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Idilman R, Demir M, Aladag M, Erol C, Cavus B, Iliaz R, Koklu H, Cakaloglu Y, Sahin M, Ersoz G, Koksal İ, Karasu Z, Ozgenel M, Turan İ, Gunduz F, Ataseven H, Akdogan M, Kiyici M, Koksal AS, Akhan S, Gunsar F, Tabak F, Kaymakoglu S, Akarca US. Low recurrence rate of hepatocellular carcinoma following ledipasvir and sofosbuvir treatment in a real-world chronic hepatitis C patients cohort. J Viral Hepat 2019; 26:666-674. [PMID: 30740820 DOI: 10.1111/jvh.13075] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 01/11/2019] [Indexed: 01/05/2023]
Abstract
The aims of the present study were to evaluate the efficacy and tolerability of ledipasvir/sofosbuvir (LDV/SOF) with or without ribavirin in the treatment of chronic hepatitis C (CHC) in patients with advanced liver disease and to analyse whether the use of LDV/SOF treatment is associated with a new occurrence of hepatocellular carcinoma (HCC) during and after LDV/SOF treatment. The Turkish Early Access Program provided LDV/SOF treatment to a total of 200 eligible CHC patients with advanced liver disease. The median follow-up period was 22 months. All patients were Caucasian, 84% were infected with genotype 1b, and 24% had a liver transplantation before treatment. The sustained virological response (SVR12) was 86.0% with ITT analysis. SVR12 was similar among patients with Child-Pugh classes A, B and C disease and transplant recipients. From baseline to SVR12, serum ALT level and MELD score were significantly improved (P < 0.001). LDV/SOF treatment was generally well tolerated. Only one patient developed a new diagnosed HCC. Seventeen of the 35 patients, who had a history of previous HCC, developed HCC recurrence during the LDV/SOF treatment or by a median follow-up of 6 months after treatment. HCC recurrence was less commonly observed in patients who received curative treatment for HCC compared with those patients who received noncurative treatment (P = 0.007). In conclusion, LDV/SOF with or without ribavirin is an effective and tolerable treatment in CHC patients with advanced liver disease. Eradication is associated with improvements in liver function and a reduced risk of developing a new occurrence of HCC.
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Affiliation(s)
- Ramazan Idilman
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
| | - Mehmet Demir
- Department of Gastroenterology, Mustafa Kemal University School of Medicine, Hatay, Turkey
| | - Murat Aladag
- Department of Gastroenterology, İnönü University School of Medicine, Malatya, Turkey
| | - Cihan Erol
- Department of Internal Medicine, Ankara University School of Medicine, Ankara, Turkey
| | - Bilger Cavus
- Department of Gastroenterology, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | - Raim Iliaz
- Department of Gastroenterology, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | - Hayrettin Koklu
- Department of Gastroenterology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Yilmaz Cakaloglu
- Department of Gastroenterology, Memorial Sisli Hospital, İstanbul, Turkey
| | | | - Galip Ersoz
- Department of Gastroenterology, Ege University School of Medicine, İzmir, Turkey
| | - İftihar Koksal
- Department of Infectious Disease, Karadeniz Technical University, Faculty of Medicine, Trabzon, Turkey
| | - Zeki Karasu
- Department of Gastroenterology, Ege University School of Medicine, İzmir, Turkey
| | - Meric Ozgenel
- Department of Gastroenterology, Osmangazi University School of Medicine, Eskişehir, Turkey
| | - İlker Turan
- Department of Gastroenterology, Ege University School of Medicine, İzmir, Turkey
| | - Feyza Gunduz
- Department of Gastroenterology, Marmara University School of Medicine, İstanbul, Turkey
| | - Huseyin Ataseven
- Department of Gastroenterology, Necmettin Erbakan University Meram School of Medicine, Konya, Turkey
| | - Meral Akdogan
- Department of Gastroenterology, Türkiye Yüksek İhtisas Hospital, Ankara, Turkey
| | - Murat Kiyici
- Department of Gastroenterology, Uludag University School of Medicine, Bursa, Turkey
| | - Aydın Seref Koksal
- Department of Gastroenterology, Sakarya University School of Medicine, Sakarya, Turkey
| | - Sila Akhan
- Department of Gastroenterology, Kocaeli University School of Medicine, Department of Infectious Disease and Clinical Microbiology, Kocaeli, Turkey
| | - Fulya Gunsar
- Department of Gastroenterology, Ege University School of Medicine, İzmir, Turkey
| | - Fehmi Tabak
- Department of Infectious Disease and Clinical Microbiology, İstanbul University Cerrahpasa School of Medicine, İstanbul, Turkey
| | - Sabahattin Kaymakoglu
- Department of Gastroenterology, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | - Ulus S Akarca
- Department of Gastroenterology, Ege University School of Medicine, İzmir, Turkey
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Parlak E, Eminler AT, Koksal AS, Toka B, Uslan MI, Sokmensuer C, Guven M. A new method for lumen restoration in a patient with aphagia: Oro-oesophageal through-the-scope magnetic compression anastomosis. Clin Otolaryngol 2019; 44:1214-1217. [PMID: 30968566 DOI: 10.1111/coa.13337] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 04/04/2019] [Indexed: 12/22/2022]
Affiliation(s)
- Erkan Parlak
- Department of Gastroenterology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ahmet Tarık Eminler
- Department of Gastroenterology, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Aydın Seref Koksal
- Department of Gastroenterology, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Bilal Toka
- Department of Gastroenterology, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Mustafa Ihsan Uslan
- Department of Gastroenterology, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Cenk Sokmensuer
- Department of Pathology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Mehmet Guven
- Department of Otorhinolaryngology, Faculty of Medicine, Sakarya University, Sakarya, Turkey
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Eminler AT, Parlak E, Koksal AS. Response. Gastrointest Endosc 2019; 89:649-650. [PMID: 30784507 DOI: 10.1016/j.gie.2018.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Accepted: 11/07/2018] [Indexed: 02/08/2023]
Affiliation(s)
- Ahmet Tarık Eminler
- Department of Gastroenterology, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Erkan Parlak
- Department of Gastroenterology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Aydın Seref Koksal
- Department of Gastroenterology, Faculty of Medicine, Sakarya University, Sakarya, Turkey
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Eminler AT, Parlak E, Koksal AS. Response. Gastrointest Endosc 2019; 89:654-655. [PMID: 30784512 DOI: 10.1016/j.gie.2018.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Accepted: 11/06/2018] [Indexed: 02/08/2023]
Affiliation(s)
- Ahmet Tarık Eminler
- Department of Gastroenterology, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Erkan Parlak
- Department of Gastroenterology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Aydın Seref Koksal
- Department of Gastroenterology, Faculty of Medicine, Sakarya University, Sakarya, Turkey
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Eminler AT, Parlak E, Koksal AS, Toka B, Uslan MI. Wire-guided cannulation over a pancreatic stent method increases the need for needle-knife precutting ın patients with difficult biliary cannulations. Gastrointest Endosc 2019; 89:301-308. [PMID: 30148994 DOI: 10.1016/j.gie.2018.08.034] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 08/10/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Cannulation of the major papilla can be problematic, and selective biliary cannulation may fail in up to 18% of cases. Various techniques, such as double-guidewire technique (DGWT), wire-guided cannulation over a pancreatic stent (WGC-PS), the precut endoscopic sphincterotomy (needle-knife precutting technique (NKP), and transpancreatic septostomy have been used to improve the success rate of biliary cannulation. We conducted a prospective, randomized study in order to compare the biliary cannulation success rates of DGWT and WGC-PS techniques in patients with inadvertent passage of guidewire to the pancreatic duct. METHODS A total of 100 patients were included in the study and randomized to DGWT (n = 50) or WGC-PS (n = 50) groups. The primary outcome was successful selective cannulation, defined as deep cannulation with selective injection of radiographic contrast material into the common bile duct within 5 minutes by DGW or WGC-PS techniques without performing precut sphincterotomy. RESULTS Successful selective cannulation was achieved in 45 patients in the DGWT group (90%) and in 27 patients in the WGC-PS group (54%) (P < .001). Five patients (10%) in the DGWT group and 23 (46%) in the WGC-PS group required NKP for biliary access (P < .001). The overall cannulation rate was 98% for DGWT and 98% for WGC-PS (P = 1.00). CONCLUSIONS In patients with unintentional passage of a guidewire into the pancreatic duct during biliary cannulation attempts, the WGC-PS technique significantly increased the need for NKP compared with DGWT.
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Affiliation(s)
- Ahmet Tarık Eminler
- Sakarya University Faculty of Medicine Department of Gastroenterology, Sakarya, Turkey
| | - Erkan Parlak
- Hacettepe University Faculty of Medicine Department of Gastroenterology, Ankara, Turkey
| | - Aydın Seref Koksal
- Sakarya University Faculty of Medicine Department of Gastroenterology, Sakarya, Turkey
| | - Bilal Toka
- Sakarya University Faculty of Medicine Department of Gastroenterology, Sakarya, Turkey
| | - Mustafa Ihsan Uslan
- Sakarya University Faculty of Medicine Department of Gastroenterology, Sakarya, Turkey
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Koksal AS, Toka B, Eminler AT, Hacibekiroglu I, Uslan MI, Parlak E. HBV-related acute hepatitis due to immune checkpoint inhibitors in a patient with malignant melanoma. Ann Oncol 2018; 28:3103-3104. [PMID: 28945827 DOI: 10.1093/annonc/mdx502] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
| | - B Toka
- Departments of Gastroenterology
| | | | - I Hacibekiroglu
- Medical Oncology, Sakarya University Faculty of Medicine, Sakarya, Turkey
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Koksal AS, Eminler AT, Parlak E. How to predict the severity of acute pancreatitis? An ongoing debate. Turk J Gastroenterol 2017; 28:229-229. [DOI: 10.5152/tjg.2017.17027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Parlak E, Koksal AS, Kucukay F, Eminler AT, Toka B, Uslan MI. A novel technique for the endoscopic treatment of complete biliary anastomosis obstructions after liver transplantation: through-the-scope magnetic compression anastomosis. Gastrointest Endosc 2017; 85:841-847. [PMID: 27566054 DOI: 10.1016/j.gie.2016.07.068] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 07/29/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Magnetic compression anastomosis is a rescue technique for recanalization of complete biliary strictures. Here, we present magnetic compression anastomosis with novel through-the-scope magnets in patients with complete duct-to-duct anastomosis obstruction after liver transplantation. METHODS The magnets were 2 and 2.4 mm in diameter, with a hole at the center for inserting a guidewire. One of the magnets was advanced through the scope up to the distal site of the stricture by using a 7F pusher. The other magnet was pushed percutaneously through the 10F sheath. The procedure was terminated when the magnets were approximated or properly aligned. Recanalization was followed by percutaneous cholangiography. Patients underwent multiple plastic stenting after recanalization was achieved. RESULTS Nine patients with a stricture length of less than 1 cm, a stump in the donor bile ducts close to the stricture, and proper positioning of the bile duct stumps, underwent magnetic compression anastomosis. Seven patients had a live donor-related liver transplantation. The mean stricture time was 24.1 ± 17.1 months. The mean stricture length was 4.0 ± 1.2 mm. Recanalization was achieved in 7 patients (77%) after a mean recanalization time of 8.1 ± 4.7 days. There was no recurrence after 4.8 ± 3.8 months of stent-free follow-up. No adverse events were observed. CONCLUSIONS The through-the-scope magnet procedure was effective in the recanalization of complete anastomotic biliary obstructions after liver transplantation in a selected group of patients with a short stricture length and an appropriate anatomy.
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Affiliation(s)
- Erkan Parlak
- Department of Gastroenterology, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Aydın Seref Koksal
- Department of Gastroenterology, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Fahrettin Kucukay
- Department of Radiology, Türkiye Yüksek İhtisas Hospital, Ankara, Turkey
| | - Ahmet Tarık Eminler
- Department of Gastroenterology, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Bilal Toka
- Department of Gastroenterology, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Mustafa Ihsan Uslan
- Department of Gastroenterology, Faculty of Medicine, Sakarya University, Sakarya, Turkey
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Eminler AT, Savas AY, Yilmaz B, Akgul M, Uslan MI, Koksal AS, Parlak E. Endoscopic Treatment of Biloma: Bilo-gastric drainage. Acta Gastroenterol Belg 2015; 78:348-349. [PMID: 26448421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Koksal AS, Taskiran I, Kalkan IH, Kayacetin E. A rare endoscopic appearance of primary gastrointestinal mantle cell lymphoma resembling ulcerative colitis. ACTA ACUST UNITED AC 2014; 115:800-1. [PMID: 25520232 DOI: 10.4149/bll_2014_155] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Cicek B, Parlak E, Oguz D, Disibeyaz S, Koksal AS, Sahin B. Endoscopic treatment of pancreatic fistulas. Surg Endosc 2006; 20:1706-12. [PMID: 16960673 DOI: 10.1007/s00464-005-0764-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2005] [Accepted: 04/05/2006] [Indexed: 01/09/2023]
Abstract
BACKGROUND Pancreatic fistulas are managed primarily by conservative treatment. Surgery is performed in cases of conservative treatment failure. Endoscopic treatment is reported to be both effective and safe as an alternative treatment method. METHODS A total of 26 patients underwent endoscopic treatment after failure of conservative treatment between January 2002 and November 2004. The mean time between the onset of fistula and the endoscopic retrograde cholangiopancreatography (ERCP) procedure was 95 days. The mean fistula output volume was 400 ml per day. Four patients had pancreatic ascites. The aim of the endoscopic treatment was to bypass the ductal disruption by placing stents or drains where the origin of fistulous tract could be identified, and to lower the pancreatic duct pressure by performing pancreatic sphincterotomy or by placing stents where the site of the leak could not be identified. RESULTS Pancreatography could be performed in all the patients except one. Partial duct disruption occurred in 16 patients. All of the fistulas closed after the ductal disruption was bypassed. Pancreatic sphincterotomy or endoprothesis placement was effective for eight of the remaining nine patients in whom the ductal disruption originated from the tail of the pancreas and hence could not be bypassed. The overall success rate was 94% for the patients with partial duct disruption. Four patients had side branch leaks. All of them closed after placement of an endoprothesis. Fistulas closed in only one (20%) of the five patients with complete duct disruption. Pancreatic ascites resolved in two of the four patients after endoscopic treatment. No serious complications resulted from endoscopic treatment other than proximally migrated stents in two patients. CONCLUSIONS Endoscopic treatment is an effective and safe method for patients with pancreatic fistulas unresponsive to conservative treatment. The success rate is very high, especially for patients with partial and side branch duct disruption.
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Affiliation(s)
- B Cicek
- Department of Gastroenterology, Turkey Yuksek Ihtisas Hospital, Ankara, Turkey.
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Disibeyaz S, Parlak E, Koksal AS, Cicek B, Koc U, Sahin B. Endoscopic treatment of a large upper gastrointestinal anastomotic leak using a prolene plug and cyanoacrylate. Endoscopy 2005; 37:1032-3. [PMID: 16189781 DOI: 10.1055/s-2005-870439] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- S Disibeyaz
- Dept. of Gastroenterology, Türkiye Yüksek Ihtisas Hospital, Ankara, Turkey.
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