Person: SEVEN, GÜLSEREN
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Publication Open Access Differentiating Gastrointestinal Stromal Tumors from Leiomyomas Using a Neural Network Trained on Endoscopic Ultrasonography Images.(2021-10-07T00:00:00Z) Seven, GÜLSEREN; Silahtaroglu, Gokhan; Seven, Ozden Ozluk; Senturk, Hakan; SEVEN, GÜLSERENBackground: Endoscopic ultrasonography (EUS) is crucial to diagnose and evaluate gastrointestinal mesenchymal tumors (GIMTs). However, EUS-guided biopsy does not always differentiate gastrointestinal stromal tumors (GISTs) from leiomyomas. We evaluated the ability of a convolutional neural network (CNN) to differentiate GISTs from leiomyomas using EUS images. The conventional EUS features of GISTs were also compared with leiomyomas. Patients and methods: Patients who underwent EUS for evaluation of upper GIMTs between 2010 and 2020 were retrospectively reviewed, and 145 patients (73 women and 72 men; mean age 54.8 ± 13.5 years) with GISTs (n = 109) or leiomyomas (n = 36), confirmed by immunohistochemistry, were included. A total of 978 images collected from 100 patients were used to train and test the CNN system, and 384 images from 45 patients were used for validation. EUS images were also evaluated by an EUS expert for comparison with the CNN system. Results: The sensitivity, specificity, and accuracy of the CNN system for diagnosis of GIST were 92.0%, 64.3%, and 86.98% for the validation dataset, respectively. In contrast, the sensitivity, specificity, and accuracy of the EUS expert interpretations were 60.5%, 74.3%, and 63.0%, respectively. Concerning EUS features, only higher echogenicity was an independent and significant factor for differentiating GISTs from leiomyomas (p < 0.05). Conclusions: The CNN system could diagnose GIMTs with higher accuracy than an EUS expert and could be helpful in differentiating GISTs from leiomyomas. A higher echogenicity may also aid in differentiation.Publication Metadata only Early prediction of the severe course, survival, and ICU requirements in acute pancreatitis by artificial intelligence(2023-01-01) İnce A. T.; Silahtaroğlu G.; Seven G.; Koçhan K.; Yıldız K.; Şentürk H.; İNCE, ALİ TÜZÜN; SEVEN, GÜLSEREN; KOÇHAN, KORAY; ŞENTÜRK, HAKANAbstractObjectiveTo evaluate the success of artificial intelligence for early prediction of severe course, survival, and intensive care unit(ICU) requirement in patients with acute pancreatitis(AP).MethodsRetrospectively, 1334 patients were included the study. Severity is determined according to the Revised Atlanta Classification(RAC). The success of machine learning(ML) method was evaluated by 13 simple demographic, clinical, etiologic, and laboratory features obtained on ER admission. Additionally, it was evaluated whether Balthazar-computerized tomography severity index(CTSI) at 48-h contributed to success. The dataset was split into two parts, 90% for ML(of which 70% for learning and 30% for testing) and 10% for validation and 5-fold stratified sampling has been utilized. Variable Importance was used in the selection of features during training phase of machine. The Gradient Boost Algorithm trained the machine by KNIME analytics platform. SMOTE has been applied to increase the minority classes for training. The combined effects of the measured features were examined by multivariate logistic regression analysis and reciever operating curve curves of the prediction and confidence of the target variables were obtained.ResultsAccuracy values for the early estimation of Atlanta severity score, ICU requirement, and survival were found as 88.20%, 98.25%, and 92.77% respectively. When Balthazar-CTSI score is used, results were found as 91.02%, 92.25%, and 98% respectively.ConclusionsThe ML method we used successfully predicted the severe course, ICU requirement and survival, with promising accuracy values of over 88%. If 48-h Balthazar-CTSI is included in the calculation, the severity score and survival rates increase even more.Publication Metadata only Pankreas Divisum’un Akut Pankreatit’te Yeri, Takipli Hastalarda Restenoz ve Malignite Gelişenlerin Özellikleri(2021-11-21T00:00:00Z) Köker, İbrahim Hakkı; Biberci Keskin, Elmas; Koçhan, Koray; Kiremitçi, Sercan; Değirmencioğlu, Şerife; Seven, Gülseren; İnce, Ali Tüzün; Şentürk, Hakan; KÖKER, İBRAHİM HAKKI; BİBERCİ KESKİN, ELMAS; KOÇHAN, KORAY; KİREMİTÇİ, SERCAN; DEĞİRMENCİOĞLU, ŞERİFE; SEVEN, GÜLSEREN; İNCE, ALİ TÜZÜN; ŞENTÜRK, HAKANGİRİŞ: Pankreas divisum (PD) akut pankreatit’le (AP) başvuran hastalarda tanı konulması zor olabilen bir konjenital patolojidir. Amacımız PD’lu hastaların AP’deki sıklıklarını ve takip sonuçlarını değerlendirmekti.METODLAR: Retrospektif olarak AP ile başvuran 524 hastanın 32 (%6.1)’inde kesitsel ve endosonografik olarak PD tanısı koyduk. Pankreas divisum’lu hastaların yaş ve cinsiyet özellikleriyle takipte restenoz ve malignite gelişen hastaların özelliklerini değerlendirdik.BULGULAR: Akut pankreatitle başvuran 524 hastada etyolojik olarak ilk sırada biliyer patolojiler (n=308(58.7), 191(%62) kadın) bulunurken, PD’lu 32 (%6), 18(%56.3) erkek, yaş ortalaması 44.7±15.1 yıl (min-maks 16-75) hastada biliyer etyolojiden anlamlı olarak yaş (p<0.001) ve cinsiyet (p<0.001) farklı saptadık. Hastaların 29’u (%90.6) komplet tipti (17(58.6) erkek). Inkomplet PD’nin 2’si kadın, 1’i erkekti. Hastaların 20’sine (%62.5) tedavi amaçlı wirsung’a minor papilladan plastik stent yerleştirildi. Takipte 4 (%20) hastada stent sonrası minor papilla’da restenoz gelişti. Bunların 3 (%75)’ü erkekti. Restenoz gelişen 4 hastanın yaş ortalaması 44±12.3, (min-maks 28-57) yıldı. Bu hastalardan 1’ine endosonografik wirsungogastrostomi ile wirsung-gastrik duvar arasında fistül oluşturularak wirsung içindeki taşlar temizlendi. Takip esnasında 1 inkomplet (60 yaş), 1 komplet PD’li (44 yaş) 2 erkekten birisinin pankreas baş ve gövdesinde, diğerinin pankreas başında CA 19-9 eksprese etmeyen agresif seyirli pankreatik duktal adeno karsinom saptadık.SONUÇ: Pankreas divisum AP’de düşük oranda ve erkek cinsiyette daha fazla iken, restenoz ve malignite gelişimini de yine erkeklerde daha sık saptadık. Restenoz tedavisinde ise wirsungo-gastrostomik fistül oluşturma yaklaşımı uygun bir seçenek olabilir. Anahtar Kelimeler: akut pankreatit, malignite, pankreas divisum, restenozPublication Metadata only EFFECT OF CHOLECYSTECTOMY ON PREVENTING RECURRENCE OF ACUTE PANCREATITIS(2022-10-11) Seven G.; Musayeva G.; İnce A. T.; Biberci Keskin E.; SEVEN, GÜLSEREN; İNCE, ALİ TÜZÜN; BİBERCİ KESKİN, ELMASBackground and AimsCurrent guidelines recommend cholecystectomy in patients with acute biliary pancreatitis (ABP) to prevent recurrence. Some studies suggest that a significant portion of patients with idiopathic acute pancreatitis (IAP) results from occult biliary disease and cholecystectomy, after an episode of IAP, reduces the risk of recurrent pancreatitis. However, in these studies, the work-up for potential biliary cause is not extensive and do not include endoscopic ultrasound (EUS), which can detect a biliary disease up to one-third of patients with IAP. In this study, we aimed to ascertain whether cholecystectomy can prevent pancreatitis recurrence in patients with ABP and IAP.MethodsAdult patients (over 18 years) with first episode of acute pancreatitis (AP) who admitted to inpatient clinic between January 1, 2015 and December 31, 2021 at a tertiary referral center were retrospectively reviewed. Medical records were scrutinized and relevant data extracted. In addition, a questionnaire either by mail or telephone was used. Patients with biliary and idiopathic AP were included in the analysis. Patients with chronic pancreatitis, previous pancreatic surgery, pancreatic cancer, and other etiologies were excluded. Primary outcome was recurrence rate. The diagnosis of IAP was confirmed by exclusion of all known etiological factors for AP using extensive work-up, including EUS and/or magnetic resonance cholangiopancreatography (MRCP).ResultsA total of 500 patients with first episode of AP (300 patients with ABP and 200 patients with IAP) were identified. The mean age was 58 years and 267 women, 233 men. The patients were divided into three different groups: Group 1; patients who had their first pancreatitis attack after cholecystectomy, Group 2; patients who had their gallbladder in situ during the first attack and followed by cholecystectomy and Group 3; patients who had their gallbladder in situ during the first attack but did not have cholecystectomy. The number of patients with recurrence after the first episode of AP were not statistically different in whole study group (25%, 19% and 15%, respectively, P = 0.176). In the subgroup of patients with ABP, the recurrence was higher in group 1 as compared with group 2 and 3 (39%, 19% and 14%, respectively, P = 0.018). On the other hand, in the subgroup of patients with IAP, there was no significant difference among the groups in terms of recurrence (15%, 18%, and 17%, respectively, P = 0.999). When patients with in situ gallbladder during their first attack were compared according to their cholecystectomy history (group 2 vs. group 3), no significant difference was found in neither the ABP nor the IAP subgroups (19% vs 14% and 18% vs. 17%, respectively, P > 0.05). In addition, the effect of endoscopic retrograde cholangiopancreatography (ERCP) on recurrence of pancreatitis was evaluated. In subgroup of ABP, ERCP was effective for reducing the recurrence in group 2 (P = 0.008), while it was not found statistically significant in group 1 and 3. In subgroup of IAP, it ERCP did not reduce the recurrence in any of the groups.ConclusionsIn ABP, the recurrence is high in patients who have their first pancreatitis attack after cholecystectomy. Cholecystectomy alone is not effective preventing recurrence in patients with gallbladder in situ during the first episode; however, the risk can be decreased with adding ERCP to cholecystectomy. On the other hand, cholecystectomy is not effective in reducing the recurrence in patients with IAP.Key Words: Acute biliary pancreatitis; Idiopathic acute pancreatitis; Cholecystectomy.References:1. Crockett SD, Wani S, Gardner TB, et al. American Gastroenterological Association Institute Guideline on Initial Management of Acute Pancreatitis. American Gastroenterological Association Institute Clinical Guidelines Committee. Gastroenterology. 2018 Mar;154(4):1096-1101.2. Räty S, Pulkkinen J, Nordback I, et al. Can Laparoscopic Cholecystectomy Prevent Recurrent Idiopathic Acute Pancreatitis?: A Prospective Randomized Multicenter Trial. Ann Surg. 2015 Nov;262(5):736-41.3. D S Umans, N D Hallensleben , R C Verdonk, et al. Recurrence of idiopathic acute pancreatitis after cholecystectomy: systematic review and meta-analysis. Br J Surg 2020 Feb;107(3):191-199.Publication Metadata only Siroz(2021-09-01T00:00:00Z) Seven, Gülseren; SEVEN, GÜLSERENPublication Metadata only Effects of tissue cytomegalovirus quantitative polymerase chain reaction in the management of ulcerative colitis flare-ups: Should we wave aside?(2021-12-03T00:00:00Z) Kochan, Koray; Seven, Gulseren; Bas, Suleyman; Kiremitci, Sercan; Gecer, Melin; Senturk, Hakan; BİBERCİ KESKİN, ELMAS; SEVEN, GÜLSERENPublication Metadata only Evaluation of Ki67 index in endoscopic ultrasound-guided fine needle aspiration samples for the assessment of malignancy risk in gastric gastrointestinal stromal tumors.(2020-10-05T00:00:00Z) Senturk, Hakan; Seven, GÜLSEREN; Kochan, KORAY; Caglar, Erkan; Kiremitci, Sercan; Koker, Ibrahim Hakki; SEVEN, GÜLSEREN; KOÇHAN, KORAY; KÖKER, İBRAHİM HAKKI; ŞENTÜRK, HAKANBackground: The risk of malignancy in resected gastrointestinal stromal tumors (GISTs) depends on tumor size, location, and mitotic index. Reportedly, the Ki67 index has a prognostic value in resected GISTs. We aimed to analyze the accuracy of endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) samples with reference to Ki67 index, using surgical specimens as the gold standard. Methods: Fifty-five patients who underwent EUS-FNA followed by surgical resection for gastric GISTs were retrospectively analyzed. Patients’ age and sex; tumors’ size and location; mitotic index, cell type, cellularity, pleomorphism, presence of ulceration, hemorrhage, necrosis, mucosal or serosal invasion, growth pattern, and Ki67 index based on pathology were investigated. Results: Location in fundus, ulceration, hemorrhage, mucosal invasion, and Ki67 index in surgical specimens were significant in predicting high-risk groups (P < 0.05) on univariate analysis. resence of bleeding (P = 0.034) and the Ki67 index (P = 0.018) were the only independent significant factors in multivariate analysis. The optimal cutoff level of Ki67 was 5%, with 88.2% sensitivity and 52.8% specificity (P = 0.021). The mean Ki67 index was lower in EUS-FNA samples than in surgical specimens [2% (1-15) vs. 10% (1-70), P = 0.001]. The rank correlation coefficient value of Ki67 was 0.199 (P = 0.362) between EUS-FNA and surgical samples and showed no reliability for EUS-FNA samples. Conclusion: The Ki67 index in resected specimens correlated with high-risk GISTs, although it had no additive value to the current criteria. The Ki67 index in EUS-guided FNA samples is not a reliable marker of proliferation in GISTs.Publication Metadata only Gastrik Varislerin Endoscopik Ultrasonografi Eşliğinde Coil Embolizasyonu Tedavisi: Coil ve Coil+Siyanoakrilat Kombinasyonun Karşılaştırılması(2021-11-19T00:00:00Z) Seven, Gülseren; Musayeva, Günel; Seven, Özden Özlük; Kiremitçi, Sercan; İnce, Ali Tüzün; Şentürk, Hakan; SEVEN, GÜLSEREN; İNCE, ALİ TÜZÜN; ŞENTÜRK, HAKANAMAÇ: Gastrik varis kanamaları özofagus varis kanamaları ile karşılaştırıldığında daha nadir görülmekle beraber şiddeti, tekrar kanama riski ve mortalite oranı daha yüksektir. Gastroözofageal varis (GOV) tip I’lerin özofagus varisleri gibi tedavi edilmesi önerilirken GOV tip II ve izole gastric varis (IGV)’lerin yönetimi konusunda kesin görüş birliği yoktur. Çalışmanın amacı gastrik varis tedavisinde EUS eşliğinde coil embolizasyonunu coil ve siyanoakrilat kombine tedavisinin etkinliğini ile karşılaştırmaktır.YÖNTEM: Ocak 2011-Ocak 2021 yılları arasında GOV tip II ve IGV tip I gastrik varis tedavisi için EUS-eşliğinde coil embolizasyonu uygulanan 22 hasta retrospektif olarak değerlendirildi. Hastalar izole coil embolizasyonu (n=13) ve coil+siyanoakrilat kombine tedavisi (n=9) alanlar olmak üzere iki gruba ayrıldı. Tekrar kanama, tekrar girişim ve sağ kalım oranları karşılaştırıldı.BULGULAR: İki grup arasında başlangıç klinik ve endoskopik özellikler arasında fark yoktu. Hastaların ortalama yaşı 55.9±12.9 (28–77) yıl, 12’si erkekti. Varis tipi 17 hastada GOV II, 5 hastada IGV I idi. İndeks endoskopide, 3 hastada aktif kanama, 12 hastada geçirilmiş kanama bulgusu, 7 hastada ise kanama bulgusu olmaksızın yüksek riskli varis mevcuttu. Coil sayısı ve boyutları arasında iki grup arasında fark görülmedi. Ortalama yaşam süresi her iki grupta benzerdi (67.9 [34.9-100.9] vs. 85.9 [56.2-115.6] ay, P>0.05). Tekrar kanama (3 vs. 1, P>0.05) ve tekrar girişim ( 3 vs. 2, P>0.05) oranları bakımından gruplar arasında fark görülmedi.SONUÇ: EUS-eşliğinde coil embolizasyonu aktif kanama tedavisinde, primer ve sekonder kanama proflaksisinde güvenli ve etkili olup CYA ile kombine tedavi tek başına coil embolizasyonu ile karşılaştırıldığında tekrar kanama, tekrar işlem gereksinimi ve sağ kalım oranları bakımından daha üstün değildir.Anahtar Kelimeler:Coil embolizasyonu, Endoskopik Ultrasonografi, Gastrik varis, SiyanoakrilatTablo 1Coil(n = 13)Coil + Siyanoakrilat(n = 9)P değeriYaş, ortalama ± SD, yıl58.6±12.552.1±13.40.257CinsiyetErkekKadın8 (61.5%)5 (38.5%)5 (55.6%)4 (44.4%)>0.999Portal ven trombozu5 (38.5%)1 (11.1%)0.333Siroz11 (84.6%)8 (88.9%)>0.999Siroz şiddetiChild-Pugh skor, median (aralık)MELD skor, median (aralık)7 (5-9)10 (7-15)6 (5-10)9 (7-20)0.3570.794Hepatosellular karsinoma0 (0.0%)1 (11.1%)0.409Özofagus varisleri9 (69.2%)8 (88.9%)0.360Endikasyon, n (%)Primary proflaksiSecondary proflaksi6 (46.2%)7 (53.8%)1 (11.1%)8 (88.9%)0.165Gastrik varis tipi, n (%)GOV IIIGV I10 (76.9%)3 (23.1%)7 (77.8%)2 (22.2%)0.999Coil sayısı, median (aralık)5 (3-9)5 (3-9)0.471Total coil boyutu, mm78.5±29.266.1±20.20.286Erken tekrar kanama, n (%)1 (7.7%)1 (11.1%)>0.999Yan etki, n (%)1 (7.7%)1 (11.1%)>0.999Takip süresi, ay8.7 (1-29.1)10.3 (1-110.2)0.512Hastaların klinik ve demografik özellikleriPublication Metadata only The natural course of non-alcoholic fatty liver disease.(2020-01-20) Seval G. C.; Kabacam G.; Yakut M.; Seven G.; Savas B.; Elhan A.; Cinar K.; Idilman R.; SEVEN, GÜLSERENPublication Metadata only Use of Artificial Intelligence in the Prediction of Malignant Potential of Gastric Gastrointestinal Stromal Tumors.(2021-02-06T00:00:00Z) Ince, Ali Tuzun; Seven, GÜLSEREN; Senturk, Hakan; Kochan, Koray; Arici, Dilek Sema; SEVEN, GÜLSEREN; İNCE, ALİ TÜZÜN; ŞENTÜRK, HAKAN