Video 1Pushing the boundaries: circumferential endoscopic submucosal dissection in distal duodenum (7.58 seconds).

Endoscopic submucosal dissection (ESD) is a minimally invasive method for treatment of early gastrointestinal (GI) tumors at any site; however, duodenal ESD is technically challenging because of the anatomic features and high risk of complications, including bleeding and perforation [1]. Here, we report a case of en bloc removal of a distal duodenal polyp of 10 cm in length using ESD, followed by endoscopic closure.

Gastric cancer is one of the leading causes of cancer-related mortality worldwide. Endoscopic submucosal dissection (ESD), when indicated based on tumor size, stage, and histological characteristics, is a highly successful curative, minimally invasive, non-surgical endoscopic treatment option. However, the risk of adverse events is higher compared to traditional methods. Here, we present a case of ESD in an early-stage gastric carcinoma and endoscopic closure using a new hand-suturing system.

Intussusception is a rare condition in adulthood and there exists an underlying pathological lesion in most cases. Colorectal lipoma is the second most common benign tumour of the colon. Although commonly asymptomatic, it can present with intussusception. We, herein, report a case of a 79-year female with a yellowish mass with irregular surface prolapsing through the anal canal. In computed tomography (CT), sigmoido-rectal intussusception plus a lesion with the regular borders originating from the distal sigmoid colon protruding through the anal canal were observed. We resected the lesion with a transanal approach, following which the intussusception resolved spontaneously. Histopathological examination had reported lipoma. Transanal resection is a safe and efficient method of the treatment in distal colorectal lipomas presenting with intussusception. Key Words: Colorectal lipoma, Sigmoido-rectal intussusception, Transanal resection.

Impaction of a big gallstone in the duodenum, after migration through a bilioduodenal fistula, causing gastric outlet obstruction (GOO) is known as Bouveret's syndrome. In computed tomography (CT), pneumobilia and calcified bile stone in duodenal bulb leading to GOO is typical for diagnosis. Most of the cases presented to date are diagnosed with CT and their imaging features were discussed. On the other hand, there are very few published researches about the magnetic resonance imaging (MRI) findings of Bouveret's syndrome. In this paper, a case of Bouveret's syndrome diagnosed with MRI is discussed in the view of the present literature. KEY WORDS: Bouveret's syndrome, Cholecystoduodenal fistula, Gastric outlet obstruction, Gallstone ileus, MRI.

Abstract Background Intestinal ultrasound (IUS) is a valid cross-sectional imaging technique for the evaluation of Crohn’s disease (CD). With advancements in technology, portable ultrasound systems are becoming widely available, and the inevitable change to their use by non-radiologist clinicians would be a valuable contribution to improving patient care. This study aimed to investigate the diagnostic yield of IUS examination performed by a gastroenterologist with a portable system as an adjunct imaging modality in the routine care of CD patients. Methods A total of 117 CD patients were assessed by IUS imaging. Pre- and post-IUS clinical-management decisions were recorded. The primary outcome was to evaluate the change in the patients’ clinical-management decision following the IUS examination. The diagnostic accuracy was compared against the reference decision reached via a multidisiplinary meeting after the evaluation of all patient-related data. The endoscopic disease activity was determined using the simple endoscopic score for Crohn's disease (SES-CD). Results The initial clinical-management decision was changed in 47 patients (40.2%) after the IUS examination (P = 0.001). The accuracy of patient-management decisions improved from 63.2% to 90.6% in comparison to reference decisions (P < 0.001). After IUS examination, a further 13 cases (11.1%) were identified for urgent surgical/interventional procedures. The accuracy of colonoscopic (SES-CD ≥3) assessment was shown to be comparable to that of IUS (94% vs 91%). The sensitivity for disease presence was 95% with colonoscopy and 94% with the IUS assessment. Conclusion IUS examination with the use of a portable ultrasonography system significantly improves clinical-management decisions. With further supporting data, this practice would possibly become a requirement for CD management.

Infl uence of Uricacid Levels on PegylatedInterferon Plus Ribavirin Therapy in Patients with Chronic Hepatitis C Serhat Özer1, Zeynep Altın2, Sinem Namdaroglu3*, Betül Koyuncu4, Fatih Aslan5 and Belkıs Ünsal6 1Artvin State Hospital, Department of Gastroenterology, Artvin, Turkey 2İzmir Tepecik Training and Research Hospital, Department of Internal Medicine, İzmir, Turkey 3İzmir Bozyaka Training and Research Hospital, Department of Hematology, Stem Cell Transplantation Unit, İzmir, Turkey 4Uşak Training and Research Hospital, Department Of Internal Medicine ,Uşak,Turkey 5University of Koç Hospital, Department of Gastroenterology, İstanbul Turkey 6İzmir Ataturk Training and Research Hospital, Department of Gastroenterology, İzmir, Turkey

Purpose: Monitoring Crohn’s disease (CD) activity has a crucial importance, especially for evaluating treatment efficacy. Magnetic resonance enterography (MRE) and diffusion-weighted imaging (DWI) or their combination may represent potential non-invasive tools for this purpose. This study aimed to examine DWI and MRE for their potential to differentiate between different grades of ileocolonic CD activity. Materials and Methods: This retrospective study included 54 adult patients with a diagnosis of CD who underwent ileocolonoscopy and MRE including the DWI sequence. The severity of CD inflammation was categorized by Simple Endoscopic Score for Crohn’s Disease (SES-CD) as inactive, mild, moderate and severe. In addition, following conventional MRE and DWI parameters were examined: bowel wall thickness, mural T2 hyperintensity, contrast enhancement, DWI signal intensity, and apparent diffusion coefficient (ADC) values. Results: In patients with moderate to severe disease based on SES-CD, T2 hyperintensity score [1.68 ± 0.77 (1–3) vs. 2.19 ± 0.69 (1–3); p = 0.013] and mean DWI score [2.42 ± 0.58 (1–3) vs. 2.04 ± 0.69 (1–3); p = 0.037 ] were higher and mean ADC values [1.5 ± 0.4 (0.9–2.5) vs. 1.2 ± 0.3 (0.6–1.8)] were lower compared to patients with inactive to mild CD. ADC had a moderate diagnostic accuracy in predicting moderate to severe disease (AUC = 0.729, 95% CI = 0.591–0.841, p = 0.001), with a cut-off value of ≤1.47 × 10–3 mm2/sec yielded 88.5% (23/26) sensitivity, 57.1% (16/28) specificity. Conclusion: DWI, ADC and T2 signal appear to differentiate moderate to severe CD from inactive to mildly active CD, based on SES-CD evaluation and may be useful in monitoring disease activity, particularly when evaluating treatment response.

Abstract Cite this article as: Altın Z, Atabay Y, Özer S, et al. Primary intestinal lymphangiectasia and a review of the current literature. Turk J Gastroenterol 2018; 29: 714-6.

Kronik hepatit C hastalarında pegile-interferon ve ribavirin tedavisinin trigliserit indeks ve metabolik faktörler üzerine etkisiEffect of pegylated interferon and ribavirin on metabolic factors and triglyceride index in chronic hepatitis C patients ÖZ Amaç: Kronik hepatit C olgularının tedavisinde kullanılmakta olan pegile interferon alfa (PEG-IFN-a) 2a/2b ve ribavirin tedavisinin trigliserit indeks ve metabolik faktörler üzerine etkisinin incelenmesi amaçlandı.

Abstract Background In this study it was aimed to evaluate the effect of pegylated interferon alfa-2a/2b and ribavirin, which are used for treatment of chronic hepatitis C (CHC), on insulin resistance and metabolic factors. Materials and methods A total of 104 CHC patients aged 20–75 years with available serum insulin data at 0 and 48 weeks, and hepatitis C virus (HCV)-RNA data at 0, 12, 24, 48 and 72 weeks were included in the study. All clinical para-meters were assessed according to the therapy response. Results Among 104 patients, sustained virologic response (SVR) was achieved in 55 cases. A statistically significant difference was noted between SVR and non-SVR groups regarding γ-glutamyltranspeptidase (GGT), insulin level plus homeostasis model assessment (HOMA) score and insulin resistance at week 48, log HCV-RNA and stage of fibrosis. Conclusion Insulin resistance is accepted to have a negative effect on SVR. Insulin resistance may improve once SVR is achieved. Presence of IR at week 48 has been found associated with SVR. In this context, it can be advocated that insulin resistance at week 48 may be a predictive factor for prediction of SVR at week 72.

Inflamatuvar barsak hastaliklari genetik olarak yatkin kisilerde, nedeni ve mekanizmasi tam olarak bilinmeyen, kronik seyirli, remisyon ve alevlenme donemleriyle karakterize inflamatuvar bir hastalik grubudur. Ulseratif kolit ve Crohn hastaligi olmak uzere iki onemli hastaligi icermektedir. Bu hastalarda; hastalik aktivitesinin degerlendirilmesi, tedavinin sekillendirilmesi icin bircok klinik aktivite gostergeci ve non invaziv belirtec kullanilmis, fakat hicbiri inflamatuvar aktivitenin saptanmasinda histopatolojik ve endoskopik incelemeler kadar kesin bulgu vermemistir. Inflamatuvar barsak hastaliklarinda aktivitenin belirlenmesi amaci ile ulseratif kolit icin yaygin kullanim bulan klinik indeksler; Truelove-Witts ve Rachmilewitz klinik aktivite indeksidir. Crohn hastaliginda ise tum dunyada kabul edilen klinik indeks Crohn hastaligi aktivite indeksidir. Endoskopik indeksler icerisinde; ulseratif kolit icin endoskopik Mayo Skoru ve Crohn hastaligi icin basit endoskopik skor yaygin kullanim alani bulmus indekslerdir. Biz bu calismada yaygin kullanilan bu aktive indeksleriyle gunluk pratigimizde sik kullandigimiz laboratuvar parametrelerini karsi-lastirdik. Bu amacla inflamatuvar barsak hastaliklari klinik ve endoskopik takibinde bu parametrelerin degerini arastirdik.