Use of Endoscopic Ultrasound Elastography to Differentiate between Gastrointestinal Stromal Tumor and Leiomyoma Localized in the Upper Gastrointestinal Tract.

Background: Gastrointestinal stromal tumors (GISTs) have malignant potential. Distinction of GISTs from leiomyoma is important to the decision of follow-up or treatment for upper gastrointestinal tract subepithelial lesions (SELs). There are few studies on the evaluation of gastrointestinal SELs with endoscopic ultrasound (EUS) elastography. Aims: To evaluate the efficiency of strain ratio (SR) measurement and Giovannini's classification (Gc) by EUS elastography in differentiating GISTs from leiomyomas. Materials and methods: Twenty-three lesions with histopathological diagnoses of 13 GISTs and 10 leiomyomas were evaluated. The lesions' SR values were obtained from EUS reports retrospectively. Giovannini's classification was performed according to the elastography images recorded in the system. The effectiveness of SR and Gc in the distinction between GIST and leiomyomas was evaluated. Results: Twelve of the GISTs and 3 of the leiomyomas were with scores 4 and 5 according to Gc (p = 0.006). Gastrointestinal stromal tumors had a higher SR than leiomyomas (p = 0.001). For the diagnosis of GISTs, sensitivity/specificity/diagnostic accuracy were 92.3%/80%/87% for SR alone, 92.3%/70%/82.6% for Gc alone, and 84.6%/80%/82.6% for the use of both SR and Gc. Conclusions: This is the first study in which semi-quantitative (SR) and qualitative (Gc) methods were evaluated together for the distinction of GISTs and leiomyomas. The sensitivity of SR alone for diagnosing GIST is higher than that of Gc alone or the combination of both methods. Although SR alone does not diagnose GIST, it can be used as an auxiliary method in biopsy and follow-up decisions. How to cite this article: Erdem RE, Bektas M, Ellik ZM, et al. Use of Endoscopic Ultrasound Elastography to Differentiate between Gastrointestinal Stromal Tumor and Leiomyoma Localized in the Upper Gastrointestinal Tract. Euroasian J Hepato-Gastroenterol 2024;14(1):20-23.

Bacterial microbiota on digestive structure of Cybister lateralimarginalis torquatus (Fischer von Waldheim, 1829) (Dytiscidae: Coleoptera).

In the List of World Edible Insects, Cybister sp. (Dytiscidae) genus of species is known to be consumed by humans. Dried Cybister lateralimarginalis torquatus (Fischer von Waldheim, 1829) which has been collected in Turkey long before and compared to other edible insects having large body, belonging to the Dytiscidae family from the aquatic beetle fauna was aimed to determine microbiota (in digestive structure) of the insect species. In this study, Lelliottia amnigena (Enterobacter amnigenus) (male insect) and Citrobacter freundii (female insect) bacteria species were detected from insect digestion structures. Finally, the DNA sequences of the obtained bacteria were matched from the Gene Bank with the accessory numbers. Moreover, levels of some heavy elements (Al, Cr, Fe, Co, Ni, Cu, Zn, As, Se, Cd, Hg, Pb) were evaluated in this study to observe whether Dytiscidae (Coleoptera) is a useful candidate for biomonitoring studies. The result of the study analyzes agricultural, ecological and health research, influence on the microbial flora and the effect of environment would be and how big the problem we would face in our future. Calculated analysis of the results will give a positive impetus and the fighting method to destroy it in the source.

Current approach to early gastrointestinal and liver complications of hematopoietic stem cell transplantation.

The gastrointestinal (GI) system is one of the most commonly affected sites during a hematopoietic stem cell transplantation (HSCT) due to toxicities of preparative regimens, the accompanying immunodeficiency, and organ damage caused by graft versus host disease. In this review, we focus on early GI and liver complications following autologous (auto-) and allogeneic (allo-) HSCT and clarify both the risk factors and therapeutic strategies. Early GI and liver complications associated with HSCT remain challenging issues. Despite the improvements in this field during the last decade, treatments for these complications still place a significant burden on both patients and the physicians treating these patients. GI and liver complications remain some of the causes of mortality associated with HSCT. For practicing hematologists, oncologists, and gastroenterologists in this field, the awareness and early diagnosis of the GI complications remain important factors to obtain optimal outcomes in this patient population.

Effects of mobile phone exposure on biochemical parameters of cord blood: A preliminary study.

The purpose of this study is to investigate foetal impact of radiofrequencies (RFs) emitted from mobile phones in postnatal cord blood. The study carried on 149 pregnant women divided into four groups such as nonusers of mobile phone (n: 37; control group), 2-15 min/d (n: 39; group 1), 15-60 min/d (n: 37; group 2) and participants using mobile phone for more than 60 min/d (n: 36; group 3). Cord blood of the infants was taken in all groups for biochemical analyses immediately after birth. The results of the study showed that the biggest foetal impact was observed in the third study group which was pregnant exposed RFRs (RF radiation) more than 1 h/d (1 hour per day). AST (aspartat aminotransferaz), ALT (alanine aminotransferase), LDH (lactate dehydrogenase), CK (creatine kinase), CK-MB (creatine kinase-miyocardial band), CRP (c-reactive protein), PCT (procalcitonin), TnT (troponin T), uric acid and lactate levels of third group were found higher than the other groups (p < 0.001). However, Mean platelet volume values of third group were found lower than the other groups (p < 0.001). Finally, this is the first human study which was performed on pregnant and infants because there is no previous work in this area. However, the results of this study revealed that long-term RFR exposure of pregnant may result in some biochemical changes in the infants. Therefore, our suggestion to pregnant is to avoid from RFR exposure emitted from mobile phones at least during pregnancy.

Endoscopic drainage and cystoduodedonstomy in a child with pancreatic pseudocyst.

An 11-year-old morbidly obese boy was diagnosed with pancreatic pseudocyst. Following fine needle aspiration, the cyst recurred in 1-month follow-up. Therefore, endoscopic drainage and cystoduodenostomy was performed following endosonography. Control ultrasonography (USG) revealed a completely shrunken cyst. During the 3 years of follow-up, the patient was asymptomatic with no evidence of cyst on computerized tomography scans. Endoscopic drainage and cystoduodenostomy is a minimally invasive, effective, and safe approach in the management of pancreatic pseudocysts in children.

Evaluation of Esophageal Functions by Manometry in Iron Deficiency Anemia Patients.

BACKGROUND: The aim of this study was to investigate whether any esophageal motor dysfunction exists in patients with iron deficiency anemia (IDA). METHODS: The study included 39 patients (34 women, mean age: 44.17 ± 14.21 years) who met WHO diagnostic criteria for IDA. An additional 30 functional dyspepsia patients were also included as a control group. Esophageal motility testing was performed; esophagus contraction amplitude, peak velocity, contraction time, lower esophageal sphincter (LES) resting pressure, LES relaxation, and LES relaxation duration were assessed. RESULTS: A majority (76.4%) of patients had at least one IDA symptom, such as reflux, chest pain, or dysphagia. Manometric findings in IDA patients vs. controls were as follows: mean LES resting pressure (mm Hg): 25.41 ± 11.67 vs. 19.96 ± 6.58 (P = 0.025); mean esophageal contraction amplitude (mm Hg): 61.61 ± 24.21 vs. 63.23 ± 18.86 (P = 0.764); mean LES relaxation duration (s, x ± SD): 5.33 ± 1.61 vs. 8.75 ± 1.86 (P = 0.000); mean LES relaxation (%): 93.30 ± 9.88 vs. 95.53 ± 5.81 (P = 0.278); mean peak velocity (cm/s): 12.67 ± 37.95 vs. 3.50 ± 1.63 (P = 0.191). Esophageal dysmotility was found in 11 (28.2%) IDA patients. Non-specific esophageal motor disorder was found in three patients, hypomotility of the esophagus was found in three patients, achalasia was found in two patients, hypertensive LES was found in two patients, and hypotensive LES was found in one patient. CONCLUSION: LES resting pressure was higher and LES relaxation duration was shorter in patients with IDA. Esophageal dysmotility was present in 28.2% of the patients with IDA A little more than half of patients had dysphagia symptoms. IDA may contribute to esophageal motility dysfunction and esophageal symptoms.

Evaluation of Early Atherosclerosis Markers in Patients with Inflammatory Bowel Disease.

BACKGROUND The aim of this study was to investigate relationships between early atherosclerosis and inflammatory bowel disease (IBD) using laboratory, functional, and morphological markers of atherosclerosis. MATERIAL AND METHODS In the present prospective single-center study, 96 patients with IBD (58 patients with ulcerative colitis and 36 patients with Crohn's disease) and 65 healthy control subjects were included. The demographic data of each patient and control subject were recorded. The patients with IBD and healthy controls were compared in terms of the carotid intima-media thickness (CIMT), the values of flow-mediated dilatation (FMD) and nitroglycerine-mediated dilatation (NMD), and the levels of von Willebrand factor antigen (VWF-Ag), D-dimer, and lipoprotein (a). RESULTS There were no significant differences between the IBD patients and controls in terms of age, sex, BMI, systolic and diastolic BPs, serum levels of total cholesterol, low-density lipoprotein, or triglycerides. IBD patients had significantly higher levels of VWF-Ag (156.6±58.9 vs. 104.2±43.3, P<0.001) and D-dimer (337.2±710.8 vs. 175.9±110.9, P<0.001) as compared to the controls. No significant differences were determined between the 2 groups in terms of FMD and NMD values. Although statistically not significant, the CIMT values were higher in the IBD patients than in the controls (0.517±0.141 mm vs. 0.467±0.099 mm, P=0.073). In the correlation analysis, the CIMT was found to be correlated negatively with FMD and positively with high sensitive C-reactive protein, VWF-Ag, and D-dimer. CONCLUSIONS These findings suggest that VWF-Ag and D-dimer can be beneficial early atherosclerosis markers in IBD patients.

Diagnostic role of inflammatory markers in pediatric Brucella arthritis.

BACKGROUND: As a multisystem infectious disease, there is an inflammation, which causes increase in acute phase reactants in brucellosis. The mean platelet volume (MPV), platelet distribution width (PDW), red cell distribution width (RDW), neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) have been identified as markers of inflammation. The present study aimed to evaluate diagnostic values of these biomarkers in brucella arthritis (BA). METHODS: The study included 64 children with BA and 66 healthy control subjects. Demographic features, joint involvement, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and hematological variables were retrospectively recorded. In addition, results of synovial fluid and serum tube agglutination test for brucella together with treatment regimens were recorded. RESULTS: The mean age of the patients (53.1 % male) was 92.3 ± 41.2 months. The most commonly affected joint was ankle (53.1 %). Synovial fluid puncture-brucella agglutination test was positive in 22 (34.3 %) patients. Puncture culture was positive in 9 patients. Most of the patients (57.8 %) were treated with a combination of rifampicin plus sulfamethoxazole/trimethoprim and gentamicin. Significantly higher mean PDW, RDW, MPV, NLR and PLR values were found in children with BA compared to control subjects (p < 0.05). A positive correlation was found between MPV and NLR values (R (2) = 0.192, p < 0.001). CONCLUSION: Our findings indicated that NLR and PLR are indirect markers of inflammation that may be observed abnormally increased in children with brucella arthritis. Further longitudinal studies are needed to investigate this topic to establish the more clear associations.

MRI Findings of Intrinsic and Extrinsic Duodenal Abnormalities and Variations.

This pictorial review aims to illustrate the magnetic resonance imaging (MRI) findings and presentation patterns of anatomical variations and various benign and malignant pathologies of the duodenum, including sphincter contraction, major papilla variation, prominent papilla, diverticulum, annular pancreas, duplication cysts, choledochocele, duodenal wall thickening secondary to acute pancreatitis, postbulbar stenosis, celiac disease, fistula, choledochoduodenostomy, external compression, polyps, Peutz-Jeghers syndrome, ampullary carcinoma and adenocarcinoma. MRI is a useful imaging tool for demonstrating duodenal pathology and its anatomic relationships with adjacent organs, which is critical for establishing correct diagnosis and planning appropriate treatment, especially for surgery.

Prevalence of extra-pancreatic cysts in patients with cystic pancreatic lesions detected by endoscopic ultrasound.

BACKGROUND AND OBJECTIVES: Extra-pancreatic cysts (EPCs) are incidentally found in patients with pancreatic cystic lesions (PCLs). The aim of this study is to find the prevalence of concurrent EPC in patients with PCLs, investigate associations with neoplastic lesions, and compare the prevalence of EPC to a control population. MATERIALS AND METHODS: A retrospective study of patients who underwent endoscopic ultrasound (EUS) over a 3-year period. The study group consisted of patients with PCLs. The control group included equal number of matched (age and sex) patients who had undergone EUS for reasons other than evaluation of PCLs. All patients had undergone computed tomography (CT) that was reviewed for EPCs. RESULTS: A total of 191 patients were found to have PCLs. One patient with Von Hippel-Lindau (VHL) disease was excluded. Majority of the patients were female (60%); most PCLs were solitary (68.9%), unilocular (56.8%), predominantly located in the head of the pancreas (37.4%); and mean PCL diameter was 28.12 ± 18.4mm. EUS-guided fine-needle aspiration (FNA) was performed in 171 (90%) patients with 73 (42.7%) PCLs demonstrating cysts with benign epithelial cells, 37 (21.6%) mucinous cysts, 18 (10.5%) mucinous adenocarcinomas, 11 (6.4%) neuroendocrine tumors, nine intraductal papillary mucinous cystic neoplasms (IPMNs), six pseudocysts, five serous cyst adenomas (SCAs), and five with inadequate sampling. An EPC was observed in 97 of 190 (51.18%) patients with PCLs and in 67 of 190 (35.3%) controls (P < 0.001). The distribution of EPCs in PCL patients and controls (n = 190) were 32.1% vs. 15.8% (P < 0.001) for liver cysts, 30.0% vs. 20.5% (P = 0.04) for renal cysts, and 3.7% vs. 1.6% (P = 0.34) for cysts in other organs. Mean liver cyst diameter (15.6 mm vs. 10.1 mm, P = 0.23) and renal cyst diameter (20.4 mm vs. 20.1 mm, P = 0.95) were not statistically different in PCL patients compared to controls. Multivariate analysis demonstrated that among patients with PCLs, EPCs increased with age (mean age 69.6 vs. 62.4 years, P ≤ 0.001, odds ratio (OR) 1.06, 95% confidence interval (CI) 1.03, 1.09), and male gender was associated with higher chance of finding renal cysts (OR 2.17, P = 0.021, 95% CI 1.13, 4.19). There was no association between FNA result and prevalence or type of EPC. CONCLUSION: The prevalence of EPCs in patients with PCLs was significantly higher than in a matched control group. Among patients with PCLs, a liver cyst is the most common EPC. Increasing age is associated with higher prevalence of EPCs.

Manometric assessment of esophageal motor function in patients with primary biliary cirrhosis.

INTRODUCTION/AIM: Primary biliary cirrhosis is associated with other autoimmune diseases including Sjögren's syndrome, and scleroderma. Esophageal dysmotility is well known in scleroderma, and Sjögren's syndrome. The aim of this study is to investigate whether any esophageal motor dysfunction exists in patients with primary biliary cirrhosis. METHOD: The study was performed in 37 patients (36 women, mean age: 56.29 ± 10.01 years) who met diagnostic criteria for primary biliary cirrhosis. Thirty-seven functional dyspepsia patients, were also included as a control group. Patients entering the study were asked to complete a symptom questionnaire. Distal esophageal contraction amplitude, and lower esophageal sphincter resting pressure were assessed. RESULTS: Manometric findings in primary biliary cirrhosis patients vs. controls were as follows: Median lower esophageal sphincter resting pressure (mmHg): (24 vs 20, p=0.033); median esophageal contraction amplitude (mmHg): (71 vs 56, p=0.050); mean lower esophageal sphincter relaxation duration (sc, x ± SD): (6.10 ± 1.18 vs 8.29 ± 1.92, p<0.001); and median lower esophageal sphincter relaxation (%) (96 vs 98, p=0.019); respectively. No significant differences were evident in median peak velocity (sc) (3.20 vs 3.02, p=0.778) between patients with primary biliary cirrhosis and the functional dyspepsia patients. Esophageal dysmotility was found in 17 (45.9%) primary biliary cirrhosis patients (non-specific esophageal motor disorder in ten patients, hypomotility of esophagus in five patients, nutcracker esophagus in one patient and hypertensive lower esophageal sphincter in one patient). CONCLUSION: Esophageal dysmotility was detected in 45.9% of patients. The study suggests that subclinic esophageal dysmotility is frequent in patients with primary biliary cirrhosis.

Vanishing bile duct syndrome after allogeneic bone marrow transplantation: is it the end of the road?

In this paper, we report the case of a 19-year-old male patient who presented with lymphoblastic phase of chronic myeloid leukemia and received an allogeneic bone marrow transplant from his cousin. The patient experienced severe, steroid-refractory acute graft versus-host disease of skin, gastrointestinal tract and liver that required further immunosuppression. However, hepatic graft-versus-host disease was complicated with vanishing bile duct syndrome, characterized by progressive destruction of small intrahepatic bile ducts, which was refractory to all available therapies and eventually led to end-stage liver disease. The pathogenesis and treatment of graft-versus-host disease after allogeneic hematopoietic cell transplantation is discussed with an emphasis on liver transplantation for intractable hepatic graft-versus-host disease.

Infantile digital fibromatosis (inclusion body fibromatosis) observed in a baby without finger involvement.

A 9-day-old male baby was hospitalized after his birth due to some swells under the skin. The hard consistency nodules observed under the skin all over the body of the patient were of different size, and presented lesions, among which the biggest was 1 × 1 cm. No lesions were observed on the fingers. By superficial ultrasonography, multiple isoechoic hypoechoic lesions were observed among the muscle plan. In thoracolumbar magnetic resonance imaging, multiple massif lesions retaining peripheral contrast (the biggest was 1.7 × 1.4 cm large) had been observed under the skin muscle plans, between the muscles of the extremities. The biopsy was positive for smooth muscle actin, but negative for desmin, S100, and CD34. These findings were diagnosed as infantile digital fibromatosis (IDF) (inclusion body fibromatosis). The case was presented with an objective to illustrate and remind that IDF can be observed in babies without finger involvement.

Determination of underlying causes in asymptomatic, early-stage renal diseases by dipstick test.

AIM: To prevent possible chronic kidney diseases in healthy school- age children by screening for hematuria and proteinuria using a urine strip. METHODS: The incidence of hematuria and proteinuria was determined in 1848 healthy school-age children aged 7 to 14 years by urine screening in the eastern region of Turkey in 2008. Cases with persistent hematuria and/or proteinuria were referred to a pediatric nephrologist, and further examinations were carried out. RESULTS: Isolated hematuria, isolated proteinuria, and combined hematuria-proteinuria were found in 92 (4.9%), 16 (0.8%) and 10 (0.5%) patients, respectively. In addition, 11.9% (11/92) of cases of isolated hematuria and 40% (4/10) of cases of combined hematuria- proteinuria were observed to have persisted. Persistent hematuria and persistent hematuria-proteinuria were found in 11 (0.5%) and 4 (0.2%) patients, respectively. In these cases, underlying causes were found: renal stone disease, hypercalciuria, urinary tract infection, vesicoureteral reflux, atrophic kidney, and IgA nephropathy. CONCLUSION: According to this study, cases with persistent hematuria should be examined especially in terms of renal stones, hypercalciuria, and urinary tract infection.

Feasibility study of EUS-NOTES as a novel approach for pancreatic cancer staging and therapy: an international collaborative study.

BACKGROUND/AIMS: EUS guided Natural Orifice Transluminal Endoscopic Surgery (NOTES) could be a potentially viable approach for pancreatic surgery. EUS-guided access through the stomach wall may prove to be a safe and effective method for accessing the pancreas. The aim of the study was to assess the EUS-guided diagnostic and therapeutic procedures during NOTES for both anterior and posterior approach of the pancreas. METHODOLOGY: The feasibility of peritoneoscopy through an anterior EUS-guided transgastric approach, as well as direct access to the pancreas through a posterior EUS-guided transgastric approach was tested for ease of access to the tail of the pancreas. Gastric wound closure was finally performed in several animals using various commercial and prototype endoscopic accessories. RESULTS: The results showed the ability of EUS-NOTES technology to facilitate a transgastric approach and provide both an anterior and posterior access the pancreas. Identification the pancreatic tail by EUS with the aid of EUS-guided T-tag insertion, as well as posterior access and subsequent inspection/dissection of the pancreatic tail may also be possible. CONCLUSIONS: It is technically possible by EUS-guided NOTES procedures to achieve a systematic anterior and posterior access for NOTES transgastric peritoneoscopy and direct pancreatic endoscopic procedures.

Role of EUS-FNA in Recurrent Lung Cancer: Maximum Results with Minimum (minimally invasive) Effort.

Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is an excellent method for primary lung cancer staging. We describe a 66-year-old male who underwent EUS-FNA for the diagnosis of recurrent lung cancer. Two years after initial radiation therapy followed by complete remission, routine follow-up imaging study revealed a mass in the right hilum. Trans-esophageal EUS revealed a 1.3-cm mass and the result of EUS-FNA was consistent with non-small lung cancer. EUS-FNA can play an important role in diagnosis of recurrent lung cancer as well as primary staging avoiding the more invasive diagnostic technique.

Clinical profiles, endoscopic and laboratory features and associated factors in patients with autoimmune gastritis.

BACKGROUND/AIMS: Autoimmune gastritis (AIG) may predispose to gastric carcinoid tumors or adenocarcinomas and may also cause unexplained iron and/or vitamin B(12) deficiency. The aims of this study were to explore clinical manifestations, endoscopic findings and laboratory features of patients with AIG. METHODS: 109 patients with AIG were enrolled into the study. In addition to demographic and clinical data, gastric lesions, serum gastrin, vitamin B(12), antiparietal cell antibody (APA), current Helicobacter pylori status, and anti-H. pylori IgG were also investigated. RESULTS: The mean age of the patients was 53.06 ± 12.7 years (range 24-81; 72 (66.1%) women). The most common main presenting symptom was abdominal symptoms in 51 patients, consultation for iron and/or vitamin B(12) deficiency in 36, and non-specific symptoms including intermittent diarrhea in 15 patients. Endoscopic lesions were detected in 17 patients, hyperplastic polyps in 8, gastric carcinoid tumor in 4, fundic gland polyps in 3, and adenomatous polyps in 2 patients. H. pylori was negative in all patients in biopsy specimens; however, anti-H. pylori IgG was positive in 30 (27.5%) patients. 91 patients (83.4%) were positive for APA. CONCLUSION: In patients with AIG, the main symptoms prompted for clinical investigation were: abdominal symptoms, iron/B(12) deficiency and non-specific symptoms. 20% of patients with AIG had various gastric lesions including type I gastric carcinoids. None of the patients were positive for H. pylori by means of invasive tests; however, anti-H. pylori IgG was found in 27.5% of patients. Patients referring with non-specific abdominal symptoms such as bloating, diarrhea and iron/B(12) deficiency should be investigated for the presence of AIG.

Retrospective clinical and laboratory evaluation of children with brucellosis.

BACKGROUND: Acute brucellosis is a zoonotic disease seen in childhood, with non-specific complaints and clinical findings that can affect the locomotor, gastrointestinal, genitourinary, hematologic, cardiovascular, respiratory, and central nervous systems. Particularly in endemic regions, it occurs as a result of consumption of unpasteurized milk and dairy products. In this study, clinical and laboratory findings of children with acute brucellosis are presented. METHODS: Data for 147 patients, aged 2-16 years, were evaluated retrospectively. RESULTS: The most frequent complaints and clinical findings were abdominal pain and fever. Other complaints and clinical findings included arthralgia, myalgia, loss of appetite, weakness, sweating, fatigue, headache, arthritis, hepatomegaly, and splenomegaly. Anemia was the most frequent hematological abnormality detected; other abnormalities included leukopenia, thrombocytopenia, and pancytopenia. CONCLUSION: Childhood brucellosis can cause non-specific complaints and particularly anemia and leukopenia as hematological abnormalities. It is easily treated, however, with appropriate antibiotics.