertiary-referral center.nnnRESULTSnGastric polypoid lesions were detected in 666 (2.22%) patients. Hyperplastic polyps were the most common type of polyps (36.2%), followed by fundic gland polyps (8.3%), inflammatory fibroid polyps (2.4%) and adenomatous polyps (1.9%). Foveolar hyperplasia, neuroendocrine tumor, xanthoma, gastrointestinal stromal tumor, adenocarcinoma and lymphoma were less commonly seen. Malignant transformation was seen in 0.42% of hyperplastic polyps and in 23.1% of adenomatous polyps.nnnCONCLUSIONnEndoscopic appearance of gastric polyps can be variable, distinguishing macroscopically can be misleading. Because of their malignant potential histopathological evaluation is mandatory and polypectomy should be performed whenever possible.

The usage of overtube has a favorable effect on endoscopic submucosal dissection

BackgroundEndoscopic 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.MethodsRecords 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.ResultsThere 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 (pxa0>xa00,05). But the size of the lesions, the size of the resected specimen, and the speed of dissection were statistically different in two groups (pxa0=xa00.018, pxa0<xa00.001, pxa0<xa00.001, respectively).The need for suction during the procedure was much lower in the overtube group than those with no overtube (pxa0<xa00.001).ConclusionsWe 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.

En bloc resection of a 9 cm giant gastro-duodenal lipoma by endoscopic submucosal dissection

covered with a capsule, slow-growing, submucosal lesions which We thank Bart Haagmans from the Institute of Virology, Erasus MC University Medical Center, Rotterdam, Netherlands for ranting us access to the data set of the historical control group nd Andre Boonstra from the Department of Gastroenterology and epatology, Erasmus MC University Medical Center, Rotterdam, etherlands for the IL28B rs12979860 genotyping in the patients rom the pilot studies. This study was partly supported by the Virgo consortium, unded by the Dutch government project number FES0908, and y the Netherlands Genomics Initiative (NGI) project number 05060-452.

The last innovation in achalasia treatment; per-oral endoscopic myotomy

BACKGROUND/AIMSnPer-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.nnnMATERIALS AND METHODSnWe 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.nnnRESULTSnThe 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.nnnCONCLUSIONnPOEM is a safe endoscopic treatment modality for patients with achalasia in centers that are experienced in advanced endoscopic techniques.

What Is the Most Accurate Method for the Treatment of Diminutive Colonic Polyps?: Standard Versus Jumbo Forceps Polypectomy

AbstractDifferent 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 ⩽5u200amm. 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 (Pu200a<u200a0.001). In the subgroup analysis performed according to polyp sizes, complete resection rate among polyps with 3-mm diameter was determined as 100%. However, numbers of bites in 4-mm and 5-mm polyps were higher in the standard forceps polypectomy group, and complete resection rate was lower than in the jumbo forceps polypectomy group (Pu200a<u200a0.001). Both endoscopic treatment methods may be employed in treatment of diminutive colon polyps with ⩽5u200amm. However, jumbo forceps polypectomy is a more effective treatment method in 4- to 5-mm polyps with high one-bite polypectomy and complete resection rate.

Single tunneling method with endoscopic submucosal dissection for treatment of a rectal giant (18-cm) laterally spreading tumor

Endoscopic submucosal dissection (ESD) is an effective method for en bloc complete resection of lesions. We report a case of an 18-cm laterally spreading tumor (LST) in the colon that was successfully removed by colorectal ESD using a tunneling technique. The patient was a 61-year-old man who had a giant LST at the rectum starting 3 cm from the anal canal and extending proximally, measuring 13 cm endoscopically (▶Fig. 1). The procedure was performed after he had been sedated using spinal anesthesia. The lesion was examined by chromoendoscopy and endoscopic ultrasonography before ESD. The ESD strategy involved creating a tunnel from the anal site to a point proximal to the rectum, then joining the tunnel to the left part of the lesion using incision and dissection. Finally, the dissected part and the right part of the lesion were connected using incision and dissection assisted by gravity (▶Fig. 2, ▶Video1). The time between the initial incision and the separation of the lesion from normal tissue was recorded as the duration of the procedure. The resected tumor was removed en bloc and measured 179×108mm (▶Fig. 3). The procedure time was 224min. Examination of the pathological specimen showed intramucosal carcinoma, and all of the margins were clear. No complications occurred during or after the procedures (▶Fig. 4). No residual tissue was seen on control colonoscopy (▶Fig. 5). The single tunneling technique may easily provide orientation during procedures with controlled dissection of huge lesions. In addition, this method can allow effective isolation and coagulation of the main blood vessels rather than vessel branches. Therefore, as excessive bleeding is prevented, it can help the endoscopist to obtain a cleaner submucosal layer and increase the quality of the procedure. We consider that these advantages may be beneficial for increasing the quality of the sample and removing huge lesions en bloc, decreasing the total procedure duration and helping the endoscopist to use operating time effectively.