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Öğe Acute pancreatitis in Turkey: Results of a nationwide multicenter study(Elsevier, 2024) Koksal, Aydin Seref; Tozlu, Mukaddes; Sezgin, Orhan; Oguz, Dilek; Kalkan, Ismail Hakk; Altntas, Engin; Yaras, SerkanBackground: Acute pancreatitis (AP) is the most common gastrointestinal disease requiring hospitalization, with significant mortality and morbidity. We aimed to evaluate the clinical characteristics of AP and physicians ' compliance with international guidelines during its management. Methods: All patients with AP who were hospitalized at 17 tertiary centers in Turkey between April and October 2022 were evaluated in a prospective cohort study. Patients with insufficient data, COVID-19 and those aged below 18 years were excluded. The definitions were based on the 2012 revised Atlanta criteria. Results: The study included 2144 patients (median age:58, 52 % female). The most common etiologies were biliary (n = 1438, 67.1 %), idiopathic (n = 259, 12 %), hypertriglyceridemia (n = 128, 6 %) and alcohol (n = 90, 4.2 %). Disease severity was mild in 1567 (73.1 %), moderate in 521 (24.3 %), and severe in 58 (2.6 %) patients. Morphology was necrotizing in 4.7 % of the patients. The overall mortality rate was 1.6 %. PASS and BISAP had the highest accuracy in predicting severe pancreatitis on admission (AUC:0.85 and 0.81, respectively). CT was performed in 61 % of the patients, with the majority (90 %) being within 72 h after admission. Prophylactic NSAIDs were not administered in 44 % of the patients with post-ERCP pancreatitis (n = 86). Antibiotics were administered to 53.7 % of the patients, and 38 % of those received them prophylactically. Conclusions: This prospective study provides an extensive report on clinical characteristics, management and outcomes of AP in real -world practice. Mortality remains high in severe cases and physicians ' adherence to guidelines during management of the disease needs improvement in some aspects. (c) 2023 IAP and EPC. Published by Elsevier B.V. All rights reserved.Öğe The Classification of Biliary Strictures in Patients With Right-Lobe Liver Transplant Recipients and Its Relation to Traversing the Stricture With a Guidewire(Lippincott Williams & Wilkins, 2022) Parlak, Erkan; Simsek, Cem; Koksal, Aydin Seref; Eminler, Ahmet Tarik; Unal, Emre; Ciftci, Turkmen Turan; Akinci, DevrimBackground. Traversing the stricture with a guidewire is a prerequisite for the endoscopic treatment of biliary strictures after living donor liver transplantation. We aimed to evaluate the effect of variations in the biliary anastomosis and strictures on the success of endoscopic treatment and suggest a cholangiographic classification. Methods. The 125 strictures among the 104 patients with right-lobe living donor liver transplantation were reviewed. The strictures were classified by the anastomosis pattern according to the number (1, 2, or >2), location (common bile, hepatic, or cystic duct), the angle between the proximal and distal sites of the anastomosis, and the contrast enhancement pattern. The relationship between the success rate of traversing the anastomosis and the classification was evaluated. Results. Of the 125 biliary strictures, 86 (68.8%) could be passed via endoscopically. Thirty-three strictures were managed either percutaneously (n = 13) or by magnetic compression anastomosis (n = 20). Compared with the round, the triangular (odds ratio [OR], 6.5), the intermediate form (OR, 17.7), and the end-to-side anastomosis (OR, 5.1) were associated with an increased chance of traversing. The contrast enhancement pattern of the strictures and the bile ducts was also related to the successful rate of the endoscopic treatment (P < 0.001). The success rate was higher in the patients with the angle between the proximal and distal sites of the anastomosis approximated was small (0 degrees-30 degrees = 74%, 30 degrees-60 degrees = 69%, 60 degrees-90 degrees = 63%, >90 degrees = 41%). Conclusions. The type of biliary anastomoses and stricture affect the success rate of endoscopic treatment. These data may play role in making decision about the type of anastomosis during the surgery.Öğe Recanalization of Complete Anastomotic Biliary Obstruction After Living Donor Related Liver Transplantation With a Novel Through-the-Scope Magnet(Wiley-Blackwell, 2015) Parlak, Erkan; Kucukay, Fahrettin; Koksal, Aydin Seref; Eminler, Ahmet Tarik; Uslan, Mustafa Ihsan; Yilmaz, Sezai[Abstract Not Available]Öğe Surgical removal of a self-expanding metallic stent from jejunum in a patient with Roux-en-Y esophagojejunostomy(2020) Subasi, Ozkan; Karaman, Kerem; Aziret, Mehmet; Eminler, Ahmet Tarik; Koksal, Aydin Seref; Ercan, MetinSelf-expanding metallic stent is useful in esophageal perforations, trachea-esophageal fistulas, benign esophageal strictures, and unresectable esophageal cancers. However, self-expanding metallic stent itself has the risk of mucosal necrosis with subsequent perforation and /or trachea-esophageal fistula development –particularly- in long-term usage. Further, gastro-esophageal reflux, stent occlusion, stent migration and intestinal obstruction are other common complications. We report surgical management of a case whose self-expanding metallic stent migrated from the esophagojejunostomy anastomosis towards to the jejunal Y-limp.
