Association of macroscopic gut inflammation with disease activity, functional status and quality of life in ankylosing spondylitis.

The aim of this cross-sectional study was to evaluate the frequency of intestinal inflammation and its association with disease activity, functional status and quality of life in patients with ankylosing spondylitis (AS). A total of 25 patients with AS had undergone ileocolonoscopy and concomitant histological study. Clinical and demographical parameters, BASDAI, BASFI, and SF-36 scores were compared between patients with and without macroscopic gut inflammation (MGI). Colonoscopic study revealed MGI in 9 patients and macroscopically normal gut mucosa in 16 patients. On histological examination, of 25 patients 20 had gut inflammation, mostly in ileum. BASDAI score was higher (P < 0.05), SF-36 pain and physical scores, and chest expansion measurement were lower (P = 0.00, P = 0.01, P = 0.01), duration of morning stiffness was longer (P = 0.01) in patients with MGI. Serum C-reactive protein, erytrocyte sedimentation rate levels were similar between groups (P > 0.05). There is high prevalence of histological gut inflammation in AS patients. More active disease should suggest gut inflammation in AS patients.

Endoscopic sphincterotomy alone in the management of low-grade biliary leaks due to cholecystectomy.

AIM: Endoscopic retrograde cholangiopancreatography (ERCP) is important in the diagnosis and management of postoperative bile leaks. Endoscopic sphincterotomy (ES) alone, ES with stent or nasobiliary drain (NBD) placement and stent or NBD without ES are the methods of choice. In the present study, we aimed to show the efficacy of ES alone in the management of low-grade (LGL) cystic duct stump (CDS) leaks due to cholecystectomy. METHODS: Between September 2005 and January 2008, ES was carried out on 31 patients with LGL from the CDS due to cholecystectomy who were referred to the endoscopy unit of Izmir Ataturk Training and Research Hospital. Biliary leakage was detected by biliary discharge from a tube drain inserted during the operation. In cases of retaining common bile duct stones, balloon extraction was carried out. If bile discharge continued, a stent was introduced for cessation of the leak as a second procedure. RESULTS: The success rate of ES alone was 87.1% (27 of 31 patients). In four patients (12.9%), ES alone was inadequate, therefore a stent was placed. The biliary leak ceased gradually and stopped in all patients at a mean of 11 (7-21) days. Balloon extraction of retained stones was carried out in six patients (19.6%). In two (6.5%) patients, mild hemorrhage and in two patients self-limited pancreatitis was seen (6.5%) as complications. CONCLUSION: Endoscopic retrograde cholangiopancreatography is essential in the management of postoperative biliary leaks. Endoscopic sphincterotomy alone can be the initial procedure in the treatment of LGL from the CDS due to cholecystectomy.

Transanal endoscopic repair of rectal perforation with hemoclips.

A 74-year-old male patient had a full-thickness laceration of the mid-rectum during transurethral urologic surgery. The perforation site was 8-cm above the dentate line and 15 x 6 mm in size. Transanal direct access to the injury site was difficult and endoscopic repair with hemoclips was performed without any further intervention. He was discharged from the hospital uneventfully and complete healing was observed 6 weeks after the procedure. We concluded that endoscopic repair with hemoclips may offer a successful and simple closure method for extraperitoneal high lying rectal lacerations.

Is prolapse gastropathy a cause of upper gastrointestinal bleeding?

BACKGROUND/AIMS: Prolapse gastropathy is a clinical syndrome involving the invagination of a part of the gastric mucosa into the lower esophagus resulting in well demarcated hemorrhagic mucosa and sometimes bleeding. The importance of this syndrome is that it has been reported as a cause of hematemesis. As this syndrome is considered to be seen in patients with retching and vomiting and to be one of the causes of upper gastrointestinal bleeding, this study was undertaken to evaluate its frequency and importance in our patients. METHODS: The study groups comprised of 941 patients with hematemesis and 54 with recurrent retching and vomiting. Biopsies were obtained from the prolapsing mucosa when detected. Hematoxylin and eosin stained specimens were reviewed by an experienced histopathologist. RESULTS: Prolapse gastropathy was detected in 20 patients (2%), of whom six (0.6%) were in the hematemesis group and 14 (25.9%) in the retching and vomiting group. The location of the lesion was the greater curvature in 10 patients (50%), lesser curvature in seven patients (35%) and anterior wall in three patients (15%). In all six cases from the hematemesis group, bleeding was not related to prolapse gastropathy because other causative lesions were identified. Histologic evaluation of the biopsies revealed acute inflammation, chronic inflammation and submucosal hemorrhage. CONCLUSIONS: According to the results of this study, prolapse gastropathy is not a cause of hematemesis. Other causes should be identified when prolapse gastropathy is detected in a patient with hematemesis.

Adenocarcinoma of the ileocecal valve: report of a case.

Tumors of the ileocecal valve are rarely mentioned, and are mostly defined radiologically. In this manuscript, we report a case of ileocecal valve adenocarcinoma diagnosed endoscopically. The case is a male patient, 78-years-old, with abdominal pain and weight loss in whom a mass was palpated in the lower right quadrant. Abdominal ultrasound examination followed by colonoscopy and pathological diagnosis revealed adenocarcinoma of the ileocecal valve confirmed by surgical diagnosis. We report this case because of its rarity and because there is no endoscopic image in the medical literature.

Colonoscopy without sedation.

BACKGROUND/AIMS: In Turkey, colonoscopy is a procedure generally performed with intravenous sedation and analgesia. Most of the complications of colonoscopy are related to sedation. The aims of this study were to determine the percentage of patients who could successfully undergo nonsedated colonoscopy without sedation and to assess patient tolerance and acceptance. METHODS: The study included 120 consecutive patients undergoing colonoscopy by two endoscopists in our endoscopy unit. The procedure routinely began without sedation, which was later given (midazolam and hyoscine butylbromide) only if significant discomfort occurred. Parameters of blood pressure, oxygen saturation and heart rate were measured before and during colonoscopy. After the procedure patients were asked to rate their pain on a four point scale 1=no pain, 2=slight, 3=moderate, 4=severe and they were also asked if they would be willing to undergo colonoscopy again without sedation. RESULTS: Eighty eight percent of all colonoscopies were completed without sedation. Mean PaO2 was 96.46 in nonsedated patients and 93.90 (significant p<0.05) in sedated patients. No difference was found between blood pressure and pulse rate of nonsedated and sedated patients. The mean pain score was 2.0 for the nonsedated patients and 3.8 (significant p<0.05) for the sedated patients. Eighty eight percent of patients stated that they would be willing to undergo colonoscopy without sedation again. CONCLUSIONS: In experienced hands, colonoscopy without sedation can be completed successfully in most patients, without any complications and use of extra instrumentation.

Jejunogastric intussusception, a rare complication of gastric surgery: report of two cases.

Jejunogastric intussusception is a rare complication of gastric surgery. It usually presents with abdominal pain, nausea, vomiting, and hematemesis. A history of gastric surgery can help in making an accurate diagnosis. An early diagnosis and urgent surgical intervention is mandatory. We herein report two cases of patients with jejunogastric intussusception who presented with acute abdomen and hematemesis.