Background: Diabetes mellitus (DM) is a condition that may increase the severity of acute pancreatitis (AP) through chronic inflammation and disturbances in immune responses. However, the independent effect of DM on clinical outcomes in AP has not yet been fully elucidated. Methods: In this retrospective cohort study, 492 patients diagnosed with acute pancreatitis at the Gastroenterology Clinic of Ankara Bilkent City Hospital between January 2022 and March 2025 were included. Patients were divided into two groups based on the presence of diabetes, and outcomes were compared using statistical methods. Results: Of the total 492 patients (mean age 58.6 ± 17.2 years; 50.2% female) included, 98 (19.9%) had DM. Moderate-to-severe AP occurred in 67.3% of diabetic versus 37.8% of non-diabetic patients (p < 0.0001), and severe disease developed more frequently in the diabetic group (6.1% vs. 1.0%, p = 0.0057). Systemic complications were significantly more common in patients with diabetes (45.9% vs. 26.9%, p = 0.0004). Hospital mortality was higher among patients with diabetes (9.2% vs. 4.6%, p = 0.0344), and Kaplan–Meier analysis demonstrated numerically lower overall survival in patients with diabetes (log-rank p = 0.095), with early divergence in survival curves. Cox proportional hazards analysis confirmed diabetes as an independent predictor of in-hospital mortality (adjusted HR 2.64, 95% CI 1.17–5.97; p = 0.019). After adjustment for confounders, diabetes remained independently associated with the development of moderate/severe pancreatitis (adjusted OR 2.00, 95% CI 1.24–3.22; p = 0.004). Diabetes also independently predicted in-hospital mortality (adjusted OR 3.36, 95% CI 1.35–8.34; p = 0.009), along with APACHE II score. ROC analysis demonstrated that adding diabetes mellitus to the APACHE II score significantly improved mortality prediction compared with APACHE II alone (AUC 0.785 vs. 0.724). The retrospective and single-center design of this study may limit its generalizability and create potential selection bias. There were insufficient data on the type of diabetes, its duration, and glycemic control (e.g., HbA1c), and therefore, we could not assess these factors, all of which may influence risk estimates. Although the survival curves showed early divergence, the borderline log-rank significance (p = 0.095) highlights the limited statistical power to detect long-term survival differences in this cohort. Conclusions: DM is associated with substantially increased severity and in-hospital mortality in AP, primarily through an elevated risk of systemic organ failure. Incorporation of diabetes status into early severity stratification may improve prognostic accuracy and guide closer monitoring and timely interventions in this high-risk population.

Background: Pre-procedural anxiety is known to impact the quality of upper gastrointestinal endoscopy (esophagogastroduodenoscopy, EGD), particularly in non-sedated patients. Elevated anxiety levels can cause discomfort and reduce procedural success. Objectives: This study aimed to evaluate the effect of pre-procedural anxiety, measured by the State-Trait Anxiety Inventory (STAI), on the quality of EGD and to determine whether anxiety levels can predict the need for sedation. Design: This was a prospective, cross-sectional study conducted at a tertiary care hospital. Methods: This study included 1344 non-sedated patients aged 18–90 years undergoing EGD at Ankara Etlik City Hospital (September 2023–March 2024). Anxiety levels were assessed using STAI before the procedure. Receiver operating characteristic (ROC) analysis determined the optimal STAI-I cutoff for predicting sedation needs. EGD quality was evaluated by examination thoroughness and biopsy adequacy. Logistic regression identified predictors of unsuccessful procedures. Results: The mean participant age was 50.6 years; 47.8% were male. The average STAI-I score was 42.14. ROC analysis identified an STAI-I cutoff of 36, above which unsuccessful procedures were more likely (area under the curve = 0.720, p < 0.001). Higher STAI-I and STAI-II scores were independent predictors of unsuccessful endoscopy, with each unit increase in STAI-I raising the odds by 3.8%. Conclusion: Pre-procedural anxiety, as measured by STAI, significantly affects non-sedated EGD quality. An STAI-I cutoff of 36 predicts the need for sedation. Routine anxiety assessment could enhance sedation strategies, patient satisfaction, and procedure quality. Trial registration : Not applicable.

Background/Aims: The efficacy and safety of Zenker’s peroral endoscopic myotomy (Z-POEM), a current method in the treatment of Zenker’s diverticulum (ZD), have been demonstrated in a limited number of studies and case reports. This study aimed to report our experience with the Z-POEM method. Materials and Methods: Patients with ZD who were treated with Z-POEM between January 2019 and March 2023 and had a followup period of at least 3 months were included in the study. Our primary endpoint was clinical success. A Kothari–Haber score (KHS) of 2 or less at 1 month postoperatively was defined as clinical success. Our secondary endpoints were adverse events and recurrence rates. Results: In total, 20 patients (males, 65%; mean age, 63 ± 14.4 years) were treated with Z-POEM. The mean ZD septum length was 33.7 (±11.04) mm. The technical success rate was 100% (20/20), and the clinical success rate was 95% (19/20). In 1 case with a large ZD (septum length of 60 mm), the mucosal septum, which was thought to cause partial persistence of symptoms, was treated by endoscopic septotomy. The mean KHS decreased significantly after Z-POEM (preoperative KHS: 7.3 and postoperative KHS: 0.15, P < .0001). The median follow-up period was 10 months (interquartile range, 3-39). No recurrence was observed in any case. Intraprocedural mild subcutaneous emphysema was observed in 4 (20%) cases. Emphysema regressed spontaneously in the postoperative period without any treatment. Conclusion: Zenker’s peroral endoscopic myotomy is a successful and reliable method in the treatment of ZD, with low recurrence rates. Cite this article as: Buyruk AM, Erdoğan Ç. Efficacy and safety of peroral endoscopic myotomy in the treatment of Zenker’s diverticulum: A single-center experience. Turk J Gastroenterol. 2024;35(2):119-124.

Traumatic pancreatic injuries (TPI) are rare, critical complications increasingly managed by minimally invasive Endoscopic Retrograde Cholangiopancreatography (ERCP). We systematically reviewed and meta-analyzed ERCP’s efficacy and safety for TPI regarding pancreatic duct integrity and clinical outcomes in diverse populations. PubMed, Scopus, Cochrane Library, and Web of Science were searched (2000–2024) for studies reporting on ERCP for TPI. Primary outcomes were pancreatic duct integrity and complications; secondary outcomes included mortality and hospital stay. Pediatric and adult populations were compared via subgroup analysis. Publication bias was assessed. Fifteen studies comprising 1,823 patients (54% male, 32% pediatric) were included in the meta-analysis. ERCP demonstrated a pooled clinical success rate of 89% (95% CI: 83–93%) and significantly improved pancreatic duct integrity (OR for pancreatic duct integrity: 9.17, 95% CI: 6.73–12.49). Complication rates ranged from 4 to 17%, with pancreatitis and bleeding being the most common adverse events. Mortality rates were low (3–5%), and ERCP significantly reduced hospital stay by an average of 3.1 days compared to surgical interventions. Pediatric patients had slightly lower success rates (OR: 6.73, 95% CI: 4.01–11.31) compared to adults (OR: 10.87, 95% CI: 7.40–15.98). ERCP is an effective and safe modality for managing TPI in both pediatric and adult patients, yielding high success rates in maintaining ductal integrity and reducing complications, although interpretation requires caution due to potential publication bias. Further prospective studies are required to optimize standardized protocols.

Non-gastric upper gastrointestinal system polyps are detected rarely and mostly incidentally during upper gastrointestinal endoscopy. While the majority of lesions are asymptomatic and benign, some lesions have the potential to become malignant, and may be associated with other malignancies. Between May 2010 and June 2022, a total of 127,493 patients who underwent upper gastrointestinal endoscopy were retrospectively screened. Among these patients, those who had polyps in the esophagus and duodenum and biopsied were included in the study. A total of 248 patients with non-gastric polyps were included in this study. The esophageal polyp detection rate was 80.00/100,000, while the duodenal polyp detection rate was 114.52/100,000. In 102 patients (41.1%) with esophageal polyps, the mean age was 50.6 ± 15.1, and 44.1% (n = 45) were male. The most common type of polyps was squamous papilloma (n = 61, 59.8%), followed by inflammatory papilloma (n = 18, 17.6%). In 146 patients (58.9%) with duodenal polyps, the mean age of patients was 58.3 ± 16.5, and 69.8% (n = 102) were male. Brunner's gland hyperplasia, inflammatory polyp, ectopic gastric mucosa, and adenomatous polyp were reported to be the most prevalent types of polyps in the duodenum overall (28.1%, 27.4%, 14.4%, and 13.7%, respectively). It is crucial to identify rare non-gastric polyps and create an effective follow-up and treatment plan in the era of frequently performed upper gastrointestinal endoscopies. The epidemiological assessment of non-gastric polyps, as well as a follow-up and treatment strategy, are presented in this study.

Background/Aims: This retrospective single-center study aimed to assess the safety of early feeding in patients who met certain criteria following peroral endoscopic myotomy (POEM). Materials and Methods: Data from 100 patients who underwent POEM at our center between January and December 2022 were collected. Early feeding was defined as the introduction of clear liquid foods at 4 hours post procedure. At 4 and 24 hours, the pain was rated using the visual analog scale (VAS) in all patients. Patients without intraoperative complications (pneumoperitoneum requiring needle drainage, severe arterial bleeding requiring the use of hemostatic forceps, severe mucosal injury) and severe pain (VAS score 6) and nausea-vomiting at the fourth postoperative hour were given the early feeding approach. In patients who did not meet these requirements, enteral feeding was initiated after 24 hours (late feeding). Results: Among the 100 patients, 50 patients were categorized early feeding. No patients had a control esophagogram. In the early and late enteral feeding groups, VAS scores were 4 (0-6) and 6 (1-8) (P < .001) at 4 hours and 1 (0-3) and 1 (0-6) (P = .043) at 24 hours, respectively. No severe complications were developed after early feeding. The median hospital stay in the early feeding group was 1 (1-3) day. There was no emergency readmission in any of early feeding patients. Conclusion: Our study showed early feeding following POEM can be begun in achalasia patients who do not have intraoperative complications, severe pain, or nausea/vomiting. Cite this article as: Buyruk AM, Erdoğan Ç, Tekin F. The impact of early nutrition following peroral endoscopic myotomy in achalasia: A tertiary center experience. Turk J Gastroenterol. 2024;35(3):186-192.