Objective: Irritable bowel syndrome is a common functional gastrointestinal disorder that affects the quality of life and the ability to work.It is known that irritable bowel syndrome occurs as a result of a multifactorial change in microbiota and immunology.We aimed to evaluate the effects of Bacillus subtilis on inflammatory parameters and quality of life in irritable bowel syndrome.Methods: Irritable bowel syndrome volunteers diagnosed according to Rome IV criteria were recruited in the single-center prospective study and were given 5 billion B. subtilis once a day for 3 weeks.The primary outcome, the irritable bowel syndrome symptom severity score, fecal microbiota analysis, and serum inflammatory parameters were evaluated at the beginning of the study and at the end of the 3-week study period.Results: The mean age of 22 patients included in the study was 39.90 ± 11.93 years.The mean irritable bowel syndrome symptom severity score was 144.31 ± 104.86 before the treatment and 62.50 ± 43.69 after the treatment and the difference between them was statistically significant (P < .001).After treatment, an increase in total oxidant status, total antioxidant status, oxidative stress index, interleukin-10, interferon-gamma levels, and a decrease in interleukin-6 and tumor necrosis factor-α levels were observed, but the difference was not statistically significant (P > .05).While there was no difference in Shannon diversity after the application of alpha diversity analysis, a decrease was observed in the Chao (P < .006)analysis. Conclusion:The use of probiotics containing B. subtilis spores in patients with diarrheal-type irritable bowel syndrome reduces the severity of the disease, but no significant effect was observed in terms of inflammatory parameters.

Aims: Mesenteric panniculitis is a rare, non-specific, chronic inflammatory disease with a reported incidence of 0.16-3.3% that primarily involves the mesenteric adipose tissue. We aimed to retrospectively analyze the clinical features of patients diagnosed with mesenteric panniculitis. Methods: We retrospectively analyzed the reports of 941 patients who were examined in the Gastroenterology Clinic of Lokman Hekim Hospital and underwent abdominal computerized tomography (CT) between January 2019 and December 2021. Results: Among CT scan reports of 941 patients, the diagnosis of mesenteric panniculitis was present in 89 (9.45%) patients (55 male and 34 female). The reasons for obtaining a CT scan in those patients were as follows: severe abdominal pain in 53 (59.6%) patients, weight loss in 16 (17.9%) patients, bloating, distention, and suspicion of sub-ileus in 12 (13.5%) patients, and alterations in abdominal movements (constipation or diarrhea) in 8 (8.9%) patients. Among patients with mesenteric panniculitis, autoimmune diseases were also analyzed 21 were having Hashimoto thyroiditis, 2 were having vitiligo, 2 were having Sjögren’s disease, 1 was having primary biliary cholangiopathy, and 1 was having a diagnosis of celiac disease. Conclusion: Mesenteric panniculitis is not a very rare disease, diagnosed with mainly CT findings. Although the disease may be associated with some autoimmune diseases and malignancies, the disease outcomes are generally fine. However, there are still many unknown points, especially about the etiology and outcomes of the disease.

Background: The aim of this study is to describe the clinical features and imaging findings of 14 patients diagnosed with primary epiploic appendagitis on computed tomography (CT). Methods: Between January 2019 and August 2022, the hospital records of 14 patients were retrospectively reviewed. We recorded patients' age, gender, fever presence, blood leukocyte count (WBC), C-reactive Protein (CRP) level, localization of abdominal pain, the presence of nausea or vomiting, the involved part of the colon on CT, whether they received treatment or not, and whether they underwent surgery. Results: This study included 14 patients, 8 male and 6 female. Their ages ranged from 27 to 63 years. All patients presented with acute abdominal pain in most cases, with no elevation in body temperature or significant increase in inflammation markers. CT scan images showed a fat oval lesion corresponding to the inflamed Appendix epiploica, with a peripheral hyper-attenuated frame and a central "dot" in some cases referring to the thrombosed vessel. The patients were successfully treated with conservative methods. Conclusions: Epiploic appendagitis can mimic surgical diseases such as appendicitis and diverticulitis due to its non-specific clinical presentation. CT scan is essential in diagnosing this disease, which can be managed with more conservative treatment methods.

Ulcerative colitis is a chronic, immune-mediated disease characterized by recurring episodes of mucosal inflammation in the colon and rectum. The primary pathogenic mechanism of ulcerative colitis is the dysregulation of the mucosal immune response. The disease follows a relapsing-remitting course, and the goal of management is to successfully induce and then maintain remission. Effectively managing this chronic disease requires addressing all aspects of it. Currently, we have various antitumor necrosis factor agents and novel biologics available for treating ulcerative colitis patients with moderate-to-severe disease. However, none of the existing treatments are considered entirely satisfactory or ideal in these cases. After extensive progressive research, oral small molecule therapies targeting mediators of ongoing inflammation represent an exciting and revolutionary change in the treatment of ulcerative colitis, especially for patients with moderate-to-severe disease. In this review, we aimed to summarize the available experience and ongoing research on oral small molecule agents in the management of ulcerative colitis. The available experience and ongoing research with promising outcomes provide convincing evidence that the value of oral small molecule agents is fact not fancy.

Aim: To compare the D-Dimer levels in patients with mild COVID-19 disease with and without hereditary thrombophilia. Material and Method: Factor V Leiden (G1691A) mutation, methylene tetrahydrofolate gene mutation (C677T, A1298C), and PAI-1 (4G-5G) and FXIII (V34L) gene mutations were examined in all patients included in the study for various reasons such as recurrent miscarriage and venous embolism. Patients with any mutation were included in the hereditary thrombophilia group, while patients without mutations were included in the control group. D-dimer levels of the patients were also analyzed for the second time at least 25 days after admission. All included patients had received previously at least two doses of the BioNTech-Pfizer or CoronaVac vaccines. Results: A total of 158 patients, 46 (29.1%) male and 112 (70.9%) female, were included in the study. The mean age of the patients included in the study was 39.08 ± 9.09 years. A total of 121 patients, 33 (27.3%) men and 88 (72.7) women, with hereditary thrombophilia were in the first group. A total of 37 patients, 13 (35.1%) male and 24 (64.9%) female, who did not have any mutations, were taken as the control group. Of the patients with hereditary thrombophilia, 47 (38.8%) had Factor V Leiden, 63 (52.1%) had MTHFR gene mutations, 32 (26.4%) had PAI-1 and 12 (9.9%) had FXIII gene mutations. When the D-dimer values of both groups were examined 20-35 days after admission to the hospital, the D-dimer level of the hereditary thrombophilia group was 667.26 ±354.11 while the D-dimer level of the control group was 369.76±173.45 (P=0.031). The D-dimer level of 23 patients in the hereditary thrombophilia group and 2 patients without thrombophilia were found to be above 1000ng/ml when they came for control. Conclusion: It should be kept in mind that if there is prolonged or newly emerging D-dimer elevation in patients who had COVID-19 disease with mild-moderate symptoms, these patients may have hereditary thrombophilia.

Aim: To determine the effect of lactose intolerance on serum glucose levels and related biochemical parameters in the adult population who refrain from consuming milk and milk products. Material and Method: This retrospective, observational study was conducted in a tertiary care hospital between January 2016 and December 2019 with 296 participants. Plasma glucose, calcium, 25-hydroxyvitamin D3, folate, vitamin B12, thyroid-stimulating hormone (TSH), and ferritin levels were controlled. Patients with positive lactose intolerance test results were accepted as the study group and negative results were accepted as the control group, and data of two groups were compared. Results: Of the total 296 participants 212 (71.7%) were found to have lactose intolerance and 84 (28.3%) were found to be normal. In the lactose intolerant group, blood glucose levels were significantly lower than the control group (5.14±0.53 mmol/L versus 5.47±0.54 mmol/L, p

Amaç: Bu çalışmada herediter trombofili olan ve olmayan hafif Covid-19 hastalarında D-Dimer düzeylerinin karşılaştırılması amaçlanmıştır. Gereç ve Yöntem: Tekrarlayan düşük ve venöz emboli gibi çeşitli nedenlerle daha önce Faktör V leiden (G1691A) mutasyonu, metilen tetrahidrofolat gen mutasyonu (C677T, A1298C), PAI-1 (4G-5G) ve FXIII (V34L) gen mutasyonları bakılmış olan hastalar çalışmaya alındı. Herhangi bir mutasyonu olan hastalar kalıtsal trombofili grubuna, mutasyonu olmayan hastalar kontrol grubuna alındı. Hastaların D-dimer düzeyleri başvurudan en az 25 gün sonra bir kez daha kontrol edilmişti. Çalışmaya dahil edilen tüm hastalar daha önce BioNTech-Pfizer veya CoronaVac aşılarından en az iki doz olmuştu. Bulgular: Çalışmaya 46 (%29,1) erkek ve 112 (%70,9) kadın olmak üzere toplam 158 hasta dahil edildi. Hastaların yaş ortalaması 39,08±9,09 idi. Herediter trombofilisi olan 33 (%27,3) erkek, 88 (72,7) kadın toplam 121 hasta birinci grup olarak alındı. Herhangi bir mutasyonu olmayan 13 (%35,1) erkek ve 24 (%64,9) kadın toplam 37 hasta ise kotrol grubu olarak alındı. Kalıtsal trombofili hastalarının 47’sinde (%38,8) Faktör V Leiden, 63’ünde (%52,1) MTHFR gen mutasyonu, 32’sinde (%26,4) PAI-1 ve 12’sinde (%9,9) FXIII gen mutasyonu vardı. Hastaneye yatıştan 20-35 gün sonra her iki grubun D-dimer değerleri incelendiğinde, herediter trombofili grubunun D-dimer düzeyi 667,26 ±354,11, kontrol grubunun D-dimer düzeyi 369,76±3; 173,45 (P=0,031) olarak buluındu. Herediter trombofili grubundaki 23 hastanın ve trombofili olmayan 2 hastanın kontrole geldiklerinde D-dimer düzeyleri 1000ng/ml’nin üzerinde bulundu. Sonuç: Hafif-orta semptomları olan COVID-19 hastalığında uzamış veya yeni ortaya çıkan D-dimer yüksekliği varsa bu hastalarda kalıtsal trombofili olabileceği akılda tutulmalıdır.

PURPOSE:To evaluate the radial peripapillary capillary density using optical coherence tomography angiography in patients with and without Helicobacter pylori infection. METHODS:This prospective, cross-sectional study comprised 52 patients (52 eyes: Group 1) and 38 patients (38 eyes: Group 2) with and without H. pylori infections, respectively. The radial peripapillary capillary density and retinal nerve fiber layer thickness in 4 equal quadrants and 2 equal hemispheres in the peripapillary region were calculated using optical coherence tomography angiography. The optic nerve head parameters of the patients were also assessed. RESULTS:The groups were similar in terms of age, gender, and the optic nerve head parameters. The radial peripapillary capillary densities in the superior hemisphere and quadrant were significantly lower in Group 1 than in Group 2 (p=0.039 and p=0.028, respectively) and were positively correlated with the superior hemisphere's retinal nerve fiber layer thickness (p<0.001 and p<0.001, respectively). Similarly, the radial peripapillary capillary densities in the inferior hemisphere and quadrant were also significantly lower in Group 1 compared to Group 2 (p=0.03 and p=0.017, respectively) and were positively correlated with the inferior hemisphere's retinal nerve fiber layer thickness (p<0.001 and p<0.001, respectively). The retinal nerve fiber layer thickness in the nasal and temporal quadrants were significantly decreased in Group 1 when compared to Group 2 (p=0.013 and p=0.022) and were positively correlated with the corresponding radial peripapillary capillary densities of the 2 quadrants (p=0.002 and p=0.022). CONCLUSION:The decreased radial peripapillary capillary density in the H. pylori-positive patients suggests that H. pylori may play a role in the etiopathogenesis of glaucoma.

Introduction: In this study, we aimed to report the clinical outcomes of antral BTX-A injection in the absence of wide- spread injections and compare the results with the control cases who only were under a diet program without any invasive procedure. Methods: Intragastric BTX-A injection was performed in 42 patients. Meanwhile, 38 age- and gender-matched pa- tients who started a new diet program were included in the control group. Only the patients with a body mass index (BMI) between 30 kg/m2 and 35 kg/m2 were included for analysis. Results: In total, 42 patients (11 males, 31 females) who had intragastric BTX-A injection and 38 patients (8 males, 30 females) who were under a diet program were included in this study. In the group administered with BTX-A, the mini- mum weight loss in this 5-month period was 7 kg, and the maximum weight lost was 19 kg with a mean of 14.48±2.20 kg; while the minimum weight loss in this 5-month period was 5 kg and the maximum weight lost was 13 kg with a mean of 10.78±2.09 kg in the control group (p=0.001). Discussion and Conclusion: Intragastric BTX-A injection, barely to the antrum, was determined to be more effec- tive in inducing significant weight loss in patients with grade 1 obesity than only diet and exercise. Approximately 10%–15% weight loss was achieved after antral BTX-A injection in about 3 months without any significant adverse events. In that aspect, intragastric BTX-A injection could be a promising way of inducing weight loss in obese patients.

BACKGROUND:Non-alcoholic hepatic steatosis (NAS) is characterized by excess fat accumulation in hepatocytes, causing portal and lobular inflammation and hepatocyte injury.OBJECTIVE:We aimed to evaluate the alterations in monocyte count to high-density lipoprotein cholesterol ratio (MHR) in patients with grade 2 or 3 fatty liver disease and the association of this marker with liver function tests and insulin resistance.METHODS:In this retrospective analysis; patients diagnosed and followed for the grade 2 or 3 fatty liver disease were included in the patient group and the patients who had undergone abdominal ultrasound for any reason and who were not having any fatty liver disease were included in the control group.RESULTS:Totally 409 cases were included in the study. Among participants, 201 were in the control group, and 208 were in the NAS group (111 were having grade 2 and 97 were having grade 3 steatosis). The monocyte/HDL ratio was significantly higher in the NAS group compared with the healthy controls (P=0.001). There was a significant positive correlation between the monocyte/HDL ratio and age (r=0.109; P=0.028), ALT (r=0.123, P=0.014) and HOMA-IR (r=0.325, P=0.001) values.CONCLUSION:In conclusion, the monocyte to high-density lipoprotein ratio significantly increases in fatty liver disease and correlates with insulin resistance. Since it was suggested as a prognostic marker in atherosclerotic diseases, elevated MHR values in fatty liver disease should be evaluated cautiously.

Background and Aim: Immunohistochemistry may serve as a surrogate to define Diffuse large B-cell lymphoma (DLBCL) cases as germinal center B cell-like (GCB) or non-GCB subtypes and to provide prognostic information.In this study, we aimed to investigate the frequency and prognostic impact of CD10, B-cell lymphoma 2 and 6 (BCL2 and BCL6) and multiple myeloma oncogene 1 (MUM1) expressions in pathology sections of patients with DLBCL to determine the response of these subgroups to the rituximab including chemotherapy regimens.Materials and Method: Patients were grouped into 2 regarding the chemotherapy regimens they were treated, as cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) or Rituximab-CHOP.The treatment response, follow-up periods and outcomes of patients were recorded.The immunohistochemical panel was stained in pathology sections for CD10, BCL6 and MUM1/IRF 4 biomarkers.The patients were subgrouped as GCB or ABC regarding the immunohistochemical panel.Results: Totally 81 patients, (39 male, 42 female) were included in the study.At the time of diagnosis, CD10 was positive in 31 patients (38.3%);BCL-6 in 53 patients (65.4%);MUM-1 was positive in 47 patients (58%) and BCL-2 was positive in 53 patients (65.4).With these results, 36 patients (44.4%) were in the GCB group and 45 patients (55.6%) were in the ABC group.No significant difference was found between the individual markers and subgroups in survival analyses. Conclusion:We did not determine any significant effect of CD10, BCL-6, MUM-1 or BCL-2 positivity or GCB and non-GCB groups in the survival of patients with DLBCL.

Celiac disease is an autoimmune, inflammatory disease that may affect many systems and organs. Herein we will report a young patient diagnosed with celiac disease after three times of spontaneous abortus. Clinicians should be aware that celiac disease may have some diverse clinical presentations which should be kept in mind during the differential diagnosis of patients with recurrent abortus.

Background and aim: Viral hepatitis is the most important cause of chronic hepatitis worldwide. Stigmatization is defined as a feeling of rejection and isolation of patients by society due to illness. There are no studies on chronic viral hepatitis in the literature in English, which has its own religious and socio-cultural structure. In our study, we aimed to investigate the presence of social stigmatism and psychosocial effects on patients with different stages of chronic viral hepatitis B and C. Methods: Forty-five patients with chronic hepatitis C and 114 patients with chronic hepatitis B were enrolled in the study. Berger's scale was used for stigmatization, composed of 40 four-point Likert items that have four subscales: personalized stigma, disclosure, negative self-image, and public attitude. Stigma score ranges between one and four. Stigma is accepted as present if the overall score is above two. Results: Overall the mean stigma scores were 1.97 +/- 0.58 and 2.14 +/- 0.57 for chronic hepatitis B and C, respectively. There was stigma in 47.4% of the patients with chronic hepatitis B, and 60% of the patients with chronic hepatitis C. Being male was the risk factor on overall stigma, disclosure and public attitude in chronic hepatitis C. Living in an urban setting was the risk factor on negative self-image in chronic hepatitis C and on personalized stigma and disclosure in chronic hepatitis B. Conclusions: To the best of our knowledge, this is the first study that provides qualitative information about chronic hepatitis-related stigma. Stigmatization is a major problem in Turkey and worldwide. We believe that increasing the knowledge of the patients and society by teaching about the transmission routes of the disease and focusing on vaccination studies will prevent stigmatization. (C) 2020 Elsevier Espana, S.L.U. All rights reserved.

Background and aim:The aim of this study is to evaluate whether the long-term (≥4 weeks) use of proton pump inhibitors (PPIs) is arisk factor for intubation requirement and mortality in patients hospitalized for COVID-19.Materials and methods:In this multicentric retrospective study, a total of 382 adult patients (≥18 years of age) with confirmed COVID-19 who were hospitalized for treatment were enrolled. The patients were divided into two groups according to the periods during which they used PPIs: the first group included patients who were not on PPI treatment, and the second group included those who have used PPIs for more than 4 weeks.Results:The study participants were grouped according to their PPI usage history over the last 6 months. In total, 291 patients did not use any type of PPI over the last 6 months, and 91 patients used PPIs for more than 4 weeks. Older age (HR: 1.047, 95% CI: 1.026–1.068), current smoking (HR: 2.590, 95% CI: 1.334–5.025), and PPI therapy for more than 4 weeks (HR: 1.83, 95% CI: 1.06–2.41) were found to be independent risk factors for mortality.Conclusion:The results obtained in this study show that using PPIs for more than 4 weeks is associated with negative outcomes for patients with COVID-19. Patients receiving PPI therapy should be evaluated more carefully if they are hospitalized for COVID-19 treatment.

Aim: In this study, we aimed to define the predictive role of liver function tests at admission to the hospital in outcomes of hospitalized patients with COVID-19. Material and Method: In this multicentric retrospective study, a total of 269 adult patients (≥18 years of age) with confirmed COVID-19 who were hospitalized for the treatment were enrolled. Demographic features, complete medical history, and laboratory findings of the study participants at admission were obtained from the medical records. Patients were grouped regarding their ICU requirements during their hospitalization periods. Results: Among all 269 participants, 106 were hospitalized in the intensive care unit (ICU) and 66 died. The patients hospitalized in ICU were older than patients hospitalized in wards (p=0.001) and expired patients were older than alive patients (p=0.001). Age, elevated serum D-dimer, creatinine, and gamma-glutamyl transferase (GGT) levels at admission were independent factors predicting ICU hospitalization and mortality in COVID-19 patients. Conclusion: In conclusion, in hospitalized patients with COVID-19, laboratory data on admission, including serum, creatinine, GGT and d-dimer levels have an important predictive role for the ICU requirement and mortality. Since these tests are readily available in all hospitals and inexpensive, some predictive formulas may be calculated with these parameters at admission, to define the patients requiring intensive care.

Celiac disease (CD), intolerance to gluten, is characterized by the autoimmune inflammation of the small intestine in genetically susceptible individuals. Herein, we will report a case of a patient diagnosed with CD during investigations performed for recurrent vertigo attacks. Clinicians should be aware that CD may also present with vertigo, and espe- cially in patients with recurrent and prolonged vertigo attacks, CD should also be ruled out.

Aim: Helicobacter pylori (H. pylori) eradication is still an important issue in countries with high antibiotic resistance. This study aimed to compare the efficacy and safety of two bismuth-containing treatment modalities in H. pyloritreatment in Turkey. Material and methods: subjects with H. pylori infection who were treated with either bismuth-containing quadruple therapy (pantoprazole 40 mg bid, tetracycline 500 mg qid, metronidazole 500 mg tid, bismuth subcitrate 262 mg qid daily) (BQT group) or modified quadruple therapy (pantoprazole 40 mg bid, amoxicillin 1g bid, metronidazole 500 mg tid, bismuth subcitrate 262 mg qid daily) (MBQT group) for 14 days were compared, retrospectively. The eradication success rate, adverse events related to the medications and compliance were investigated. Results: a total of 128 patients in the BQT group and 102 patients in the MBQT group completed the treatment. The overall rate of adverse events was significantly higher in the BQT group compared with the MBQT group (39.4 % vs 18.6; p: 0.001). Among the adverse events, nausea-vomiting and abdominal discomfort was significantly more frequent in the BQT group than in the MBQT group (p: 0.001). The adverse events were mild-moderate in both groups and life threatening adverse events were not present in any of the patients. Conclusion: although both regimens were highly effective and safe in H. pylori eradication, both intention-to-treat (ITT) and per-protocol (PP) eradication rates were higher and adverse events were lower in the modified quadruple therapy group. Modified quadruple therapy should be kept in mind for the first-line treatment of H. pylori in regions with high clarithromycin and metronidazole resistance.

AIMS: This study aimed to investigate the levels of adiponectin, leptin, resistin and RBP-4 in the serum of NAFLD with non-obese and non-diabetic cases. METHODS: A total of 81 people aged between 25-72 were included in the study. 56 obese and non-diabetic NAFLD cases with fatty liver detected by ultrasonography (US) were compared with a control group of 25. Liver function tests and lipid profile analysis of all cases were performed, insulin resistance (HOMA –IR) was evaluated. Liver biopsy was performed in 18 patients. Biopsy patients were staged according to their groups. Serum values of adiponectin, leptin, resistin and RBP-4 were measured in all cases by ELISA method. RESULTS: Waist circumference, body mass index (BMI), alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma glutamyl transferase (GGT) and HOMA-IR values were higher in the NAFLD group and were considered statistically significant. Lipid profiles and adipokine levels were similar in both groups. There was no statistically significant difference between the groups. The mean values of adiponectin, resistin, leptin and RBP-4 were compared according to the biopsy stage, and the mean of leptin and resistin was not associated with the biopsy stage. A positive correlation was found between HOMA-IR and biopsy stage, and a negative correlation between averages of adiponectin and RBP-4. CONCLUSION: Unfortunately, not being overweight or fit doesn’t always lead to better health. Obese and non-diabetic individuals may also be at risk of fatty liver and steatohepatitis. Adipokines, which have roles in the pathogenesis of NAFLD, are increasingly important in detecting steohepatitis at an early stage. However, in our study, we did not find any significant differences between the groups in terms of adipokine profiles. For this purpose, studies with larger biopsy-based cases are needed.

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus-2 is now a pandemic worldwide and clinicians have many questions about the safety of interventional procedures, even in an emergency [1]. Here, we will present an endoscopic retrograde cholangiopancreatography (ERCP) case safely performed in emergency situations in a case known to be COVID-19 positive. An 81-year-old male patient was admitted to the emergency department with right upper quadrant pain, jaundice and fever of the last 2 days. In his evaluation, obstructive jaundice due to cholelithiasis and cholangitis was determined. ERCP was performed by duodenoscope (Olympus, TJF-150) with needle-knife sphincterotomy (Microtech) and precut. The procedure was completed without acute complications, after ERCP his bilirubin levels and complaints improved. On the fourth day of ERCP, he had an acute coronary syndrome, coronary angiography was performed and a coronary stent was inserted. Due to stent insertion, 600 mg clopidogrel, 300 mg acetylsalicylic acid, and 6000 IU enoxaparin were given to the patient. On the fifth day of ERCP, he had melena, with a 2 g/dl decrease in hemoglobin levels. Because he was having a 38.5°C of fever and cough, COVID-19 rapid blood test (OVIOSR) determining the serology of Corona virus-19 was performed which was positive. We performed ERCP again, with maximum protection using appropriate equipment (Fig. 1). On the sphincterotomy line, there were blood cloths and they were cleaned with serum physiologic. Coagulation was achieved with the tapered tip sphincterotome (Microtech), choledoch was selectively cannulated, and 10F 10 cm plastic stent (10F, 10 cm; Microtech) was inserted. Two hemoclips (Sureclip, MicroTech) were inserted, and at the end of the procedure, there was no bleeding. After ERCP, because COVID-19 rapid blood test was positive, the real-time PCR test for nucleic acid determination in respiratory samples for COVID-19 was sent to the laboratory which was positive and thorax computerized tomography was performed which revealed bilateral ground-glass opacities in basal parts of the lungs. Instantly, COVID-19 treatment including hydroxychloroquine (2 × 400 mg loading and 2 × 200 mg maintenance) and azitromycine (1 × 500 mg loading and 1 × 250 mg maintenance) started [2]. On follow-ups, his hemoglobin levels did not decrease and his vital signs were stable. After 7 days of treatment for Coronavirus-19 in ICU, his real-time PCR test for nucleic acid determination in respiratory samples (NCOV-19) was negative and he was discharged. Due to the contact history, rapid test results and PCR in healthcare workers in this team were negative, and no COVID symptom was observed during the 14-day follow-up. In conclusion, if adequate precautions are taken, emergency ERCP procedures can be performed safely without any harm to the healthcare workers and patients.Fig. 1.: Maximum protection before the procedure.Acknowledgements Conflicts of interest There are no conflicts of interest.

Coronavirus disease is a highly contagious disease caused by systemic acute respiratory syndrome coronavirus 2 with high mortality rates. We aimed to evaluate the relationship between serum d-dimer levels and tomography findings at the time of admission in patients diagnosed with coronavirus disease 2019 (COVID-19). This study included 94 patients, 48 women (51%) and 46 men (49%), diagnosed by PCR method. Patients without any suspicious findings on thorax tomography and having oxygen saturation above 90% at the time of presentation were included as the first group. Patients with suspicious tomography findings but having oxygen saturation above 90% were designed as the second group, and patients with both suspicious tomography findings for COVID-19 and low oxygen saturation levels (<90%) at the time of admission were taken as the third group. Patients with oxygen desaturation were significantly older than the patients with normal oxygen saturations (P = 0.001). Patients with thorax tomography findings were having significantly higher d-dimer levels (P = 0.001). Patients with oxygen desaturation were having significantly higher d-dimer levels than the patients with normal oxygen saturations (P = 0.001). There was a significant negative correlation between oxygen saturation and d-dimer levels in all patients with and without tomography findings (r = −0.301, P = 0.016). Similarly, there was a significant positive correlation between the oxygen saturation and the lymphocyte count (r = 0.300, P < 0.017). Thorax tomography and d-dimer levels significantly correlate in patients with suspected COVID-19 admission. It should be kept in mind that patients with low oxygen saturation and high d-dimer levels may have serious lung involvement.