Turkiye Klinikleri Journal of Medical Sciences

.: ORIGINAL RESEARCH
Çift Balonlu Enteroskopi ve Crohn Hastalığı: Gerçekten Güvenli ve Etkili Çalışır
Double Balloon Enteroscopy and Crohn's Disease: It Really Works Safely and Effectively
Göktuğ ŞİRİNa, Altay ÇELEBİa
aKocaeli Üniversitesi Tıp Fakültesi, Gastroenteroloji Bilim Dalı, Kocaeli, TÜRKİYE
Turkiye Klinikleri J Med Sci. 2020;40(2):132-40
doi: 10.5336/medsci.2020-73789
Article Language: TR
Full Text
ÖZET
 Amaç: Çift balonlu enteroskopi (ÇBE) yönteminin, Crohn hastalığı (CH) tanısı veya şüphesi olan hasta grubunda, hastalığın tanı ve tedavisindeki etkinliğinin ve güvenliliğinin değerlendirilmesidir. Gereç ve Yöntemler: Ocak 2008-Aralık 2015 tarihleri arasında, üniversitemiz gastroenteroloji bilim dalında ÇBE işlemi yapılan hastaların dosya ve bilgi kartları geriye dönük olarak incelendi. CH şüphesi veya CH tanısı olup ÇBE işlemi yapılmış olan hastalar ile farklı endikasyonlarda yapılan ÇBE işlemleri sonrasında CH tanısı konulan hastalar çalışmaya dâhil edildi. Bulgular: Altı yüz elli sekiz (405 erkek; ortalama yaş 57,9±11,6) hastaya toplam 936 ÇBE işlemi yapılmıştı. İşlem yapılan hastaların 440 (%66,9)'ında patolojik bulgu tespit edildi. ÇBE yapılması için en sık endikasyon, obskür gastrointestinal sistem kanaması (%41,3) idi. CH endikasyonuyla enteroskopi yapılmış hasta oranı %13,2 iken, CH şüphesi nedeni ile ÇBE işlemi yapılma oranının %8,4 olduğu görüldü. CH şüphesi ile ÇBE yapılan 55 hastanın 31'inde bu tanı doğrulanırken, tanısı bilinen 32 hastanın 9'unda yeni darlık alanı bulunduğu ve 11'inde ise hastalığın yayılımının arttığı görüldü. Farklı endikasyonlarla yapılan ÇBE işlemlerinde toplam 27 hastaya yeni CH tanısı konuldu. Yeni bulgu tespit edilen CH tanılı hastalar da değerlendirmeye katıldığında, ÇBE işleminin tanısal katkısı %11,9 (78/658) oldu. Sonuç: ÇBE işlemleri esnasında, özellikle histolojik tanı desteği sayesinde birçok hastada kesinleşmiş CH tanısı konulması mümkün olmaktadır. Klinik, radyolojik ve biyoşimik göstergelerin kılavuzluğunda kullanılması, ÇBE'nin tanı oranının artırılması için en doğru yöntem gibi gözükmektedir. Bu uygulama, deneyimli eller tarafından gerçekleştirildiğinde son derece emniyetlidir.

Anahtar Kelimeler: Çift balonlu endoskopi; enteroskopi; çift balonlu enteroskopi; Crohn hastalığı
ABSTRACT
 Objective: To evaluate the efficacy and safety of double balloon enteroscopy (DBE) method in the diagnosis and treatment of patients with known or suspicion Crohn's disease (CD). Material and Methods: Between January 2008-December 2015, data cards of patients who underwent DBE procedures in gastroenterology department of our university were examined retrospectively. Patients with suspected or known CD who underwent DBE procedure and patients diagnosed with CD after DBE procedures for different indications were included in the study. Results: A total of 936 DBEs were performed in 658 patients (405 men; mean age 57.9±11.6). The pathological findings were detected in 440 (66.9%) patients. The most common indication for DBE was obscure gastrointestinal bleeding (41.3%). The rate of patients who underwent enteroscopy with the indication of CD was 13.2%, whereas the rate of DBE procedure was 8.4% due to suspected CD. This diagnosis was confirmed in 31 of 55 patients who underwent DBE with the suspicion of CD. A total of 27 patients were diagnosed with new CD in DBE procedures with different indications. The diagnostic contribution of the DBE procedure was 11.9% (78/658) when included of patients with known CD who have been detected new findings. Conclusion: The definitive diagnosis of CD is possible in many patients during DBE procedures especially with the support of histology. Use of DBE guided by clinical, radiological, and biochemical indicators appears to be the most accurate way to increase the diagnostic rate of DBE. Procedure is highly safe, when performed by experienced hands.

Keywords: Double baloon endoscopy; enteroscopy; double balloon enteroscopy; Crohn's disease
REFERENCES:
  1. Loftus EV Jr. Clinical epidemiology of inflammatory bowel disease: incidence, prevalence, and environmental influences. Gastroenterology. 2004;126(6):1504-17. [Crossref]  [PubMed] 
  2. Cosnes J, Cattan S, Blain A, Beaugerie L, Carbonnel F, Parc R, et al. Long-term evolution of disease behavior of Crohn's disease. Inflamm Bowel Dis. 2002;8(4):244-50. [Crossref]  [PubMed] 
  3. Steinhardt HJ, Loeschke K, Kasper H, Holtermüller KH, Schäfer H. European Cooperative Crohn's Disease Study (ECCDS): clinical features and natural history. Digestion. 1985;31(2-3):97-108. [Crossref]  [PubMed] 
  4. Voderholzer WA, Beinhoelzl J, Rogalla P, Murrer S, Schachschal G, Lochs H, et al. Small bowel involvement in Crohn's disease: a prospective comparison of wireless capsule endoscopy and computed tomography enteroclysis. Gut. 2005;54(3):369-73. [Crossref]  [PubMed]  [PMC] 
  5. Pimentel M, Chang M, Chow EJ, Tabibzadeh S, Kirit-Kiriak V, Targan SR, et al. Identification of a prodromal period in Crohn's disease but not ulcerative colitis. Am J Gastroenterol. 2000;95(12):3458-62. [Crossref]  [PubMed] 
  6. Oshitani N, Yukawa T, Yamagami H, Inagawa M, Kamata N, Watanabe K, et al. Evaluation of deep small bowel involvement by double-balloon enteroscopy in Crohn's disease. Am J Gastroenterol. 2006;101(7):1484-9. [Crossref]  [PubMed] 
  7. Kopylov U, Yablecovitch D, Lahat A, Neuman S, Levhar N, Greener T, et al. Detection of small bowel mucosal healing and deep remission in patients with known small bowel Crohn's disease using biomarkers, capsule endoscopy, and imaging. Am J Gastroenterol. 2015;110(9):1316-23. [Crossref]  [PubMed] 
  8. Yamamoto H, Yano T, Kita H, Sunada K, Ido K, Sugano K. New system of double-balloon enteroscopy for diagnosis and treatment of small intestinal disorders. Gastroenterology. 2003;125(5):1556-7. [Crossref]  [PubMed] 
  9. Hülagü S, Şirin G. [Double balloon endoscopy and its role in current gastroenterology practice]. Turkiye Klinikleri J Gastroenterohepatol-Special Topics. 2012;5(1):78-87.
  10. Pata C, Akyüz Ü, Erzın Y, Mercan A. Double-balloon enteroscopy: the diagnosis and management of small bowel diseases. Turk J Gastroenterol. 2010;21(4):353-9. [Crossref]  [PubMed] 
  11. Akarsu M, Akkaya Özdinç S, Celtik A, Akpınar H. Diagnostic and therapeutic efficacy of double-balloon endoscopy in patients with small intestinal diseases: single-center experience in 513 procedures. Turk J Gastroenterol. 2014;25(4):374-80. [Crossref]  [PubMed] 
  12. Yamamoto H, Kita H, Sunada K, Hayashi Y, Sato H, Yano T, et al. Clinical outcomes of double-balloon endoscopy for the diagnosis and treatment of small-intestinal diseases. Clin Gastroenterol Hepatol. 2004;2(11):1010-6. [Crossref] 
  13. Rondonotti E, Spada C, Adler S, May A, Despott EJ, Koulaouzidis A, et al. Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) Technical Review. Endoscopy. 2018;50(4):423-46. [Crossref]  [PubMed] 
  14. Lee SD, Cohen RD. Endoscopy of the small bowel in inflammatory bowel disease. Gastrointest Endosc Clin N Am. 2002;12(3):485-93. [Crossref] 
  15. Stange EF, Travis SPL, Vermeire S, Beglinger C, Kupcinkas L, Geboes K, et al. European evidence based consensus on the diagnosis and management of Crohn's disease: definitions and diagnosis. Gut. 2006;55(Suppl 1):i1-15. [Crossref]  [PubMed]  [PMC] 
  16. Lakatos PL, Czegledi Z, Szamosi T, Banai J, David G, Zsigmond F, et al. Perianal disease, small bowel disease, smoking, prior steroid or early azathioprine/biological therapy are predictors of disease behavior change in patients with Crohn's disease. World J Gastroenterol. 2009;15(28):3504-10. [Crossref]  [PubMed]  [PMC] 
  17. Bourreille A, Ignjatovic A, Aabakken L, Loftus EV Jr, Eliakim R, Pennazio M, et al. Role of small-bowel endoscopy in the management of patients with inflammatory bowel disease: an international OMED-ECCO consensus. Endoscopy. 2009;41(7):618-37. [Crossref]  [PubMed] 
  18. Tun GSZ, Rattehalli D, Sanders DS, McAlindon ME, Drew K, Sidhu R. Clinical utility of double-balloon enteroscopy in suspected Crohn's disease: a single-centre experience. Eur J Gastroenterol Hepatol. 2016;28(7):820-5. [Crossref]  [PubMed] 
  19. Rahman A, Ross A, Leighton JA, Schembre D, Gerson L, Lo SK, et al. Double-balloon enteroscopy in Crohn's disease: findings and impact on management in a multicenter retrospective study. Gastrointest Endosc. 2015;82(1):102-7. [Crossref]  [PubMed] 
  20. Jeong SH, Lee KJ, Kim YB, Kwon HC, Sin SJ, Chung JY. Diagnostic value of terminal ileum intubation during colonoscopy. J Gastroenterol Hepatol. 2008;23(1):51-5. [Crossref]  [PubMed] 
  21. Koksal AR, Boga S, Alkim H, Ergun M, Bayram M, Sakiz D, et al. How does a biopsy of endoscopically normal terminal ileum contribute to the diagnosis? Which patients should undergo biopsy? Libyan J Med. 2014;9:23441. [Crossref]  [PMC] 
  22. Arulanandan A, Dulai PS, Singh S, Sandborn WJ, Kalmaz D. Systematic review: safety of balloon assisted enteroscopy in Crohn's disease. World J Gastroenterol. 2016;22(40):8999-9011. [Crossref]  [PubMed]  [PMC] 
  23. Morar PS, Faiz O, Warusavitarne J, Brown S, Cohen R, Hind D, et al. Systematic review with meta-analysis: endoscopic balloon dilatation for Crohn's disease strictures. Aliment Pharmacol Ther. 2015;42(10):1137-48. [Crossref]  [PubMed] 
  24. Kondo J, Iijima H, Abe T, Komori M, Hiyama S, Ito T, et al. Roles of double-balloon endoscopy in the diagnosis and treatment of Crohn's disease: a multicenter experience. J Gastroenterol. 2010;45(7):713-20. [Crossref]  [PubMed] 
  25. Sabaté JM, Villarejo J, Bouhnik Y, Allez M, Gornet JM, Vahedi K, et al. Hydrostatic balloon dilatation of Crohn's strictures. Aliment Pharmacol Ther. 2003;18(4):409-13. [Crossref]  [PubMed] 
  26. Pennazio M, Spada C, Eliakim R, Keuchel M, May A, Mulder CJ, et al. Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of smallbowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy. 2015;47(4):352-76. [Crossref]  [PubMed] 

.: Up To Date

.: Process List

Login

 Forgot your password?

 New Registration  

Contact

Ortadoğu Reklam Tanıtım Yayıncılık Turizm Eğitim İnşaat Sanayi ve Ticaret A.Ş.

.: Address

Turkocagi Caddesi No:30 06520 Balgat / ANKARA
Phone: +90 312 286 56 56
Fax: +90 312 220 04 70
E-mail: info@turkiyeklinikleri.com

.: Manuscript Editing Department

Phone: +90 312 286 56 56/ 2
E-mail: yaziisleri@turkiyeklinikleri.com

.: English Language Redaction

Phone: +90 312 286 56 56/ 145
E-mail: tkyayindestek@turkiyeklinikleri.com

.: Marketing Sales-Project Department

Phone: +90 312 286 56 56/ 142
E-mail: reklam@turkiyeklinikleri.com

.: Subscription and Public Relations Department

Phone: +90 312 286 56 56/ 118
E-mail: abone@turkiyeklinikleri.com

.: Customer Services

Phone: +90 312 286 56 56/ 118
E-mail: satisdestek@turkiyeklinikleri.com

1. TERMS OF USE

1.1. To use the web pages with http://www.turkiyeklinikleri.com domain name or the websites reached through the sub domain names attached to the domain name (They will be collectively referred as "SITE"), please read the conditions below. If you do not accept these terms, please cease to use the "SITE." "SITE" owner reserves the right to change the information on the website, forms, contents, the "SITE," "SITE" terms of use anytime they want.

1.2. The owner of the "SITE" is Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. (From now on it is going to be referred as "Turkiye Klinikleri", shortly) and it resides at Turkocagi cad. No:30, 06520 Balgat Ankara. The services in the "SITE" are provided by "Turkiye Klinikleri."

1.3. Anyone accessing the "SITE" with or without a fee whether they are a natural person or a legal identity is considered to agree these terms of use. In this contract hereby, "Turkiye Klinikleri" may change the stated terms anytime. These changes will be published in the "SITE" periodically and they will be valid when they are published. Any natural person or legal identity benefiting from and reaching to the "SITE" are considered to be agreed to any change on hereby contract terms done by "Turkiye Klinikleri."

1.4. The "Terms of Use" hereby is published in the website with the last change on March 30th 2014 and the "SITE" is activated by enabling the access to everyone. The "Terms of Use" hereby is also a part of the any "USER Contract" was and/or will be done with the users using "Turkiye Klinikleri" services with or without a fee an inseparable.

2. DEFINITIONS

2.1. "SITE": A website offering different kind of services and context with a certain frame determined by "Turkiye Klinikleri" and it is accessible on-line on http://www.turkiyeklinikleri.com domain name and/or subdomains connected to the domain name.

2.2. USER: A natural person or a legal identity accessing to the "SITE" through online settings.

2.3. LINK: A link enabling to access to another website through the "SITE", the files, the context or through another website to the "SITE", the files and the context.

2.4. CONTEXT: Any visual, literary and auditory images published in the "Turkiye Klinikleri", "SITE" and/or any website or any accessible information, file, picture, number/figures, price, etc.

2.5. "USER CONTRACT": An electronically signed contract between a natural or a legal identity benefiting from special services "Turkiye Klinikleri" will provide and "Turkiye Klinikleri".

3. SCOPE OF THE SERVICES

3.1. "Turkiye Klinikleri" is completely free to determine the scope and quality of the services via the "SITE".

3.2. To benefit the services of "Turkiye Klinikleri" "SITE", the "USER" must deliver the features that will be specified by "Turkiye Klinikleri". "Turkiye Klinikleri" may change this necessity any time single-sided.

3.3. Not for a limited number, the services "Turkiye Klinikleri" will provide through the "SITE" for a certain price or for free are;

- Providing scientific articles, books and informative publications for health industry.

- Providing structural, statistical and editorial support to article preparation stage for scientific journals.

4. GENERAL PROVISIONS

4.1. "Turkiye Klinikleri" is completely free to determine which of the services and contents provided in the "SITE" will be charged.

4.2. People benefiting from the services provided by "Turkiye Klinikleri" and using the website can use the "SITE" only according to the law and only for personal reasons. Users have the criminal and civil liability for every process and action they take in the "SITE". Every USER agrees, declares and undertakes that they will not proceed by any function or action infringement of rights of "Turkiye Klinikleri"s and/or other third parties', they are the exclusive right holder on usage, processing, storage, made public and revealing any written, visual or auditory information reported to Turkiye Klinikleri" and/or "SITE" to the third parties. "USER" agrees and undertakes that s/he will not duplicate, copy, distribute, process, the pictures, text, visual and auditory images, video clips, files, databases, catalogs and lists within the "SITE", s/he will not be using these actions or with other ways to compete with "Turkiye Klinikleri", directly or indirectly.

4.3. The services provided and the context published within the "SITE" by third parties is not under the responsibility of "Turkiye Klinikleri", institutions collaborated with "Turkiye Klinikleri", "Turkiye Klinikleri" employee and directors, "Turkiye Klinikleri" authorized salespeople. Commitment to accuracy and legality of the published information, context, visual and auditory images provided by any third party are under the full responsibility of the third party. "Turkiye Klinikleri" does not promise and guarantee the safety, accuracy and legality of the services and context provided by a third party.

4.4. "USER"s cannot act against "Turkiye Klinikleri", other "USER"s and third parties by using the "SITE". "Turkiye Klinikleri" has no direct and/or indirect responsibility for any damage a third party suffered or will suffer regarding "USER"s actions on the "SITE" against the rules of the hereby "Terms of Use" and the law.

4.5. "USER"s accept and undertake that the information and context they provided to the "SITE" are accurate and legal. "Turkiye Klinikleri" is not liable and responsible for promising and guaranteeing the verification of the information and context transmitted to "Turkiye Klinikleri" by the "USER"s, or uploaded, changed and provided through the "SITE" by them and whether these information are safe, accurate and legal.

4.6. "USER"s agree and undertake that they will not perform any action leading to unfair competition, weakening the personal and commercial credit of "Turkiye Klinikleri" and a third party,  encroaching and attacking on personal rights within the "SITE" in accordance with the Turkish Commercial Code Law.

4.7. "Turkiye Klinikleri" reserves the right to change the services and the context within the "SITE"  anytime. "Turkiye Klinikleri" may use this right without any notification and timelessly. "USER"s have to make the changes and/or corrections "Turkiye Klinikleri" required immediately. Any changes and/or corrections that are required by "Turkiye Klinikleri", may be made by "Turkiye Klinikleri" when needed. Any harm, criminal and civil liability resulted or will result from changes and/or corrections required by "Turkiye Klinikleri" and were not made on time by the "USER"s belongs completely to the users.

4.8. "Turkiye Klinikleri" may give links through the "SITE" to other websites and/or "CONTEXT"s and/or folders that are outside of their control and owned and run by third parties. These links are provided for ease of reference only and do not hold qualification for support the respective web SITE or the admin or declaration or guarantee for the information inside. "Turkiye Klinikleri" does not hold any responsibility over the web-sites connected through the links on the "SITE", folders and context, the services or products on the websites provided through these links or their context.

4.9. "Turkiye Klinikleri" may use the information provided to them by the "USERS" through the "SITE" in line with the terms of the "PRIVACY POLICY" and "USER CONTRACT". It may process the information or classify and save them on a database. "Turkiye Klinikleri" may also use the USER's or visitor's identity, address, e-mail address, phone number, IP number, which sections of the "SITE" they visited, domain type, browser type, date and time information to provide statistical evaluation and customized services.

5. PROPRIETARY RIGHTS

5.1. The information accessed through this "SITE" or provided by the users legally and all the elements (including but not limited to design, text, image, html code and other codes) of the "SITE" (all of them will be called as studies tied to "Turkiye Klinikleri"s copyrights) belongs to "Turkiye Klinikleri". Users do not have the right to resell, process, share, distribute, display or give someone permission to access or to use the "Turkiye Klinikleri" services, "Turkiye Klinikleri" information and the products under copyright protection by "Turkiye Klinikleri". Within hereby "Terms of Use" unless explicitly permitted by "Turkiye Klinikleri" nobody can reproduce, process, distribute or produce or prepare any study from those under "Turkiye Klinikleri" copyright protection.

5.2. Within hereby "Terms of Use", "Turkiye Klinikleri" reserves the rights for "Turkiye Klinikleri" services, "Turkiye Klinikleri" information, the products associated with "Turkiye Klinikleri" copyrights, "Turkiye Klinikleri" trademarks, "Turkiye Klinikleri" trade looks or its all rights for other entity and information it has through this website unless it is explicitly authorized by "Turkiye Klinikleri".

6. CHANGES IN THE TERMS OF USE

"Turkiye Klinikleri" in its sole discretion may change the hereby "Terms of Use" anytime announcing within the "SITE". The changed terms of the hereby "Terms of Use" will become valid when they are announced. Hereby "Terms of Use" cannot be changed by unilateral declarations of users.

7. FORCE MAJEURE

"Turkiye Klinikleri" is not responsible for executing late or never of this hereby "Terms of Use", privacy policy and "USER Contract" in any situation legally taken into account as force majeure. Being late or failure of performance or non-defaulting of this and similar cases like this will not be the case from the viewpoint of "Turkiye Klinikleri", and "Turkiye Klinikleri" will not have any damage liability for these situations. "Force majeure" term will be regarded as outside of the concerned party's reasonable control and any situation that "Turkiye Klinikleri" cannot prevent even though it shows due diligence. Also, force majeure situations include but not limited to natural disasters, rebellion, war, strike, communication problems, infrastructure and internet failure, power cut and bad weather conditions.

8. LAW AND AUTHORISATION TO FOLLOW

Turkish Law will be applied in practicing, interpreting the hereby "Terms of Use" and managing the emerging legal relationships within this "Terms of Use" in case of finding element of foreignness, except for the rules of Turkish conflict of laws. Ankara Courts and Enforcement Offices are entitled in any controversy happened or may happen due to hereby contract.

9. CLOSING AND AGREEMENT

Hereby "Terms of Use" come into force when announced in the "SITE" by "Turkiye Klinikleri". The users are regarded to agree to hereby contract terms by using the "SITE". "Turkiye Klinikleri" may change the contract terms and the changes will be come into force by specifying the version number and the date of change on time it is published in the "SITE".

 

30.03.2014

Privacy Policy

We recommend you to read the terms of use below before you visit our website. In case you agree these terms, following our rules will be to your favor. Please read our Terms of Use thoroughly.

www.turkiyeklinikleri.com website belongs to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. and is designed in order to inform physicians in the field of health

www.turkiyeklinikleri.com cannot reach to user’s identity, address, service providers or other information. The users may send this information to the website through forms if they would like to. However, www.turkiyeklinikleri.com may collect your hardware and software information. The information consists of your IP address, browser type, operating system, domain name, access time, and related websites. www.turkiyeklinikleri.com cannot sell the provided user information (your name, e-mail address, home and work address, phone number) to the third parties, publish it publicly, or keep it in the website. Gathered information has a directing feature to be a source for the website’s visitor profile, reporting and promotion of the services.

www.turkiyeklinikleri.com uses the taken information:

-To enhance, improve and maintain the quality of the website

-To generate visitor’s profile and statistical data

-To determine the tendency of the visitors on using our website

-To send print publications/correspondences

-To send press releases or notifications through e-mail

-To generate a list for an event or competition

By using www.turkiyeklinikleri.com you are considered to agree that;

-Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. cannot be hold responsible for any user’s illegal and immoral behavior,

-Terms of use may change from time to time,

-It is not responsible for other websites’ contents it cannot control or the harms they may cause although it uses the connection they provided.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. may block the website to users in the following events:

-Information with wrong, incomplete, deceiving or immoral expressions is recorded to the website,

-Proclamation, advertisement, announcement, libelous expressions are used against natural person or legal identity,

-During various attacks to the website,

-Disruption of the website because of a virus.

Written, visual and audible materials of the website, including the code and the software are under protection by legal legislation.

Without the written consent of Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. the information on the website cannot be downloaded, changed, reproduced, copied, republished, posted or distributed.

All rights of the software and the design of the website belong to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. will be pleased to hear your comments about our terms of use. Please share the subjects you think may enrich our website or if there is any problem regarding our website.

info@turkiyeklinikleri.com