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    Benign karaciğer hastalıklarında endoskopik ultrason eşliğinde ince iğne aspirasyonu: Tek merkez deneyimi
    (2023) Tokmak, Salih; Kantarcıoğlu Coşkun, Sinem; Torun, Serkan
    Giriş ve Amaç: Endoskopik ultrason kılavuzluğunda karaciğer biyopsisi (EUS-LB) ile ilgili ilk deneyimimizin etkinlik ve güvenlik sonuçlarını bildirmek. Gereç ve Yöntem: Üçüncü basamak merkezimizde, ileriye dönük olarak tutulan bir veri tabanının geriye dönük analizi yapıldı. Haziran 2022 ile Aralık 2022 tarihleri arasında, benign parankimal hastalıklar nedeniyle, tek geçişli, üç hamleli ve ıslak aspirasyon tekniği ve 19 gauge ince iğne kullanılarak EUS-LB uygulanan ardışık hastalar çalışmaya dahil edildi. Hastaların demografik bilgileri, işlem ile ilgili parametreler ve örneklerin kalitesi değerlendirildi. Sonuçlar: Teknik başarı %100 idi. Toplam 16 hastadan dördüne yetersiz örnekleme nedeniyle ikinci kez işlem uygulandı. Medyan toplam numune uzunluğu, medyan parça sayısı ve parçalanmış numunelerdeki en uzun parçanın medyan uzunluğu ve tam portal yolların medyan sayısı sırayla 11 mm (aralık, 0,2-2,5), 9,6 (aralık, 0-20), 0,2mm (aralık 0,2-1,5) ve 3,5 (aralık 0-19) olarak bulundu. İşlem sonrası hiçbir hastada yan etki görülmedi. Sonuç: EUS-LB, diğer karaciğer biyopsi prosedürlerine bir alternatif olabilir, ancak ideal iğne tipini ve tekniğini belirlemek için daha fazla çalışmaya ihtiyaç vardır.
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    The Change in the Susceptible Populations with the Shift in Hepatitis A Epidemiology
    (Duzce University Medical School, 2022) Şirin, A.; Tokmak, Salih; Akan, K.; Ulaşoğlu, H.C.; Yılmaz, Enç, F.
    Aim: The incidence of hepatitis A (HepA) has decreased due to vaccination and improved hygiene conditions. However, the age of onset of the disease has shifted from childhood to adulthood. Children with HepA are mildly symptomatic, whereas the course of the disease in adults may be severe. The aim of this study was to examine the change in HepA seroprevalence and identify the population susceptible to HepA. Material and Methods: A total of 10132 patients who were tested anti-Hepatitis A virus immunoglobulin G (anti-HAV IgG) between 2016 and 2019 were reviewed retrospectively, and included in this study. The patients were divided into five groups according to their age, and seropositivity rates were compared between age groups. The relevant data of the healthcare professionals were also evaluated separately. Results: The overall seropositivity rate was 60.1% (n=6088). The seropositivity rate was found 29.0% (n=944) in the 18 to 24 years range, 49.7% (n=837) in the 25 to 29 years range, 60.6% (n=689) in the 30 to 34 years range, 76.6% (n=784) in the 35 to 39 years range, and 93.3% (n=2834) in the ?40 years groups. The seropositivity rate was found 36.1% (n=1781) and 82.9% (n=4307) in patients <30 and ?30 years groups, respectively (p<0.001). Conclusion: In recent decades, there has been a significant change in HepA seroprevalence. This change has resulted in the emergence of a young adult population susceptible to possible HepA outbreaks. Thus, seronegative young adults may be considered at risk for HepA and routine vaccination may be considered. © 2022, Duzce University Medical School. All rights reserved.
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    Efficacy and safety of endoscopic retrograde cholangiopancreatography in the very elderly by using a combination of intravenous midazolam, ketamine and pethidine
    (Wiley, 2021) Tokmak, Salih; Cetin, Mehmet F.; Torun, Serkan
    Aim The number of therapeutic endoscopic procedures in elderly individuals keeps increasing and this population has a high risk of adverse events related to sedation and general anesthesia. However, there is a paucity on data about the efficacy and safety of endoscopic retrograde cholangiopancreatography (ERCP) in this population. Methods In total, 417 consecutive ERCP procedures were performed in 362 patients between September 2018 and January 2020. Of these, 59 patients (74 sessions) were aged >= 80 years (Group A) and 173 patients (193 procedures) were aged <= 65 years (Group B). We analyzed the prospectively collected data of patient- and procedure-related variables. Results The procedure time was significantly longer in Group A (P < 0.05). The prevalence of comorbidities, use of anticoagulants and American Society of Anesthesiologists (ASA) physical status classification levels were significantly higher in Group A (P < 0.05). The incidence of periampullary diverticula, malignancy, rate of difficult cannulation, mean number of stones, use of biliary stents and stent dysfunction was also significantly higher in Group A (P < 0.05). The medication doses used were significantly higher and emergence symptoms were significantly more frequent in Group B (P < 0.05). The rates of bleeding, pancreatitis, perforation, cholangitis, hypoxia, hypotension and the length of hospital stay did not significantly differ between the two groups. The overall success rate of the procedure was comparable in the two groups (P = 0.874). Conclusions ERCP can be safely performed in elderly patients using a combination of midazolam and ketamine without propofol. The incidence of complications is comparable with that observed in younger patients. Geriatr Gerontol Int center dot center dot; center dot center dot: center dot center dot-center dot center dot Geriatr Gerontol Int 2021; center dot center dot: center dot center dot-center dot center dot.
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    Efficacy of Exclusive Enteral Nutrition and Weekly Adalimumab Combination in Crohn's Patients With Fibroinflammatory Stenosis
    (Lippincott Williams & Wilkins, 2021) Tokmak, Salih
    [Bastract Not Available]
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    ERCP'nin tarihçesi
    (2021) Tokmak, Salih; Torun, Serkan
    [No Abstract Available]
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    Feasibility and safety of partial ampullary endoscopic mucosal resection: a novel technique for difficult biliary cannulation (with video)
    (Springer, 2022) Tokmak, Salih; Çetin, Mehmet Fuat; Torun, Serkan
    Background Biliary cannulation can be challenging even for expert endoscopists, and rescue techniques are limited. Our objective was to determine the feasibility and safety of partial ampullary endoscopic mucosal resection (PA-EMR), a novel technique for biliary cannulation. Methods Monocentric, retrospective analysis of a prospectively maintained database in a tertiary referral university hospital. Fourteen patients who required endoscopic retrograde cholangiopancreatography (ERCP) and underwent PA-EMR between January 1, 2020 and January 31, 2021 were included. For biliary cannulation of prominent papillae, PA-EMR was performed using a standard polypectomy snare, alone or in combination with needle-knife sphincterotomy. In patients with non-prominent papilla, the papillary mucosa was elevated with the aid of methylene blue injection before resection and combined with needle-knife fistulotomy when needed. The rate of technical success and adverse events was assessed. Results The bile duct cannulation success was 99% in the first attempt and 100% overall with the PA-EMR technique. Only one patient experienced mild bleeding, which spontaneously stopped. Conclusion PA-EMR is an effective technique that may be considered as a rescue technique for difficult biliary cannulation in expert hands. Future studies including larger cohorts and comparisons with other techniques are warranted to further confirm the feasibility and safety of this novel technique.
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    Hepatocellular Carcinoma with Increased AFP Levels and Extrahepatic Manifestation after Liver Transplantation: A Case of Late-Onset Recurrence
    (Düzce Üniversitesi, 2019) Tokmak, Salih
    Liver transplantation is the best treatment modality in patients with hepatocellular carcinoma. The major concern after liver transplantation for hepatocellular carcinoma treatment is recurrence, because it’s the most important factor for the long term survival. There are two forms of recurrence; early-onset (within 2 years of liver transplantation) and late-onset (after 2 years of liver transplantation). A lot of factors have been reported in the literature to foresee recurrence after liver transplantation and one of them is alpha-fetoprotein. Many studies have shown that high levels of pre-transplant alpha-fetoprotein is related to early-onset recurrence and worse outcomes in the long term. In this case report, we report a case of late-onset recurrence, despite having high levels of pre-transplant alpha-fetoprotein in contrary to the literature, and still survive with a high quality of life 6 years after transplantation.
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    Metastatic Melanoma of the Common Bile Duct Presented with Dyspepsia
    (Korean Soc Gastroenterology, 2024) Cetiner, Omer Faruk; Dundar, Huseyin Emre; Kantarcioglu-Coskun, Sinem; Torun, Serkan; Tokmak, Salih
    Malignant melanoma (MM) is an aggressive tumor that can metastasize to any organ, but biliary tract metastasis is scarce. We describe a very rare case of MM metastasis to the common bile duct (CBD), presented with only dyspeptic symptoms. The patient had mildly elevated alkaline phosphatase and gamma-glutamyl transferase levels. Magnetic resonance cholangiopancreatography demonstrated a dilated common bile duct with a distal stricture. The MM diagnosis was established with the ampulla of Vater biopsy specimens obtained by endoscopic retrograde cholangiopancreatography (ERCP), and the patient's symptoms were resolved after biliary stenting. Both primary CBD cancer and other cancer types like MM that metastasize to CBD can cause obstruction and can be manifested only by dyspeptic symptoms. MM metastasis to CBD can cause obstruction manifested only by dyspeptic symptoms without obstructive jaundice. ERCP can be employed as a promising option for treatment and diagnosis. New-onset dyspeptic symptoms in patients with a history of MM should be investigated thoroughly, especially in the context of biliary metastasis.
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    Response to the letter to the editor sedation strategy for retrograde cholangiopancreatography in older patients by He et al.
    (Wiley, 2022) Tokmak, Salih; Çetin, Mehmet Fuat; Torun, Serkan
    [Bastract Not Available]
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    Sirotik Hastalarda ve Spontan Bakteriyel Peritonitte Fekal Calprotectin Düzeylerinde Artış
    (Düzce Üniversitesi, 2019) Tokmak, Salih; Harmancı Özakyol, Ayşegül
    Amaç: Bu çalışmanın amacı, intestinal inflamasyonun göstergesi olan fekal calprotectin (FC) ile artmış intestinal inflamasyon ve buna bağlı artan bakteriyel translokasyon sonucu meydana gelen sirozun komplikasyonları arasındaki ilişkiyi araştırmaktır.Gereç ve Yöntemler: Hastanemize başvuran 18 ve 80 yaş arası 156 sirotik hastadan, dışlama kriterlerine göre 64’ü çıkartıldı ve toplam 92 hasta ve benzer yaş ve cinsiyette 20 gönüllü kontrol grubu olarak çalışmaya dahil edildi. Başvuru sırasında alınan kan örneklerinden eritrosit sedimantasyon değeri (ESR), c-reaktif protein (CRP) ve beyaz küre sayımı (WBC) çalışıldı. Her hastadan ve kontrol grubundan başvurudan sonraki 24 saat içinde bir adet spot gaita örneği alındı. Çalışma grubu, sirozun evresi ilerledikçe veya komplikasyonlar meydana geldiğinde FC değerlerinin değişip değişmediğini incelemek için beş alt gruba (Child-Pugh Evre-A, Evre-B, Evre-C, hepatiks ensefalopati ve spontan bakteriyel peritonit) ayrıldı.Bulgular: Ortanca FC değerleri sirotik hastalarda 168,8 mg/kg ve kontrol grubunda 9,8 mg/kg idi ve gruplar arasındaki farklılık istatistiksel olarak anlamlıydı (p=0,039). Alt grup incelemesinde, spontan bakteriyel peritonit grubu ile diğer tüm alt gruplar arasındaki farklılıklar istatistiksel olarak anlamlıydı (p=0,002). Sirotik hastalarda FC ile ESR (r=0.439, p=0.545) veya CRP (r=0.403, p=0.321) ya da WBC sayımı (r=0.061, p=0.645) arasında korelasyon saptanmadı.Sonuç: Sirotik hastalarda FC değerleri yükselmektedir ve sistemik inflamasyon belirteçlerinden önce FC değerlerinin erken yükselmesi sayesinde, spontan bakteriyel peritonitte tanısal bir test olarak kullanılabilir.
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    Unpredictable Event during EUS-Guided Hepaticojejunostomy
    (Duzce Univ, Fac Medicine, 2023) Sirin, Abdullatif; Cetin, Mehmet Fuat; Tokmak, Salih
    Endoscopic ultrasound (EUS)-guided biliary drainage is a therapeutic alternative method in patients with cholestasis where the ampulla of Vater cannot be reached because several reasons. An unfortunate complication during EUS-guided biliary drainage was presented in this report. A 53 -year -old male patient presented with jaundice and pruritus. He had a history of total gastrectomy due to gastric cancer. An abdominal tomography scan detected a tumoral mass in the common bile duct due to the recurrence of gastric cancer. We decided to perform EUS-guided hepaticojejunostomy because biliary drainage cannot be obtained by conventional methods and percutaneous drainage impairs patient comfort. A double pigtail plastic stent was placed from the jejunum into the segment -3 bile duct towards the hilus. After that echoduodenoscope was removed to the outside gently. We noticed that the stent was stuck in the echoduedonoscope elevator. We reached into the bile duct again and placed a doublepigtail plastic stent successfully.