Introduction: Methotrexate (MTX) causes hepatotoxicity by producing oxidative stress. Benfotiamine and irisin have protective effects against oxidative stress. The aim of this study was to investigate the changes in irisin activity in the liver as a result of toxicity produced by MTX and the protective role of benfotiamine in the hepatotoxicity. Material and methods: Rats were divided into 4 groups as follows: control, benfotiamine (50 mg/kg, oral gavage (o.g.), for 14 days), MTX (MTX 20 mg/kg intraperitoneally (i.p.) on day 1), MTX + benfotiamine (MTX 20 mg/kg (i.p.) on day 1, then 50 mg/kg (o.g.) benfotiamine for 14 days). Liver tissue was used to examine histopathological and immunohistochemical changes. Serum was used to look for oxidative stress markers (total antioxidant status (TAS) and total oxidant status (TOS)). Results: Administration of MTX caused a significant TOS increase and TAS decrease in the serum as compared to the control group. Immunohistochemically, irisin was significantly increased in immunoreactivity in the MTX group as compared to the control group (p < 0.05). Significant histopathological improvement and decrease in serum TOS levels were observed in the MTX + benfotiamine group compared to the MTX group (p < 0.05). In addition, an increase in TAS level and a decrease in irisin immunoreactivity were observed but they were not statistically significant (p > 0.05). Conclusions: Our results showed that MTX caused an increase in the activity of irisin after producing toxicity in the liver. In addition, we found that benfotiamine was effective in preventing damage caused by MTX in the liver.

Aim: To investigate whether mean platelet volume (MPV) is a predictor of variceal bleeding in patients with cirrhotic portal hypertension. Materials and methods: This prospective cohort was performed in the internal medicine department of our tertiary care center. Cirrhotic patients were allocated into two groups: Group I consisted of 31 cases without a history of variceal bleeding, whereas group II was made up of 31 patients with a history of variceal bleeding. Data derived from medical history, physical examination, ultrasonography, gastrointestinal system endoscopy, complete blood count, hepatic, and renal function tests were recorded and compared between two groups. On physical examination, encephalopathy and ascites were evaluated and graded with respect to Child–Pugh–Turcotte classification. Results: There was no significant difference between the two groups in terms of age, duration of the disease, and gender of the patient. The only remarkable difference was that hemoglobin (p = 0.02) and hematocrit (p = 0.02) values were lower in group II. Neither the etiology of bleeding was different between groups nor did MPV seem to have a noteworthy impact on bleeding. Interestingly, risk of variceal bleeding increased in parallel to the higher grade of varices. Conclusion: Our results imply that there is a correlation between the grade of varices and esophageal variceal bleeding in cirrhotic patients. However, association between MPV and variceal bleeding could not be demonstrated. Utilization of noninvasive tests as predictors in these patients necessitates further controlled trials on larger series. How to cite this article: Erdogan MA, Benli AR, Acmali SB, Koroglu M, Atayan Y, Danalioglu A, Kayhan B. Predictive Value of Mean Platelet Volume in Variceal Bleeding due to Cirrhotic Portal Hypertension. Euroasian J Hepato-Gastroenterol 2017;7(1):6-10.

Background/Aims: Although living donor liver transplantation (LDLT) has been accepted as a primary treatment for adults with end-stage liver disease, concerns about donor health have been emerged. As LDLT is technically complex, it creates perioperative morbidity and mortality risk in donors. Biliary complications such as stricture and leakage are seen most frequently in donors after liver transplantation. While some of these complications get treated with conservative approach, endoscopic, surgical, and percutaneous interventions may be required in some others. We aimed to present endoscopic retrograde cholangiography (ERC) results in donors who developed biliary complications after LDLT. Materials and Methods: Between June 2010 and January 2018, a total of 1521 donors (1291 right lobe grafts, 230 left lobe grafts) of patients who underwent LDLT, were retrospectively reviewed. 63 donors who underwent ERC due to biliary complication, were included in the study. Results: Biliary stricture was found in 1.6% (25/1521), biliary leakage in 2.1% (33/1521), and stricture and leakage together in 0.3% (5/1521) donors. Our endoscopic success rates in patients with biliary leakage, biliary stricture, and stricture and leakage were 85% (28/33), 92% (23/25), and 80% (4/5), respectively. Surgical treatment was performed on 12.6% (8/63) donors who failed ERC. Conclusion: We found that ERC is a successful treatment for post-LDLT donors who have biliary complications.

Purpose: Almost all of the publications regarding the treatment of biliary complications after liver transplantation are related to biliary complications after right lobe living donor liver transplantation (LDLT) and cadaveric liver transplantation (LT). The number of publications regarding endoscopic treatment of biliary complications after left lobe LDLT is negligible. In this study, we aimed to present the results of endoscopic treatments applied in the management of biliary complications developed in left-lobe duct-to-duct LDLT patients. Patients and methods: Between 2008 and 2018, patients with duct-to-duct anastomosis who underwent ERCP due to biliary complication after left lobe LDLT were included in the study. Clinical data included patient demographics, indications for LDLT, duration till the first ERCP after LDLT, number of ERCP procedures, ERCP indications (stricture or leak), and treatment outcomes, including the need for percutaneous and surgical interventions. Results: Among 13 patients who underwent ERCP, 2 (15%) had biliary leakage and 11 (8%) had an anastomotic stricture. Our endoscopic success rate was 100% in patients with biliary stricture. Despite the implementation of ERCP on two patients with leakage, they died due to the biliary complication. Conclusion: Our results suggest that endoscopic treatment methods are successful in the management of biliary stricture complication in patients with left lobe LDLT and duct-to-duct anastomosis. Although our findings show that endoscopic treatments fail when there is a leakage after left lobe LDLT, there is a need for further studies that include more patients to reach a definite conclusion.

Our aim was to present the results of endoscopic retrograde cholangiopancreatography (ERCP) after living donor liver transplantation (LDLT) between February 2015 and June 2021. Clinical data included LDLT indications, time to perform ERCP after LDLT, number of ERCP procedures, indications for ERCP, and all treatment outcomes, including ERCP, percutaneous, and surgical interventions. We compared the obtained data with our previous study published by our team in 2018, which included 446 patients who underwent ERCP for biliary complications after LDLT between 2005 and 2015. We performed ERCP in 283 of 1506 patients with LDLT who underwent duct-to-duct anastomosis during transplantation and then developed biliary complications. Our endoscopic success rates were 60.9% and 71.0% in the previous and present studies, respectively. Our findings suggest that the success rate of endoscopic treatment of biliary complications in patients with LDLT increases in correlation with the increasing experience of clinicians treating these patients.

Myeloid sarcoma (MS) is a hematologic malignancy composed of myeloblasts or immature myeloid cells presenting in the extramedullary region. MS frequently involves bone, soft tissue, skin, lymph nodes, as well as the genitourinary and gastrointestinal systems. We wanted to present a case of MS presenting with duodenal involvement. A 22-year-old male patient presented with abdominal pain and jaundice. Laboratory values of total bilurubin: 7.75 mg/dl, indirect bilurubin: 6.7 mg/dl, GGT: 215 U/L. ERCP showed dilated choledochal dilatation with migrated stent and stenosis at the distal end. The existing stent was removed and a 10 FR 12 cm biliary plastic stent was placed proximal to the stenosis. Since hyperemic, erosion lesions were observed in the mouth of Oddi and duodenum, biopsies were taken from that region. The biopsy result was reported as primary duodenal myeloid sarcoma. MS should be considered in gastrointestinal lesions.