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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 Clinical Characteristics of Inflammatory Bowel Disease in Turkey A Multicenter Epidemiologic Survey(Lippincott Williams & Wilkins, 2009) Tozun, Nurdan; Atug, Ozlen; Imeryuz, Nese; Hamzaoglu, Hulya O.; Tiftikci, Arzu; Parlak, Erkan; Dagli, UlkuAim: To investigate the epidemiologic and clinical characteristics of inflammatory bowel disease (IBD) patients in a large multicenter, countrywide, hospital-based study in Turkey. Materials and Methods: Twelve centers uniformly distributed throughout Turkey reported through a questionnaire the new IBD cases between 2001 and 2003. The incidence of ulcerative colitis (UC) and Crohn's disease (CD) has been reported per 100,000 people. Epidemiologic features and clinical characteristics of both diseases were analyzed. Results: During the study period, 661 patients of UC and 216 patients of CD were identified. The incidence in the referral population was 4.4 100,000 and 2.2/100,000 for UC and CD, respectively. The age of the patients showed the characteristic biphasic distribution with 2 peaks between 20 and 30 and 50 and 70 years. A male predominance was observed in both diseases. A history of smoking was detected in 15.5% of UC patients and 49.3% of patients with CD. Family history was positive in 4.4% in UC and 8.3% in CD patients. Concomitant amebiasis was observed in 17.3% of patients with UC and 13.5 of patients with CD. A history of appendectomy was reported in 15% of patients with CD and only 3% of patients with UC. Both extraintestinal and local complications were more frequent in CD patients, whereas arthritis was most common in both diseases. Conclusions: IBDs are frequently encountered in Turkey. IBD incidence is lower than North and West Europe but close to Middle East in our country. The majority of IBD cases are diagnosed in young people (20 to 40 y) with predominance in males. The rate of both intestinal and extraintestinal complications in our population was low when compared with the data reported in the literature. IBD and especially UC, can coexist with amebiasis or become manifest with amebic infestation. The presence of concomitant ameba may create confusion and cause dilemmas in the diagnosis and treatment of UC.Öğe Multidrug resistance of isolated microorganisms in occluded bile duct stents(Turkish Soc Gastroenterology, 2007) Demirbag, Ali E.; Karademir, Ash; Parlak, Erkan; Sen, Sueha; Karahan, Mehmet; Kayaalp, Cuenet; Sahin, BurhanBackground/aim: Biliary stents have been used for benign or malignant biliary strictures, preoperative biliary drainage, resolution of biliary or pancreatic leaks, and dissolution treatment of non-extractable bile duct stones since 1979, and should be replaced at 3-6 month intervals. The aim of this cross-sectional pioneer study was to identify the in microorganisms in occluded bile duct stents and to determine incidence and diagnosis of multidrug resistance of the isolated microorganisms in stents and in blood cultures. Methods: Fifty-one patients (14F, 37M, mean age: 58.2 +/- 11.6 yr) with cholangitis due to occluded stents were studied consecutively and prospectively after stent replacement was done. Independent variables were age, gender, underlying disease, duration of disease, size, length and period of stents, and blood biochemistry. Dependent variables were microorganisms isolated from the stent content and blood of the patients and the results of antibiogram tests. Results: Primary disease was malignant in 25 (49.0%), stent size was 7F in 30 (58.8%), and stent length was 11 cm in 11 (21.6%) and 15 cm in 12 (23.5% of the patients. The mean period after the 1(st) stent application was 207.0 +/- 111.3 days and the last stent duration was 111.0 +/- 64.0 days. Isolated microorganisms from stents and blood, respectively, were Escherichia coli (E. coli) (43.4%, 20.8%), Klebsiella spp.. (17.1%, 17.0%), Pseudomonas aeruginosa (P. aeruginosa) (13.2%, 18.9%) and Enterococcus spp. (10.5%, 17.0%). Isolated microorganisms showed multidrug resistance at high percentages (81.6% for stent, 81.1% for blood). ALT, AST, ALP, and direct bilirubin levels showed statistically significant differences between the benign and malignant groups. Conclusion: All bile duct stents are contaminated by microorganisms, of which a high majority has multidrug resistance, and they frequently cause biliary sepsis. Biliary sepsis call be prevented by changing the stents periodically and by using proper antibiotic prophylaxis.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]
