Aims: This study aimed to determine the factors predicting the development of hepatorenal syndrome (HRS) in cirrhotic patients presenting with acute kidney injury (AKI). Methods: We retrospectively analyzed 263 cirrhotic patients diagnosed with AKI between September 2022 and March 2024. Demographic characteristics, clinical findings, and laboratory results were analyzed. We diagnosed HRS using the 2019 International Club of Ascites criteria. We used bivariate and multivariate logistic regression models in our statistical analysis. Results: HRS developed in 31 patients (11.8%). MELD-Na scores were significantly higher in the HRS group (28 vs. 18, p2.5 mg/dl (OR 2.5, 95% CI 1.2-5.5), albumin 2 mg/dl (OR 7.9, 95% CI 3.7-17.0), and presence of spontaneous bacterial peritonitis (OR 5.5, 95% CI 1.4-12.2). Hemodialysis requirement (61.3% vs. 8.6%, p

Background/Aims: This retrospective single-center study aimed to assess the safety of early feeding in patients who met certain criteria following peroral endoscopic myotomy (POEM). Materials and Methods: Data from 100 patients who underwent POEM at our center between January and December 2022 were collected. Early feeding was defined as the introduction of clear liquid foods at 4 hours post procedure. At 4 and 24 hours, the pain was rated using the visual analog scale (VAS) in all patients. Patients without intraoperative complications (pneumoperitoneum requiring needle drainage, severe arterial bleeding requiring the use of hemostatic forceps, severe mucosal injury) and severe pain (VAS score > 6) and nausea-vomiting at the fourth postoperative hour were given the early feeding approach. In patients who did not meet these requirements, enteral feeding was initiated after 24 hours (late feeding). Results: Among the 100 patients, 50 patients were categorized early feeding. No patients had a control esophagogram. In the early and late enteral feeding groups, VAS scores were 4 (0-6) and 6 (1-8) (P < .001) at 4 hours and 1 (0-3) and 1 (0-6) (P = .043) at 24 hours, respectively. No severe complications were developed after early feeding. The median hospital stay in the early feeding group was 1 (1-3) day. There was no emergency readmission in any of early feeding patients. Conclusion: Our study showed early feeding following POEM can be begun in achalasia patients who do not have intraoperative complications, severe pain, or nausea/vomiting

Giriş ve Amaç: Obezite dünya çapında giderek yaygınlaşmaktadır. Son yıllarda obezite tedavisinde pek çok gelişme yaşansa da endoskopik tedavi yöntemleri, davranışsal tedavilere göre yan etkilerinin düşük olması ve başarı oranının daha yüksek olması nedeniyle önemli bir yere sahiptir. İntragastrik Botulinum toksin enjeksiyonu ile ilgili yapılan çalışmalarda kafa karıştırıcı sonuçlar olmasına rağmen bunun sebebi hala açıklığa kavuşturulamamıştır. Bu çalışmadaki amacımız Helicobacter pylori enfeksiyonunun intragastrik Botulinum toksin enjeksiyon tedavisi başarısı üzerindeki etkilerini değerlendirmektir. Gereç ve Yöntem: On sekiz ile 65 yaşları arasında, vücut kitle indeksi 25 kg/m2'nin üzerinde ve en az bir obezite ile ilişkili komplikasyonu olan veya komplikasyon olmadan vücut kitle indeksi 30 kg/m2'den fazla olan 80 hasta çalışmaya dahil edildi. Helicobacter pylori değerlendirmesi için intragastrik Botulinum toksini uygulaması esnasında mide antrumundan biyopsiler alındı ve hastalar Helicobacter pylori pozitifliği veya negatifliğine göre iki gruba ayrıldı. Bulgular: Çalışmamızda her iki grupta da başlangıç kilolarına göre istatistiksel olarak anlamlı azalma görüldü (p < 0.001). Ancak mide mukozasında Helicobacter pylori varlığı veya yoğunluğunun kilo kaybı üzerinde istatistiksel olarak anlamlı bir etkisi yoktu. Sonuç: İntragastrik Botulinum toksini uygulamasında çelişkili sonuçlara neden olabilecek durumlardan biri olan Helicobacter pylori enfeksiyonunun kilo kaybına etkisinin olmadığı gösterilmiştir.

Objectives The objective of this research was to explore the link between Helicobacter pylori (H. pylori) infection and alterations in ischemia modified albumin (IMA), thiol, and disulfide levels, with a focus on their potential clinical implications. Methods We carried out a cross-sectional study, enrolling 153 patients who underwent upper gastrointestinal endoscopy between March and July 2023. Biopsies were obtained from the stomach antrum to diagnose H. pylori. Biochemical parameters, including IMA, thiol, and disulfide, were measured in fasting blood samples. A statistical analysis, including receiver operating characteristic curve analysis, was performed to assess the diagnostic potential of these biomarkers. Results In this study, a total of 153 patients were included, of whom 99 tested positive for H. pylori and 54 tested negative. The H. pylori-positive group exhibited significantly higher levels of disulfide, disulfide/native thiol ratio, disulfide/total thiol ratio, and IMA compared to the H. pylori-negative group (p <= 0.05 for all parameters). In contrast, the native thiol/total thiol ratio was significantly lower in the H. pylori-positive group (p <= 0.05). Conclusions Our study's findings of elevated disulfide levels in H. pylori-positive individuals suggest a potential disruption in redox balance associated with H. pylori infection. This study contributes to the understanding of H. pylori's systemic effects on biochemical markers, offering insights into their diagnostic utility.

This study aimed to assess the impact of adding pancreatin (a pancreatic enzyme derivative) to standard treatment on patients diagnosed with Irritable Bowel Syndrome (IBS) and Type 2 Diabetes Mellitus (T2DM). IBS and T2DM frequently coexist, leading to significant gastrointestinal symptoms and a decrease in quality of life. Gastrointestinal symptoms arising in T2DM patients present challenges in management for both clinicians and patients. Standard treatments may not fully address these symptoms. Recent studies suggest that pancreatic enzyme replacement therapy may offer additional benefits. This study investigates whether adding pancreatin to standard treatment can improve gastrointestinal outcomes in this patient population. Conducted as a prospective observational study, the research involved patients diagnosed with IBS according to Rome IV criteria and having concomitant T2DM. The patients were divided into two groups: one receiving standard dual treatment (otilinium bromide + simethicone) and the other receiving a triple therapy including a pancreatin derivative in addition to the standard treatment. Various clinical scores and measurements, including Visual Analog Scale (VAS), Bristol Stool Chart (BSC), Irritable Bowel Syndrome-Severity Scoring System (IBS-SSS), and Irritable Bowel Syndrome Quality of Life Instrument (IBS-QOL), were assessed before and after treatment. The study comprised 121 patients, with a median age of 41 years (interquartile range [IQR] 38-48), of whom approximately 70.2% were female. Fifty-eight patients (47.9%) received dual therapy, while sixty-three patients (52.1%) received triple therapy. Before treatment, both groups exhibited similar pre-treatment Bristol stool scale results: normal (39.7% and 49.2%) and constipation (37.9% and 31.7%) in the dual and triple therapy subgroups, respectively (p > 0.05). Post-treatment, the triple therapy group showed a significantly higher proportion of normal cases on the Bristol stool scale (82.5%) compared to the dual therapy group (44.8%) (p < 0.001). After treatment, the triple therapy group demonstrated statistically significant improvements in VAS score (p < 0.001), IBS-SSS (p < 0.001), and IBS-QOL (p < 0.001) compared to the dual therapy group. There were no significant differences between groups in BMI, HbA1c levels, duration of diabetes, or diabetes treatment at baseline (p > 0.05 for all parameters). The findings suggest that adding pancreatin to standard therapies significantly enhanced the quality of life for patients with both IBS and T2DM, demonstrating improvements across various symptom measurements and indicating the potential benefits of this supplementary therapy in managing gastrointestinal symptoms in this population. Further studies are warranted to explore its broader clinical implications and mechanisms of action.

Background/Aims: The efficacy and safety of Zenker's peroral endoscopic myotomy (Z -POEM), a current method in the treatment of Zenker's diverticulum (ZD), have been demonstrated in a limited number of studies and case reports. This study aimed to report our experience with the Z -POEM method. Materials and Methods: Patients with ZD who were treated with Z -POEM between January 2019 and March 2023 and had a followup period of at least 3 months were included in the study. Our primary endpoint was clinical success. A Kothari-Haber score (KHS) of 2 or less at 1 month postoperatively was defined as clinical success. Our secondary endpoints were adverse events and recurrence rates. Results: In total, 20 patients (males, 65%; mean age, 63 +/- 14.4 years) were treated with Z -POEM. The mean ZD septum length was 33.7 (+/- 11.04) mm. The technical success rate was 100% (20/20), and the clinical success rate was 95% (19/20). In 1 case with a large ZD (septum length of 60 mm), the mucosal septum, which was thought to cause partial persistence of symptoms, was treated by endoscopic septotomy. The mean KHS decreased significantly after Z -POEM (preoperative KHS: 7.3 and postoperative KHS: 0.15, P < .0001). The median follow-up period was 10 months (interquartile range, 3-39). No recurrence was observed in any case. Intraprocedural mild subcutaneous emphysema was observed in 4 (20%) cases. Emphysema regressed spontaneously in the postoperative period without any treatment. Conclusion: Zenker's peroral endoscopic myotomy is a successful and reliable method in the treatment of ZD, with low recurrence rates.

Background: In recent years, various novel surgical and non-surgical therapeutic options have been developed for treating obesity. Due to its disputed success, intragastric botulinum toxin A (BTX-A) injection is still being debated. Objectives: We aim to contribute to this controversial issue in the literature by sharing our center’s findings regarding intragastric BTX-A injections in the treatment of obesity. Design: Patients with a body mass index (BMI) of greater than 25 kg/m 2 and at least one obesity-related complication, or a BMI of greater than 30 kg/m 2 without complications, were eligible for the study if they were between the ages of 18 and 65. Methods: Following the same procedure, two endoscopists administered BTX-A to all patients. All patients were evaluated for obesity by measuring their lipid profile, hormone profile, and insulin resistance level before treatment. Results: In our study on 82 patients, we saw a significant mean weight loss (−9.2 kg, p < 0.001) in the second month, and there was no additional mean weight loss in the sixth month of follow-up. In addition, this result seems to be independent of the patient’s insulin resistance. We did not see any serious side effects in any of the patients. Conclusion: Although the use of intragastric injection of BTX-A in the treatment of obesity is a controversial issue, we showed in our study that it causes significant weight loss. Further studies are needed on this subject, as it can be a safe method when the ideal dose and application site are combined with appropriate patient selection.

Non-gastric upper gastrointestinal system polyps are detected rarely and mostly incidentally during upper gastrointestinal endoscopy. While the majority of lesions are asymptomatic and benign, some lesions have the potential to become malignant, and may be associated with other malignancies. Between May 2010 and June 2022, a total of 127,493 patients who underwent upper gastrointestinal endoscopy were retrospectively screened. Among these patients, those who had polyps in the esophagus and duodenum and biopsied were included in the study. A total of 248 patients with non-gastric polyps were included in this study. The esophageal polyp detection rate was 80.00/100,000, while the duodenal polyp detection rate was 114.52/100,000. In 102 patients (41.1%) with esophageal polyps, the mean age was 50.6 ± 15.1, and 44.1% (n = 45) were male. The most common type of polyps was squamous papilloma (n = 61, 59.8%), followed by inflammatory papilloma (n = 18, 17.6%). In 146 patients (58.9%) with duodenal polyps, the mean age of patients was 58.3 ± 16.5, and 69.8% (n = 102) were male. Brunner's gland hyperplasia, inflammatory polyp, ectopic gastric mucosa, and adenomatous polyp were reported to be the most prevalent types of polyps in the duodenum overall (28.1%, 27.4%, 14.4%, and 13.7%, respectively). It is crucial to identify rare non-gastric polyps and create an effective follow-up and treatment plan in the era of frequently performed upper gastrointestinal endoscopies. The epidemiological assessment of non-gastric polyps, as well as a follow-up and treatment strategy, are presented in this study.

Background: The ectopic opening of the common bile duct(CBD) into the duodenal bulb is a rare biliary anomaly. The study aimed to reveal the experience with clinical and endoscopic outcomes in these patients. Materials and Methods: This study was conducted on 57 consecutive patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) for ectopic opening of the CBD into the duodenal bulb at our institution between 2010 and 2020. Results: The median age was 59 years (49 males). A total of 146 ERCP procedures were performed (once in 26 patients and 2 or more times in 31 patients). Ten patients had a history of unsuccessful ERCP in an external center. The median follow-up time was 14.6 months. All patients had a slit-like opening of the CBD into the duodenal bulb, apical stenosis, and hook-shaped distal CBD. ERCP findings were CBD stone or dilatation in 55 patients and post-cholecystectomy biliary leakage in 2 patients. Balloon dilatation was performed for apical stenosis in 7 patients and distal CBD stenosis in 26 patients. During the first ERCP session, biliary stent/nasobiliary drainage was placed in 37 patients, and CBD stones were extracted in 19 patients without stenting. Biliodigestive anastomosis was applied to 13 patients, 5 of whom had recurrent cholangitis, 7 required recurrent ERCP, and one was due to the technical difficulty of ERCP. Conclusions: Ectopic biliary opening should be remembered if the papilla cannot be seen in its usual place in a patient with apical stenosis. ERCP should be performed in experienced hands, and surgery should be considered in the need for recurrent ERCP.

Background and aims There are different therapeutic approaches for biliary strictures and reducing portal hypertension in patients with symptomatic portal cavernoma cholangiopathy (PCC). Endoscopic treatment includes endoscopic biliary sphincterotomy (EST), dilation of stricture with a biliary balloon, placement of plastic stent(s) and stone extraction. Fully covered self-expandable metal stent (FCSEMS) is placed as a rescuer in case of haemobilia seen after EST, dilation of stricture and removal of plastic stent rather than the stricture treatment itself. In this retrospective observational study, we sought to assess the clinical outcomes of FCSEMS as the initial treatment for PCC-related biliary strictures. Materials and methods Twelve symptomatic patients with PCC both clinically and radiologically between July 2009 and February 2019 were examined. Magnetic resonance cholangiopancreatography (MRCP) and cholangiography were employed as the diagnostic imaging methods. Chandra–Sarin classification was used to distinguish between biliary abnormalities in terms of localization. Llop classification was used to group biliary abnormalities associated with PCC. Endoscopic partial sphincterotomy was performed in all the patients. If patients with dominant strictures 6-8-mm balloon dilation was first performed. This was followed by removal of the stones if exist. Finally, FCSEMS placed. The stents were removed 6–12 weeks later. Results The mean age of the patients was 40.9 ± 10.3 years, and 91.6% of the patients were male. Majority of the patients (n = 9) were noncirrhotic. Endoscopic retrograde cholangiopancreatography (ERCP) findings showed that 11 of the 12 patients were Chandra Type I and one was Chandra Type IIIa. All the 12 patients were Llop Grade 3. All patients had biliary involvement in the form of strictures. Stent placement was successful in all patients. FCSEMSs were retained for a median period of 45 days (30–60). Seven (58.3%) patients developed acute cholecystitis. There was no occurrence of bleeding or other complications associated with FCSEMS replacement or removal. All patients were asymptomatic during median 3 years (1–10) follow up period. Conclusions FCSEMS placement is an effective method in biliary strictures in case of PCC. Acute cholecystitis is encountered frequently after FCSEMS, but majority of patients respond to the medical treatment. Patients should be followed in terms of the relapse of biliary strictures.

Objective: Irritable bowel syndrome (IBS) is a chronic, functional disorder of the gastrointestinal tract. Recent investigations have highlighted the potential involvement of inflammation, although the etiology of IBS remains unknown. This study aims to assess the connection between IBS and Monocyte/High-Density Lipoprotein (HDL) ratio (MHR), a new inflammatory marker. Material and Method: The study was conducted in the outpatient gastroenterology unit of a tertiary center between March-2021 and March-2022. Patients with IBS, according to the Rome IV criteria were examined retrospectively. Age- and sex-matched healthy controls were used to compute MHR and compare the results. Results: A total of 255 participants, 155 diagnosed with IBS and 100 in the control group, were included. The median (min-max) monocyte counts (cells/mm³) in the IBS and control groups were 380.0 (310.0-460.0) and 332.0 (232.0-449.3), respectively (p = 0.008). The median(min-max) HDL levels(mg/dl) in IBS and control groups were 45.0(36.0-55.0) and 49.0(43.0-57.0), respectively(p=0.001). The median MHR was higher in the IBS group (9.5) compared to healthy controls (6.73, p<0.001). Logistic regression analysis revealed MHR as an independent predictor of the presence of IBS (OR: 1.406, 95% CI: [insert confidence interval]). The cut-off value for MHR to detect IBS with 62.6% sensitivity and 63.0% specificity was 7.57, and ROC analysis revealed an AUROC value of 0.646 (95% CI: 0.577-0.715, p<0.001). Discussion: The study's primary findings were that IBS patients had significantly lower levels of HDL cholesterol and significantly higher levels of monocyte counts when compared to the control group. Consequently, monocyte/HDL ratios (MHR) were statistically substantially greater in IBS patients than in the control group. Furthermore, when the cut-off value was set at 7.6, MHR was found to be an independent predictor for IBS, with 62.6% sensitivity and 63.0% specificity. Conclusion: MHR can be a simple, inexpensive, and effective tool to demonstrate the inflammatory state in patients with IBS.

Aim: Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) is a serious complication of ERCP. In this study, we aimed to compare the use of rectal indomethacin, pancreatic stenting or both techniques for prevention of PEP. Material and Method: Patients who underwent ERCP for the first time due to choledocholithiasis between January 2022 and June 2022 were retrospectively reviewed. The clinical findings, demographics, laboratory records, endoscopic intervention characteristics, whether rectal indomethacin was applied before the procedure, whether pancreatic stent was placed or not were evaluated. Results: A total of 367 patients who underwent ERCP for the first time were included in the study. The mean age was 61 (28-92) years and 53.4% were female. In 124 (33.8%) patients, involuntary guide-wire insertion into the pancreatic duct occurred during canulation. Pancreatic stent was placed in 82 (22.3%) of the patients. Rectal indomethacin was administered to 288 patients (78.5%), while indomethacin could not be administered in 79 patients (21.5%), because they did not give consent. When patients with involuntarily pancreatic canulation were evaluated, the rate of PEP was 3.6% in the stented group, while it was 15.3% in the stent-free group (p

Objective: To determine the clinical significance of gastrointestinal (GI) symptoms in mild hospitalized patients with Covid-19 infection. Material and Methods: This study included adult patients who were hospitalized with a confirmed diagnosis of Covid-19 infection. The demographical features, symptoms, clinical presentations, medical history, medications and clinical progress and outcomes were noted using data collection form by the clinicians. The effect of GI symptoms on clinical outcomes in patients with mild Covid-19 infection was statistically evaluated. Results: 307 patients were included to the study. 159 of patients (51.7%) had an at least one GI symptoms, 18.2% of those presented only GI symptoms while 21.2% only non-GI symptoms. 27% were asymptomatic at admission. The most common GI symptom was loss of appetite that presenting 16.9% patients. The second and third most common GI symptoms were diarrhea in 15% patients, nausea and loss of taste in 14% patients, respectively. There was no significant difference in laboratory parameters between GI and non-GI symptoms groups. When age, gender, smoking status, and comorbidities of patients with GI and non-GI symptoms groups were compared, there was no difference in mean age, gender, smokers, and comorbidities. In addition, the length of hospital stay (p=0.377), complete healing (p=0.372) and mortality (p=0.351) was similar in patients with GI and non-GI symptoms groups respectively. Conclusion: Early diagnosis of Covid-19 infection presenting with GI symptoms can help prevent infection spread. The majority of these symptoms were mild, and their presence was not associated with worse clinical outcomes.

Background and Aims Standard endotherapy for pancreatic duct (PD) disruption is pancreatic stenting and sphincterotomy. In patients refractory to standard treatment, treatment algorithm is currently not standardized. This study aims to report the 10-year experience with the endoscopic treatment of postoperative or traumatic PD disruption and to share our algorithmic approach. Methods This retrospective study was conducted on 30 consecutive patients who underwent endoscopic treatment for postoperative ( n = 26) or traumatic ( n = 4) PD disruption between 2011 and 2021. Standard treatment was initially applied to all patients. Endoscopic modalities used with a step-up approach in patients unresponsive to standard treatment were stent upsizing and N -butyl-2-cyanoacrilate (NBCA) injection for partial disruption, and the bridging of the disruption with a stent and cystogastrostomy for complete disruption. Results PD disruption was partial in 26 and complete in 4 patients. Cannulation and stenting of PD was successful in all patients and sphincterotomy was performed in 22 patients. Standard treatment was successful in 20 patients (66.6%). The resolution of PD disruption in 9 of 10 patients refractory to standard treatment was achieved with stent upsizing in 4, NBCA injection in 2, the bridging of the complete disruption in one, and cystogastrostomy after spontaneously and intentionally developed pseudocyst in one patient each. Overall, therapeutic success rate was 96.6% (100% for partial, 75% for complete disruption). Procedural complications occurred in 7 patients. Conclusions Standart treatment for PD disruption is usually effective. In patients refractory to standard treatment, the outcome may be improved by step-up approach using alternative endoscopic modalities.

Background: Vedolizumab, which is a monoclonal antibody that selectively binds to alpha 4 beta 7 integrin in the gastrointestinal system, may be an effective and safe treatment alternative in those with anti-tumor necrosis factor-resistant inflammatory bowel disease. Methods: Patients administered vedolizumab due to anti-tumor necrosis factor resistant or anti-tumor necrosis factor side effects between August 2017 and November 2020 were included in the study. Crohn's patients were evaluated using the Harvey-Bradshaw index and Simple Endoscopic Score for Crohn's Disease, whereas ulcerative colitis patients were evaluated with the Partial Mayo Score Index and Rachmilewitz score. All patients were followed up for 3 months and their blood samples were taken every 3 months. Hemoglobin, white blood cell, leukocyte, lymphocyte, and platelet counts of the patients were performed. Albumin, C-reactive protein, and erythrocye sedimentation rate values were recorded. The side effect profile for vedolizumab was evaluated for all patients. Among the side effects, arthralgia and flu-like symptoms were observed. Results: A total of 48 patients (18 ulcerative colitis and 30 Crohn's disease) were included in the study. Vedolizumab therapy was initiated in the patients due to anti-tumor necrosis factor resistance (17 ulcerative colitis and 26 Crohn's disease) or anti-tumor necrosis factor side effects (1 ulcerative colitis and 4 Crohn's disease). A total of 30 (63%) patients, including 15 (83%) ulcerative colitis and 15 (50%) Crohn's disease, responded to treatment (both response and remission). The mean duration of response to treatment was 4.5 +/- 1.5 months. A total of 20 (42%) patients in the vedolizumab therapy subgroup (10/10, ulcerative colitis/Crohn's disease) went into remission. The mean Harvey-Bradshaw Index value was 9.8 +/- 2.8 in the Crohn's disease patients at the time of initial treatment. The mean Simple Endoscopic Score for Crohn's disease value was 11.2 +/- 3.1 at the time of initial treatment. The mean Harvey-Bradshaw Index value was 6.5 +/- 3.0 and the mean Simple Endoscopic Score for Crohn's disease value was 4.9 +/- 3.6 at 6 months post-treatment. The mean Ulcerative Colitis Endoscopic Index (Rachmilewitz) value was 9.3 +/- 1.2 at the time of initial treatment. In addition, the mean Partial Mayo Scoring Index was 6.4 +/- 1.5 at the time of initial treatment. The mean Ulcerative Colitis Endoscopic Index (Rachmilewitz) value was 0 (0-6.0), and the mean Partial Mayo Scoring Index was 1.5 (0.3-4.0) at 6 months post-treatment. Conclusion: Vedolizumab therapy is effective in both induction and maintenance of remission in inflammatory bowel disease patients who are resistant to anti-tumor necrosis factor or who can not receive anti-tumor necrosis factor therapy due to side effects. No significant side effect was observed in the patients during follow-up.

Standard treatment for most post-cholecystectomy bile duct injuries is Roux-en-Y hepaticojejunostomy [1]. Conventional treatment of complete anastomotic obstruction after this procedure is revision surgery, which has high morbidity and mortality. Therefore, less invasive treatments are preferred, such as guidewire tapping, needle knife puncture, and magnetic compression anastomosis [2] [3].