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    Bismuth-Based quintuple therapy: a step beyond quadruple regimens in H. Pylori treatment and the impact of patient compliance
    (Bmc, 2025) Dertli, R.; Asil, M.; Atayan, Y.; Cosar, U.; Yolacan, R.; Biyik, M.; Keskin, M.
    BackgroundHelicobacter pylori (H. pylori) infection is one of the most common infections affecting humanity. As the level of development and socio-economic status of countries decreases, the prevalence of H. pylori infection increases. Although numerous H. pylori eradication regimens have been tested in recent years, the desired level of eradication success has not been achieved. In this study, we aimed to evaluate the effectiveness of alternative treatment protocols.MethodsPatients who presented to our clinic between 2023 and 2024 were included in the study. The patient groups were treated with Rabeprazole (R), Metronidazole (M), Amoxicillin (A), and Bismuth (B) (RMAB), or with Esomeprazole (E), Metronidazole (M), Tetracycline (T), and Bismuth (B) (EMTB) regimens. Patients who were resistant to both RMAB and EMTB treatment protocols received quintuple therapy with RTAMB and ETAMB. All patients were thoroughly informed about their treatment process, management of side effects, and adherence to the therapy.ResultsA total of 611 patients who received H. pylori treatment were included in the study. Of the participants, 60.7% were women, and the mean age was 53.7 +/- 15.2 years. For post-treatment response evaluation, 73.5% (n = 449) of the patients returned to our clinic. The overall H. pylori eradication success rate for the entire patient group was 49.6%. The success rates for patients receiving RMAB and EMTB treatments were 48.2% and 51.3%, respectively. Among the group of patients who were under controlled supervision and had optimal treatment compliance (n = 449), the success rates for the RMAB and EMTB treatments were found to be 66.9% and 68.5%, respectively. A total of 105 patients who were resistant to the RMAB and EMTB treatments were given RTAMB and ETAMB therapy. Of these patients, 96.2% complied with the treatment and underwent a response evaluation. The eradication success rates for patients treated with the RTAMB and ETAMB protocols were 65.6% and 67.6%, respectively.ConclusionIn this study, we demonstrated that bismuth-based quintuple therapy can be used as an alternative to bismuth-based quadruple therapies and other high-risk treatments. However, we also highlighted the critical importance of treatment adherence.
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    Endoscopic treatment of biliary complications after living donor liver transplantation in a high volume transplant center in Turkey; a single-center experience
    (Univ Catholique Louvain-Ucl, 2018) Harputluoglu, M.; Aladag, M.; Demirel, U.; Bilgic, Y.; Dertli, R.; Erdogan, M. A.; Karincaoglu, M.
    Background and aim : Biliary complications are an important cause of mortality and morbidity after living donor liver transplantation (LDLT). We present our endoscopic treatment results after LDLT as a single center with high volume. Methods : Patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) alter LDLT between 2005 and 2015 were included. Clinical data included patient demographics. ERCP indications (stricture or leak), and treatment outcomes, including need for percutaneous and surgical interventions. Results : ERCP was performed in 446 (39.2%) patients with duct-to-duct anastomosis of 1136 LDLT patients. The most common biliary complication was stricture +/- stone (70.6%, 315/446). Stricture and leak occurred in 60 (13.4%) patients. Only binary leak was found in 40 (8.9%) patients. Our endoscopic treatment success rate in patients with biliary stricture after LDLT was 65.1%. Overall endoscopic success rates in our patients were 55.0% in patients with both leak and stricture, and only leak. In all, our percutaneous transhepatic biliary interventions (P'f BI) and ERCP success rate was 90.6% in patients with biliary complications after LDLT. Conclusions : Endoscopic treatments are highly effective for biliary complications after LDLT. Effective use of percutaneous interventions in collaboration with endoscopic treatments significantly reduces the need for surgical treatment.