Researcher:
Alper, Emrah

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Emrah

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Alper

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Alper, Emrah

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2019 - 201912020 - 20228

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    Bacterial species and total bacterial load in the distal oesophagus in patients with and without clinical gastric reflux
    (Wiley, 2019) Kayar Dogan E.; Abaci Gunyar O.; Topal F.; Ekinci N.; Alper, Emrah; Faculty Member; School of Medicine; 220444
    Aims: The purpose of this study is to compare distal oesophagus of persons with and without gastric reflux in terms of bacterial load and presence of certain bacterial species. Methods and Results: Two biopsy specimens were obtained from the distal oesophagus at 5 cm above the gastroesophageal junction of each of the 50 patients (20 with normal oesophagus and 30 with reflux oesophagitis) under endoscopic examination and used for histological examination and DNA isolation. We used a real-time PCR-based assay to quantify the bacterial load and the presence of certain bacterial species from one of the biopsy samples. The biopsy specimens taken from the patients with reflux oesophagitis were consistent with gastroesophageal reflux disease (GERD). The bacterial load did not significantly differ between the groups (P < 0·005). Conclusion: While there was no difference between the bacterial load in the two groups, variation was observed in bacterial species. Most of the bacteria identified in distal oesophagus of the patients with gastroesophageal reflux were Gram negative. Significance and Impact of the Study: The human oesophagus was considered sterile until quite recently. Molecular techniques displayed the presence of a diverse bacterial species in the oesophagus. Although it is known that dysbiosis in the oesophagus causes GERD, and that Barrett's oesophagus can trigger the development of oesophageal adenocarcinoma, its etiopathogenesis is not clear. A limited number of published studies support the importance of the present study.
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    The role of ultrasonography to estimate gastric content in a case with aspiration risk
    (Anestezi Dergisi, 2021) Gürkan, Yavuz; Karakaya, Muhammet Ahmet; Özkalaycı, Özlem; Çetin, Seçil; Alper, Emrah; Darçın, Kamil; Faculty Member; Doctor; Doctor; Doctor; Faculty Member; Teaching Faculty; School of Medicine; N/A; N/A; N/A; School of Medicine; School of Medicine; Koç University Hospital; 154129; N/A; N/A; N/A; 220444; 203217
    In this case report we present our experience in measuring the gastric volume of a mentally-motor retarded patient for percutaneous endoscopic gastrostomy replacement. The antrum of the stomach was visualized in the subcostal region of the sagittal plane with an ultrasound probe. Anteroposterior, and right-left lateral diameters were measured. Using these measurements, the antrum cross-sectional area and then the gastric volume were calculated. Ultrasonography should be kept in mind as a good alternative approach to evaluate the gastric volume in cases with aspiration risk. © Copyright Anesthesiology and Reanimation Specialists’ Society. This journal published by Logos Medical Publishing. Licenced by Creative Commons Attribution 4.0 International (CC)
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    Contribution of celiac plexus block to patient comfort in patients with inoperable cancer
    (Surgical Society of Northern Greece, 2020) Acar, Nihan; Acar, Turan; Sür, Yunus; Özgürbüz, Uğur; Dilek, Osman Nuri; Alper, Emrah; Faculty Member; School of Medicine; 220444
    Aim: Pain control is an important issue in patients with inoperable cancers of upper abdominal organs. Although various pharmacological drugs are adequate for this, more invasive and interventional methods such as celiac plexus block (CPB) come forward for the cases which are unresponsive to conventional medical treatments. In this study our aim was to evaluate the contribution of CPB to patient comfort in patients with inoperable cancer. Material and Methods: Thirty-four patients who were diagnosed with inoperable malignant and underwent CPB during five years period were included. All procedures were performed with the guidance of endoscopic ultrasonography (EUS) and ethanol was used as the neurolytic agent. Results: Majority of the cases were female (%55.9, n:19) and the median age was 66 years (range: 56-78 years). Most of the patients had pancreatic cancer (38.3%, n:13), and the remaining patients had gastric cancer, Klatskin tumor, gallbladder cancer and hepatocellular carcinoma. Pain resolved completely in 16 patients (47.2%) and was controlled with non-narcotic analgesics in six patients (17.6%) after the procedure. None of the patients developed any major complication or paraplegia. Conclusion: It was observed that pain control was not sufficiently achieved in the advanced grade of invasion. For this reason, patient selection should be done meticulously and CPB should be performed in the early period of pain in order to obtain an effective response. © 2020 Surgical Society of Northern Greece. All rights reserved.
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    Empagliflozin-induced ketoacidosis in a patient presenting with new-onset type 2 diabetes mellitus due to indolent pancreatic cancer
    (Via Medica, 2020) N/A; N/A; N/A; N/A; N/A; N/A; Sezer, Havva; Dereli, Dilek Yazıcı; Deyneli, Oğuzhan; Meriçöz, Çisel Aydın; Esin, Ayla; Alper, Emrah; Teaching Faculty; Faculty Member; Faculty Member; Teaching Faculty; Doctor; Faculty Member; School of Medicine; School of Medicine; School of Medicine; School of Medicine; N/A; School of Medicine; Koç University Hospital; 154807; 179659; 171914; 162418; N/A; 220444
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    Centrally-necrotic/hyalinizing demarcated (CND) carcinomas of the pancreas: a clinico-pathologically distinct group with divergent metaplastic patterns and high-grade characteristics
    (Elsevier, 2022) Bagci, Pelin; Altinmakas, Emre; Pehlivanoglu, Burcin; Bozkurtlar, Emine; Reid, Michelle; Cheng, Jeanette; Luchini, Claudio; Scarpa, Aldo; Basturk, Olca; N/A; Cengiz, Duygu; Saka, Burcu; Bozkurt, Emre; Armutlu, Ayşe; Meriçöz, Çisel Aydın; Alper, Emrah; Tellioğlu, Gürkan; Gürses, Bengi; Adsay, Nazmi Volkan; Other; Faculty Member; Doctor; Teaching Faculty; Teaching Faculty; Faculty Member; Faculty Member; Faculty Member; Faculty Member; School of Medicine; School of Medicine; N/A; School of Medicine; School of Medicine; School of Medicine; School of Medicine; School of Medicine; School of Medicine; Koç University Hospital; N/A; Koç University Hospital; N/A; N/A; N/A; N/A; N/A; N/A; 296729; 222921; N/A; 133567; 162418; 220444; 230736; 113169; 286248
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    PublicationOpen Access
    Evaluation of hydrogen peroxide-assisted endoscopic ultrasonography-guided necrosectomy in walled-off pancreatic necrosis: a single-center experience
    (Lippincott Williams and Wilkins (LWW), 2021) Günay, Süleyman; Paköz, Betül; Çekiç, Cem; Çamyar, Hakan; Yüksel, Elif Sarıtaş; Topal, Firdevs; Binicier, Ömer Burçak; Alper, Emrah; Faculty Member; School of Medicine
    Hydrogen peroxide is a liquid that functions in mechanical removal of the necrotic tissue via the elimination of tissue debris. In this study, we aimed to evaluate the effectiveness of the use of hydrogen peroxide in necrosectomy treatment of walled-off pancreatic necrosis. Records of 24 patients who were diagnosed with pancreatic necrosis or walled-off pancreatic necrosis and underwent endoscopic necrosectomy (EN) were retrospectively assessed. Patients were divided into 2 groups; hydrogen peroxide used for treatment or not used, and these 2 groups were compared. A total of 24 patients underwent endoscopic intervention for walled-off pancreatic necrosis. Procedural success was comparable between the 2 groups. During the post-procedural follow-up, the duration of the hospital stay, recurrence, and complication rates were found to be similar in both groups. The mean number of the endoscopic interventions was significantly lower in the hydrogen peroxide group (4.2 +/- 1.4 vs 6.1 +/- 4.2; P = .01). The use of hydrogen peroxide for EN in walled-off pancreatic necrosis patients seems to have similar efficiency and safety. However, it can be said that the use of hydrogen peroxide could reduce the number of endoscopic procedures.
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    PublicationOpen Access
    Endoscopic ultrasound versus computed tomography for preoperative evaluation of primary ampullary tumors radiological evaluation of primary ampullary tumors
    (Bayrakol Medical Publishing, 2021) Üzüm, Yusuf; Camyar, Hakan; Korkmaz, Uğur Bayram; Gümüş, Zeynep Zehra; Alper, Emrah; Faculty Member; School of Medicine
    Aim: the study aimed to compare the efficacy of endoscopic ultrasound (EUS) and computed tomography (CT) in detecting primary tumor and evaluating preoperative vascular and peripheral invasion in histopathologically proven malignant ampullar tumors. Material and Methods: fifty-two patients who underwent surgery or endoscopic ampullectomy for the primary ampullary tumors between 2014 and 2016 were evaluated. The demographic data and EUS, CT, pathology results of all patients were recorded. The efficacy of EUS and CT in detecting tumor, peripheral tissue invasion, and vascular tissue invasion was evaluated and compared with pathology results. Results: forty-nine patients had the Whipple procedure and 3 patients underwent endoscopic ampullectomy. In pathology results, all patients had adenocarcinoma histology, and the mean tumor diameter was 20.12 mm. The rate of peripheral tissue invasion and vascular invasion was 86.5%, 5.8% respectively. Ampullary mass was detected in 41 (78.8%) patients by EUS, in 35 (67.3%) by CT (p=0.002). Three patients had a vascular invasion in pathology. The sensitivity and specificity of EUS in detecting vascular invasion were 66% and 100%, respectively. CT failed to demonstrate vascular invasion in these 3 patients. Discussion: the results showed that EUS was superior to CT in detecting a mass, peripheral tissue invasion, and vascular invasion. Although EUS is superior to CT, CT plays an important role in the evaluation of distant metastases, and therefore CT and EUS are two important complementary radiological tests in the evaluation of these patients.
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    PublicationOpen Access
    Endoscopic and surgical management of iatrogenic biliary tract injuries
    (Kare Yayıncılık, 2020) Acar, Turan; Acar, Nihan; Güngör, Feyyaz; Gür, Özlem; Çamyar, Hakan; Haıyanlı, Mehmet; Dilek, Osman Nuri; Alper, Emrah; Faculty Member; School of Medicine
    Background: Iatrogenic biliary tract injury (BTI) is a rare complication but has high risks of morbidity and mortality when it is not early noticed. Although the treatment varies depending on the size of injury and the time until the injury is noticed, endoscopic and percutaneous interventions are usually sufficient. However, it should be remembered that these interventions may cause major complications in the following years, such as biliary stricture, recurrent episodes of cholangitis and even cirrhosis. In this paper, we aimed to present our approach to BTI following cholecystectomy and our treatment management in the light of the literature. Methods: the medical records of 105 patients who were treated for BTI between January 2015 and July 2019 were evaluated retrospectively. The majority of the patients consisted of the patients who underwent cholecystectomy at an external medical center and were referred to our clinic due to biliary leakage (BL). Patients were grouped according to Strasberg classification determined by the place of leakage. Results: among 105 patients included in this study, 55 were male, and 50 were female. Mean age was 55.2 ±16.26 years (range, 21– 93 years). According to Strasberg classification, type A, B, C, D and E injuries were detected in 57, 1, 3, 29 and 15 patients, respectively. Eighty-five patients were successfully treated with endoscopic and percutaneous interventions, while 20 patients underwent surgery. Conclusion: in all patients with suspected BTI, a detailed screening and appropriate treatment provide a significant decline in morbidity and mortality. Therefore, early diagnosis is very important for both early and late outcomes. / Amaç: iyatrojenik safra yolu yaralanmalarını, nadir görülen bir komplikasyon olup erken tanınmadığında yüksek morbidite ve mortaliteye neden olur. Tedavisi, yaralanma boyutu ve yaralanmanın fark edilmesine dek geçen süreye göre değişmekle birlikte, çoğunlukla endoskopik ve perkütan girişimler yeterli olmaktadır. Fakat bu tedaviler sonrasında ilerleyen yıllarda biliyer striktür, tekrarlayan kolanjit atakları ve hatta siroz gibi majör komplikasyonlara neden olabileceği unutulmamalıdır. Bu yazımızda postkolesistektomi biliyer kaçaklara yaklaşımımızı ve literatür eşliğinde tedavi yönetimini sunmayı amaçladık. Gereç ve yöntem: Ocak 2015–Temmuz 2019 tarihleri arasında biliyer kaçak nedeniyle tedavi ettiğimiz 105 hastanın dosyası geriye dönük olarak değerlendirildi. Hastaların çoğunluğunu, dış merkezde kolesistektomi geçirip, biliyer kaçak saptanması üzerine kliniğimize sevk edilenler oluşturmakta idi. Hastalar kaçak yeri ve miktarına göre belirlenen Strasberg sınıflandırmasına göre gruplandırıldı. Bulgular: çalışmaya alınan 105 hastanın 55’i erkek, 50’si kadın olup ortalama yaş 55.2±16.26 yıl (21–93 yıl) idi. Strasberg sınıflamasına göre; 57 hastada tip A, 1 hastada tip B, 3 hastada tip C, 29 hastada tip D ve 15 hastada tip E yaralanma mevcut idi. Seksen beş hasta endoskopik ve girişimsel radyolojik yöntemlerle başarı ile tedavi edilirken, 20 hastaya cerrahi girişim yapıldı.Tartışma: biliyer kaçaktan şüphelenilen her hastada, ayrıntılı tarama ve uygun tedavi morbidite ve mortalitede önemli bir düşüş sağlar. Bu sebeple, erken tanı hem erken hem de geç dönem sonuçlar açısından çok önemlidir.
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    PublicationOpen Access
    Upper socioeconomic status is associated with lower Helicobacter pylori infection rate among patients undergoing gastroscopy
    (The Journal of Infection in Developing Countries, 2020) Mungan, Zeynel; Attila, Tan; Zeybel, Müjdat; Yiğit, Yeşim Esen; Baran, Bülent; Ahıshalı, Emel; Alper, Emrah; Aslan, Fatih; Ergönül, Önder; Faculty Member; Faculty Member; Faculty Member; Faculty Member; Faculty Member; Faculty Member; Faculty Member; School of Medicine; 118342; 214694; N/A; 167583; N/A; N/A; 219202; 110398
    Introduction: socioeconomic factors play an important role in the prevalence of Helicobacter pylori (HP) infection. The aim of this study is to investigate HP prevalence among symptomatic patients in the upper socioeconomic segment of the population undergoing gastroscopy in an endemic urban region. Methodology: over a 12-month period, data were collected from the first consecutive 1000 patients (500 from university hospital, 500 from community hospital) who had gastroscopy and HP evaluation. Results: overall, 211/1000 patients (21.1 %) were found to have HP in gastric biopsies. The specificity, sensitivity, positive predictive value, negative predictive value and diagnostic accuracy of rapid urease test were 87.5%, 99.7%, 99%, 96.5%, and 96.9% respectively. Atrophic gastritis, gastric and duodenal ulcers were significantly more common in HP positive patients. Age based distribution of HP prevalence: > 6 decades (15.5%), 3rd-5th decades (26.1%), < 3rd decades (10.4%). Conclusion: in an HP endemic country, the prevalence of HP infection among symptomatic patients belonging to the upper socioeconomic segment of the population appears to be markedly lower. The lowest prevalence in young patients is expected to result in future decrease in HP prevalence.