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Tanadi C, Tandarto K, Stella MM, Sutanto KW, Steffanus M, Tenggara R, Bestari MB. Colorectal Cancer Screening Guidelines for Average-Risk and High-Risk Individuals: A Systematic Review. Rom J Intern Med 2023; 0:rjim-2023-0038. [PMID: 38153878 DOI: 10.2478/rjim-2023-0038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Indexed: 12/30/2023]
Abstract
AIMS This review aims to summarize the different colorectal cancer guidelines for average-risk and high-risk individuals from various countries. METHODS A comprehensive literature search regarding guidelines, consensus recommendations, or position statements about colorectal cancer screening published within the last 10 years (1st January 2012 to 27th August 2022), was performed at EBSCOhost, JSTOR, PubMed, ProQuest, SAGE, and ScienceDirect. RESULTS A total of 18 guidelines were included in this review. Most guidelines recommended screening between 45 and 75 years for average-risk individuals. Recommendations regarding colorectal cancer screening in high-risk individuals were more varied and depended on the risk factor. For high-risk individuals with a positive family history of colorectal cancer or advanced colorectal polyp, screening should begin at age 40. Some frequently suggested screening modalities in order of frequency are colonoscopy, FIT, and CTC. Furthermore, several screening intervals were suggested, including colonoscopy every 10 years for average-risk and every 5-10 years for high-risk individuals, FIT annually in average-risk and every 1-2 years in high-risk individuals, and CTC every five years for all individuals. CONCLUSION All individuals with average-risk should undergo colorectal cancer screening between 45 and 75. Meanwhile, individuals with higher risks, such as those with a positive family history, should begin screening at age 40. Several recommended screening modalities were suggested, including colonoscopy every 10 years in average-risk and every 5-10 years in high-risk, FIT annually in average-risk and every 1-2 years in high-risk, and CTC every five years.
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Affiliation(s)
- Caroline Tanadi
- 1Medical Profession Study Program, School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
| | - Kevin Tandarto
- 2Department of Internal Medicine, School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
| | - Maureen Miracle Stella
- 1Medical Profession Study Program, School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
| | - Kenny Wijaya Sutanto
- 1Medical Profession Study Program, School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
| | - Mario Steffanus
- 2Department of Internal Medicine, School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
| | - Riki Tenggara
- 2Department of Internal Medicine, School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
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Syam AF, Miftahussurur M, Makmun D, Abdullah M, Rani AA, Siregar GA, Simadibrata M, Zubir N, Dewa Nyoman Wibawa I, Purnomo HD, Manan C, Djojoningrat D, Fauzi A, Renaldi K, Maulahela H, Utari AP, Pribadi RR, Muzellina VN, Nursyirwan SA, Idrus MF, Ruswhandi R, Sugihartono T, Bestari MB, Bayupurnama P, Pramana TY, Wibowo BP, Bakry AF, Akil F, Parewangi AML, Widita H, Mariadi IK, Murti IS, Yusuf AI, Arles A, Yusuf F, Waleleng BJ, Abimanyu A, Mulyadi Y, Lucida MI, Rezkhita YAA, Alfaray RI, Yamaoka Y. Management of dyspepsia and Helicobacter pylori infection: the 2022 Indonesian Consensus Report. Gut Pathog 2023; 15:25. [PMID: 37217981 DOI: 10.1186/s13099-023-00551-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 05/02/2023] [Indexed: 05/24/2023] Open
Abstract
Dyspepsia still becomes a major challenge in upper gastrointestinal disease in Indonesia. This disease often correlated with Helicobacter pylori infection. However, the prevalence of this bacterium is generally low in Indonesia. Therefore, several considerations should be taken into consideration during the management of dyspepsia and H. pylori infection. "Management of dyspepsia and H. pylori infection in Indonesia: The Indonesian consensus report" comprises information gathered from 22 gastroenterology centers across Indonesia. The experts gathered to evolve a consensus, that consists of the statements, grades of recommendations, evidence levels, and rationales for the dyspepsia and H. pylori infection management for daily clinical practice. The report explains several aspects from the updated epidemiology information to comprehensive management therapy. After the experts worked together on all statements in the recommendations, the results are presented with the final agreement as a consensus to help clinicians in understanding, diagnosing, and treating dyspepsia and H. pylori infection patients in daily clinical practice in Indonesia.
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Affiliation(s)
- Ari Fahrial Syam
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine-Cipto Mangunkusumo Teaching Hospital, University of Indonesia, Jakarta, Indonesia.
| | - Muhammad Miftahussurur
- Division of Gastroentero-Hepatology, Department of Internal Medicine, Faculty of Medicine-Dr. Soetomo Teaching Hospital, Universitas Airlangga, Surabaya, Indonesia.
- Helicobacter Pylori and Microbiota Study Group, Institute of Tropical Disease, Universitas Airlangga, Surabaya, Indonesia.
| | - Dadang Makmun
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine-Cipto Mangunkusumo Teaching Hospital, University of Indonesia, Jakarta, Indonesia
| | - Murdani Abdullah
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine-Cipto Mangunkusumo Teaching Hospital, University of Indonesia, Jakarta, Indonesia
| | - Abdul Aziz Rani
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine-Cipto Mangunkusumo Teaching Hospital, University of Indonesia, Jakarta, Indonesia
| | - Gontar Alamsyah Siregar
- Division of Gastroenterohepatology, Department of Internal Medicine, Adam Malik General Hospital/Faculty of Medicine, Sumatra Utara University, Medan, Indonesia
| | - Marcellus Simadibrata
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine-Cipto Mangunkusumo Teaching Hospital, University of Indonesia, Jakarta, Indonesia
| | - Nasrul Zubir
- Division of Gastroenterohepatology, Department of Internal Medicine, M. Djamil General Hospital/Faculty of Medicine, Andalas University, Padang, Indonesia
| | - I Dewa Nyoman Wibawa
- Division of Gastroenterohepatology, Department of Internal Medicine, Udayana University/Sanglah General Hospital, Bali, Denpasar, Indonesia
| | - Hery Djagat Purnomo
- Division of Gastroenterohepatology, Department of Internal Medicine, Kariadi General Hospital/Faculty of Medicine, Diponegoro University, Semarang, Indonesia
| | - Chudahman Manan
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine-Cipto Mangunkusumo Teaching Hospital, University of Indonesia, Jakarta, Indonesia
| | - Dharmika Djojoningrat
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine-Cipto Mangunkusumo Teaching Hospital, University of Indonesia, Jakarta, Indonesia
| | - Achmad Fauzi
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine-Cipto Mangunkusumo Teaching Hospital, University of Indonesia, Jakarta, Indonesia
| | - Kaka Renaldi
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine-Cipto Mangunkusumo Teaching Hospital, University of Indonesia, Jakarta, Indonesia
| | - Hasan Maulahela
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine-Cipto Mangunkusumo Teaching Hospital, University of Indonesia, Jakarta, Indonesia
| | - Amanda Pitarini Utari
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine-Cipto Mangunkusumo Teaching Hospital, University of Indonesia, Jakarta, Indonesia
| | - Rabbinu Rangga Pribadi
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine-Cipto Mangunkusumo Teaching Hospital, University of Indonesia, Jakarta, Indonesia
| | - Virly Nanda Muzellina
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine-Cipto Mangunkusumo Teaching Hospital, University of Indonesia, Jakarta, Indonesia
| | - Saskia Aziza Nursyirwan
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine-Cipto Mangunkusumo Teaching Hospital, University of Indonesia, Jakarta, Indonesia
| | - Muhammad Firhat Idrus
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine-Cipto Mangunkusumo Teaching Hospital, University of Indonesia, Jakarta, Indonesia
| | - Ruswhandi Ruswhandi
- Department of Internal Medicine, Gatot Subroto Army Central Hospital, Jakarta, Indonesia
| | - Titong Sugihartono
- Division of Gastroentero-Hepatology, Department of Internal Medicine, Faculty of Medicine-Dr. Soetomo Teaching Hospital, Universitas Airlangga, Surabaya, Indonesia
| | - Muhammad Begawan Bestari
- Division of Gastroenterohepatology, Department of Internal Medicine, Hasan Sadikin General Hospital/Faculty of Medicine, Padjadjaran University, Bandung, Indonesia
| | - Putut Bayupurnama
- Division of Gastroenterohepatology, Department of Internal Medicine, Sardjito General Hospital/Faculty of Medicine, Public Health and Nursing, Gadjah Mada University, Yogyakarta, Indonesia
| | - Triyanta Yuli Pramana
- Division of Gastroenterohepatology, Department of Internal Medicine, Moewardi General Hospital/Faculty of Medicine, Sebelas Maret University, Surakarta, Indonesia
| | - Bogi Pratomo Wibowo
- Division of Gastroenterohepatology, Department of Internal Medicine, Saiful Anwar General Hospital/Faculty of Medicine, Brawijaya University, Malang, Indonesia
| | - Achmad Fuad Bakry
- Division of Gastroenterohepatology, Department of Internal Medicine, Moch. Hoesin General Hospital/Faculty of Medicine, Sriwijaya University, Palembang, Indonesia
| | - Fardah Akil
- Division of Gastroenterohepatology, Department of Internal Medicine, Wahidin Sudirohusodo General Hospital/Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Andi Muhammad Luthfi Parewangi
- Division of Gastroenterohepatology, Department of Internal Medicine, Wahidin Sudirohusodo General Hospital/Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Haris Widita
- Department of Internal Medicine, West Nusa Tenggara General Hospital, Mataram, Indonesia
| | - I Ketut Mariadi
- Division of Gastroenterohepatology, Department of Internal Medicine, Udayana University/Sanglah General Hospital, Bali, Denpasar, Indonesia
| | - Ignatia Sinta Murti
- Department of Internal Medicine, Abdul Wahab Sjahranie General Hospital/Faculty of Medicine, Mulawarman University, Samarinda, Indonesia
| | - Ali Imron Yusuf
- Department of Internal Medicine, Abdoel Moeloek General Hospital/Faculty of Medicine, Lampung University, Lampung, Indonesia
| | - Arles Arles
- Department of Internal Medicine, Awal Bros Pekanbaru Hospital, Pekanbaru, Indonesia
| | - Fauzi Yusuf
- Division of Gastroenterohepatology, Department of Internal Medicine, Zainoel Abidin General Hospital/Faculty of Medicine, Syiah Kuala University, Banda Aceh, Indonesia
| | - Bradley Jimmy Waleleng
- Division of Gastroenterohepatology, Department of Internal Medicine, Prof. R. D. Kandou General Hospital/Faculty of Medicine, Sam Ratulangi University, Manado, Indonesia
| | - Abimanyu Abimanyu
- Department of Internal Medicine, Ulin Banjarmasin General Hospital, Faculty of Medicine, Lambung Mangkurat University, Banjarmasin, Indonesia
| | - Yustar Mulyadi
- Department of Internal Medicine, Soedarso General Hospital, Pontianak, Indonesia
| | - Maria Inge Lucida
- Institute of Tropical Disease, Universitas Airlangga, Surabaya, Indonesia
| | - Yudith Annisa Ayu Rezkhita
- Helicobacter Pylori and Microbiota Study Group, Institute of Tropical Disease, Universitas Airlangga, Surabaya, Indonesia
- Department of Internal Medicine, Faculty of Medicine, Universitas Muhammadiyah Surabaya, Surabaya, Indonesia
| | - Ricky Indra Alfaray
- Helicobacter Pylori and Microbiota Study Group, Institute of Tropical Disease, Universitas Airlangga, Surabaya, Indonesia
- Department of Environmental and Preventive Medicine, Faculty of Medicine, Oita University, Oita, Japan
| | - Yoshio Yamaoka
- Department of Environmental and Preventive Medicine, Faculty of Medicine, Oita University, Oita, Japan
- The Research Center for GLOBAL and LOCAL Infectious Diseases (RCGLID), Oita University, Oita, Japan
- Department of Medicine, Gastroenterology and Hepatology Section, Baylor College of Medicine, Houston, USA
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Paskaria C, Sunjaya DK, Parwati I, Bestari MB. Digital Health to Strengthen District-Based Public-Private Mix Tuberculosis Control in Purwakarta District, Indonesia: A Qualitative Research. Int J Environ Res Public Health 2022; 19:12097. [PMID: 36231397 PMCID: PMC9566049 DOI: 10.3390/ijerph191912097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 09/16/2022] [Accepted: 09/21/2022] [Indexed: 06/16/2023]
Abstract
This study aimed to explore the problem that occurs in district-based public-private mix tuberculosis (DPPM TB) in the Purwakarta district, and how digital health can help overcome this problem. This study used a qualitative research design. By purposive sampling, 46 informants were selected to be interviewed and 9 informants participated in focus group discussion. Data were collected during January to November 2020 and analyzed using the content analysis technique. Trustworthiness is obtained through the triangulation method and peer debriefing. The problems identified in public and private partnership were the lack of communication and awareness, the under-reporting of TB cases in the private health sector, and the limitation of the existing information system. Communication is important in delivering information about a tuberculosis program, patient referrals, and contact investigation; therefore, digital health is considered as a potential strategy to facilitate that. Digital health must consider ethical issues, avoid redundancy, be user-friendly, and include intervention packages. We conclude that the lack of communication between the public and the private health sectors in TB control was a major problem in DPPM TB. Digital health is needed to ensure the flow of information and communication between the public and the private health sectors.
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Affiliation(s)
- Cindra Paskaria
- Faculty of Medicine, Maranatha Christian University, Bandung 40164, Indonesia
- Doctoral Study Program, Faculty of Medicine, Universitas Padjadjaran, Bandung 40132, Indonesia
| | - Deni Kurniadi Sunjaya
- Doctoral Study Program, Faculty of Medicine, Universitas Padjadjaran, Bandung 40132, Indonesia
| | - Ida Parwati
- Doctoral Study Program, Faculty of Medicine, Universitas Padjadjaran, Bandung 40132, Indonesia
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Kurniawan J, Sulaiman AS, Lesmana CRA, Bayupurnama P, Bestari MB, Akil F, Gani RA, Hasan I. National Consensus on Portal Hypertension Management in Indonesia. Acta Med Indones 2022; 54:324-346. [PMID: 35818657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Portal hypertension is a clinical syndrome that consists of hypersplenism, ascites, gastroesophageal varices, and encephalopathy. This condition is marked by increased portal pressure gradient and may occur with or without liver cirrhosis. To date, portal hypertension remains as the leading cause of severe complications and death of a patient with chronic liver disease, especially liver cirrhosis. Therefore, thorough understanding about management of portal hypertension is strongly required, especially considering that many complications of portal hypertension require early diagnosis and treatment to improve the prognosis of the patients. Additionally, although hepatic venous pressure gradient (HVPG) measurement has become a gold standard procedure for measuring portal pressure in the last twenty years, utilization of this method in Indonesia has been hindered by reluctance of the patients due to its invasiveness, high cost, and limited availability. This consensus is developed with evidence-based medicine principles to provide a guideline for portal hypertension management for general practitioners, specialists, and consultants, to achieve better clinical outcomes of portal hypertension in Indonesia. Keywords: portal hypertension, liver cirrhosis, chronic liver disease.
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Affiliation(s)
- Juferdy Kurniawan
- Division of Hepatobiliary. Department of Internal Medicine, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
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Bestari MB, Nugraha ES, Abdurachman SA. Secondary Choledocholithiasis in Obstructive Jaundice Patient due to Choledochoduodenal-fistula Stricture. Acta Med Indones 2022; 54:283-287. [PMID: 35818650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Choledochoduodenal fistula (CDF) is a rare condition marked by an abnormal connection between the biliary duct and duodenum. The common etiology of secondary CDF are cholecystolithiasis, tumor, and duodenal ulcer. CDF may also caused by prior inflammatory condition or as a complication of radiation therapy. Management for this case is based on the patient condition. Herein we aimed to present a case of secondary choledocholithiasis due to stricture in the CDF which presented with cholangitis treated by self-expanding metal stent (SEMS) for biliary drainage. Patient admitted with jaundice, fever, right upper quadrant pain, and history of cholecystectomy. Diagnosis of CDF was determined by endoscopic retrograde cholangiopancreatography (ERCP) and followed by putting biliary stent for urgent biliary drainage. The follow up result after stent removal was excellent.
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Affiliation(s)
- Muhammad Begawan Bestari
- Division of Gastroenterohepatology Department of Internal Medicine Faculty of Medicine - University of Padjadjaran Hasan Sadikin General Hospital Bandung.
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Bestari MB, Chandra M, Joewono IR, Girawan D, Andhika R, Wahyudi Y, Abdurachman SA. Gastroptosis due to Gastric Outlet Obstruction Secondary to Duodenal Tumor: Glenard’s Disease Revisited. Case Rep Gastroenterol 2022; 16:89-93. [PMID: 35431764 PMCID: PMC8958574 DOI: 10.1159/000521977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 01/07/2022] [Indexed: 11/19/2022] Open
Abstract
Currently, gastroptosis is rarely reported, and the actual prevalence is unknown. Similarly, the possible predisposing factor and cause remain unclear. A 69-year-old had melena for 1 week, and other symptoms were left upper abdominal pain, nausea, and vomiting especially postprandially that was persistent for several months with no response to medication. The nasogastric tube produced yellowish discharge and dark-colored undigested material. The CT scan showed obstruction of the gastroduodenal junction and gastroptosis. Endoscopy revealed a gastric lumen that was extended inferiorly and an occluded pyloric ring by a bleeding mass protruding from the duodenum. We report the first case of gastroptosis caused by gastric outlet obstruction secondary to duodenal tumor.
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Affiliation(s)
- Muhammad Begawan Bestari
- Division of Gastroenterohepatology, Department of Internal Medicine, Hasan Sadikin General Hospital-Faculty of Medicine University of Padjadjaran, Bandung, Indonesia
- *Muhammad Begawan Bestari,
| | - Melissa Chandra
- Division of Gastroenterohepatology, Department of Internal Medicine, Hasan Sadikin General Hospital-Faculty of Medicine University of Padjadjaran, Bandung, Indonesia
| | - Ignatius Ronaldi Joewono
- Division of Gastroenterohepatology, Department of Internal Medicine, Hasan Sadikin General Hospital-Faculty of Medicine University of Padjadjaran, Bandung, Indonesia
| | - Dolvy Girawan
- Division of Gastroenterohepatology, Department of Internal Medicine, Hasan Sadikin General Hospital-Faculty of Medicine University of Padjadjaran, Bandung, Indonesia
| | - Rizky Andhika
- Division of Nephrology and Hypertension, Department of Internal Medicine, Hasan Sadikin General Hospital-Faculty of Medicine University of Padjadjaran, Bandung, Indonesia
| | - Yudi Wahyudi
- Division of Gastroenterohepatology, Department of Internal Medicine, Hasan Sadikin General Hospital-Faculty of Medicine University of Padjadjaran, Bandung, Indonesia
| | - Siti Aminah Abdurachman
- Division of Gastroenterohepatology, Department of Internal Medicine, Hasan Sadikin General Hospital-Faculty of Medicine University of Padjadjaran, Bandung, Indonesia
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Bestari MB, Nugraha ES, Abdurachman SA. Pancreas Divisum as a Rare Etiology of Recurrent Pancreatitis: A Rare Case Ever Documented and Reported In Indonesia. Acta Med Indones 2021; 53:465-468. [PMID: 35027495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Pancreas divisum is an abnormal condition of pancreas duct that occurs from organogenesis. This abnormal condition defined as a failure in fusion between dorsal and ventral part of the pancreas. The incidence reported 4%-14% in general population. Majority patient with pancreas divisum will not present with any sign or symptom, but in some cases may present with signs of pancreatitis. We illustrate a case of 39 years old male with pancreas divisum presenting as acute recurrent pancreatitis. Diagnosis of pancreas divisum was determined through magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP). Patient treated by sphincterotomy and dilation using Soehendra's dilator catheter. This is the first pancreas divisum case successfully treated and reported in Indonesia.
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Affiliation(s)
- Muhammad Begawan Bestari
- Division of Gastroenterohepatology Department of Internal Medicine Faculty of Medicine - University of Padjadjaran Hasan Sadikin General Hospital Bandung - Indonesia.
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Zein AFMZ, Pribadi RR, Khasanah U, Bestari MB, Syam AF. Clinical Gastroenterology and Gastrointestinal Endoscopy Practices during the Coronavirus Disease 2019 Pandemic in Indonesia: An Online Nationwide Survey. Clin Endosc 2021; 54:348-355. [PMID: 33596636 PMCID: PMC8182243 DOI: 10.5946/ce.2020.216] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 10/28/2020] [Accepted: 11/29/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND/AIMS The coronavirus disease 2019 (COVID-19) pandemic has necessitated modifications to allow the safe practice of clinical gastroenterology and gastrointestinal endoscopy. This study aimed to investigate the characteristics of clinical gastroenterology and gastrointestinal endoscopy practices during the COVID-19 pandemic in Indonesia. METHODS This cross-sectional study enrolled physician members of the Indonesian Society for Digestive Endoscopy. We used an online self-administered questionnaire disseminated via social media. The 32-item survey determined the baseline characteristics of the participants, characteristics of clinical gastroenterology and gastrointestinal endoscopy practices, involvement of the physicians in the management of COVID-19, and overall impact of the pandemic on practice. All collected data were analyzed using descriptive statistics. RESULTS The 200 participants in this study had a median age of 50 (34-76) years. Modifications in clinical gastroenterology practice were frequently reported in the outpatient (95.5%) and inpatient (100%) settings. All participants reported changes in the gastrointestinal endoscopy practice patterns. Of the participants, 86.0% were working in high-risk zones, and several of them reported inadequate protective personal equipment (34.0%). The median overall impact score of the pandemic on practice was 9 (2-10). CONCLUSION Physicians practicing clinical gastroenterology and gastrointestinal endoscopy in Indonesia work in high-risk settings. Modifications in clinical gastroenterology and gastrointestinal endoscopy practices are prevalent during the COVID-19 pandemic.
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Affiliation(s)
- Ahmad Fariz Malvi Zamzam Zein
- Department of Internal Medicine, Faculty of Medicine, Universitas Swadaya Gunung Jati-Waled General Hospital, Cirebon, Indonesia
| | - Rabbinu Rangga Pribadi
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia-Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | - Uswatun Khasanah
- Department of Biostatistics and Epidemiology, Faculty of Medicine, Universitas Swadaya Gunung Jati, Cirebon, Indonesia
| | - Muhammad Begawan Bestari
- Division of Gastroenterohepatology, Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran-Hasan Sadikin Hospital, Bandung, Indonesia
| | - Ari Fahrial Syam
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia-Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
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Nugraha ES, Huang I, Supriyadi R, Girawan D, Bestari MB. Successful Nucleoside Analog and Corticosteroid Therapy for Chronic Inflammatory Demyelinating Polyneuropathy in a Patient With Hepatitis B Virus Liver Cirrhosis. ACG Case Rep J 2021; 8:e00519. [PMID: 33457438 PMCID: PMC7808564 DOI: 10.14309/crj.0000000000000519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 09/04/2020] [Indexed: 11/17/2022] Open
Abstract
Here, we describe the case of a 44-year-old man with chronic hepatitis B virus (HBV) infection, who was admitted with progressive muscle weakness and paresthesia in all extremities. He showed slight icterus. Positive HBV e-antigen test, significant HBV-deoxyribonucleic acid load, hypoalbuminemia, hyperbilirubinemia, mild ascites, and demyelinating peripheral axonal lesions in both sensory and motor nerves led to the diagnosis of Child-Pugh class B HBV cirrhosis with chronic inflammatory demyelinating polyneuropathy. Oral lamivudine, intravenous steroids, calcium, and vitamin D therapy led to a significant recovery of muscle strength within 6 weeks and a gradual return to normal after 24 weeks.
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Affiliation(s)
- Eka Surya Nugraha
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hasan Sadikin General Hospital, Universitas Padjadjaran, Bandung, Indonesia
| | - Ian Huang
- Department of Internal Medicine, Hasan Sadikin General Hospital, Universitas Padjadjaran, Bandung, Indonesia
| | - Rudi Supriyadi
- Department of Internal Medicine, Hasan Sadikin General Hospital, Universitas Padjadjaran, Bandung, Indonesia
| | - Dolvy Girawan
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hasan Sadikin General Hospital, Universitas Padjadjaran, Bandung, Indonesia
| | - Muhammad Begawan Bestari
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hasan Sadikin General Hospital, Universitas Padjadjaran, Bandung, Indonesia
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Bestari MB, Joewono IR. Screening Colonoscopy for Colon Cancer in Women during COVID-19 Pandemic. Acta Med Indones 2021; 53:132-139. [PMID: 33818416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Colorectal cancer (CRC) is one of the top three leading causes of death in both men and women. However, screening can help detect and prevent CRC. Multiple guidelines recommend CRC screening using stool-based screening and direct visualization via colonoscopy. Anatomically, women have a longer total colonic length, especially in the transverse colon, which makes it redundant; thus it is more difficult to perform complete endoscopy in women. Women also have a higher risk of developing right-sided colon cancer of the flat and depressed type, which is harder to detect than the other types. Moreover, women are less likely to undergo colonoscopy due to embarrassment, especially when the procedure is performed by male gastroenterologists, and the lack of available female gastroenterologists further complicates the problem. The current COVID-19 pandemic also decreases patients' willingness to undergo screening due to the fear of contracting the COVID-19. Delay in diagnosis leads to more advanced tumors upon detection and ultimately decreases the survival rate, especially in women, as they have lower 1-year survival rate when CRC is detected in its later stages than in men. Innovative options for CRC screening have recently emerged, including colon capsule endoscopy, which can be performed in a clinic and may reduce the need for colonoscopy. However, sex-specific CRC screening guidelines and tools are not available. The objective of this review is to identify the barriers and challenges faced when performing screening colonoscopy in women, especially during the pandemic and to encourage the development of sex-specific CRC screening.
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Affiliation(s)
- Muhammad Begawan Bestari
- Division of Gastroenterohepatology Department of Internal Medicine Faculty of Medicine - University of Padjadjaran Hasan Sadikin General Hospital Bandung - Indonesia.
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Maulahela H, Syam AF, Renaldi K, Bestari MB, Sutikno R, Abdullah M, Simadibrata M, Makmun D. A Clinical and Procedural Guideline for Gastrointestinal Endoscopy Units during COVID-19 Pandemic Era. Acta Med Indones 2020; 52:431-435. [PMID: 33377889 DOI: pmid/33377889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The World Health Organization (WHO) has declared COVID-19 as global pandemic since there are tremendous growing numbers of confirmed cases for SARS-C0V-2 infection, the number of affected countries and high mortality rate. The global COVID-19 pandemic also will affect various aspects of health care including endoscopic service. The Indonesian Society for Digestive Endoscopy (ISDE), which provides a scope for doctors who perform endoscopic procedures, has developed a clinical and procedural guideline that may serve as a reference for doctors performing gastrointestinal endoscopy in Indonesia.
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Affiliation(s)
- Hasan Maulahela
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
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Bestari MB, Joewono IR, Girawan D, Argatio JT, Abdurachman SA. Hemospray® during Emergency Endoscopy: Indonesia's First Experience from 37 Patients. Case Rep Gastroenterol 2020; 14:70-79. [PMID: 32110203 PMCID: PMC7036561 DOI: 10.1159/000505775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Accepted: 01/06/2020] [Indexed: 01/14/2023] Open
Abstract
Gastrointestinal bleeding (GIB) is one of the main indications for performing endoscopy; this condition can be life threatening. In some cases, emergency endoscopy (EE) is necessary to identify the source and stop the bleeding. Recently, hemostatic powder was introduced, one of which was Hemospray® (Cook Medical, Winston-Salem, NC, USA), which showed promising results for rapid hemostasis in primary treatment and salvage when conventional methods fails. Samples were taken retrospectively for a duration of 3 years since Hemospray was first introduced in Indonesia, from January 2016 to January 2019. The total number of EEs that used Hemospray were 37 procedures for 37 patients; 21 (56.8%) were males and 16 (43.2%) were females, while the average age was 67.8 years. Hemospray was used for upper GIB in 30 cases (81.1%) and for lower GIB in 7 (18.9%). Hemospray was used as monotherapy for 24 patients (64.9%) and as secondary modality for 13 (35.1%). The primary treatment was argon plasma coagulation in 8 cases (21.6%), adrenaline in 4 (10.8%), and Histoacryl® in 1 (2.7%). The mortality rate was 37.8% (n = 14); most deaths occurred within 30 days after the EE was performed, and none of the deaths was related to endoscopy or GIB. Hemospray was able to achieve hemostasis in all cases. Furthermore, there was no event of rebleeding. When conventional modalities alone were inadequate, the combination with Hemospray appeared to be able to control the bleeding. One of the main advantages of Hemospray is the ease in reaching difficult areas, and it require less skill compared to conventional modalities.
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Affiliation(s)
- Muhammad Begawan Bestari
- Division of Gastroenterohepatology, Department of Internal Medicine, Hasan Sadikin General Hospital-Faculty of Medicine, University of Padjadjaran, Bandung, Indonesia.,Santo Borromeus Hospital Bandung, Bandung, Indonesia
| | - Ignatius Ronaldi Joewono
- Division of Gastroenterohepatology, Department of Internal Medicine, Hasan Sadikin General Hospital-Faculty of Medicine, University of Padjadjaran, Bandung, Indonesia
| | - Dolvy Girawan
- Division of Gastroenterohepatology, Department of Internal Medicine, Hasan Sadikin General Hospital-Faculty of Medicine, University of Padjadjaran, Bandung, Indonesia.,Santo Borromeus Hospital Bandung, Bandung, Indonesia
| | | | - Siti Aminah Abdurachman
- Division of Gastroenterohepatology, Department of Internal Medicine, Hasan Sadikin General Hospital-Faculty of Medicine, University of Padjadjaran, Bandung, Indonesia.,Santo Borromeus Hospital Bandung, Bandung, Indonesia
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Bestari MB, Agustanti N, Abdurachman SA. Clindamycin-Induced Esophageal Injury: Is It an Underdiagnosed Entity? Clin Med Insights Case Rep 2019; 12:1179547619884055. [PMID: 31903026 PMCID: PMC6933540 DOI: 10.1177/1179547619884055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 10/01/2019] [Indexed: 12/19/2022]
Abstract
There are increased reports of pill-induced esophagitis in the past 2 decades,
with almost 100 different substances identified as the cause for more than 700
cases, and the overall incidence is estimated to be 0.004% per year. Antibiotics
are one of the major contributors for these cases, especially tetracycline and
doxycycline; other major contributors are bisphosphonates, nonsteroidal
anti-inflammatory drugs, and iron pills. Clindamycin is commonly prescribed by
physicians, yet side effect in the form of esophagitis is uncommon and mostly
documented in case report. It is possible that these cases are mostly unnoticed
due to initial consideration of common and more serious problems. Thus, patients
may be assumed to be having a severe episode of acid reflux, and it is not
routinely reported or recognized. In this case series, we presented 8 patients
with clindamycin-induced esophagitis. The initial presentation of all patients
was odynophagia, which appeared within the first day of taking the antibiotic.
All patients were subjected to endoscopic examination and ulcer was found in all
cases, in the form of localized solitary or multiple ulcers with sharply defined
borders. Patients were treated with proton pump inhibitor and sucralfate, and
the symptoms subside within 1 week. Patient education regarding the proper way
of ingesting drug seems to be the key factor in the prevention of pill-induced
esophagitis. The prevention of esophagitis is even more important with
antibiotics as adverse effect would decrease the patient compliance in
completing the regimen and would ultimately increase antibiotic resistance.
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Affiliation(s)
- Muhammad Begawan Bestari
- Division of Gastroentero-Hepatology, Department of Internal Medicine, Faculty of Medicine, Hasan Sadikin General Hospital, University of Padjadjaran, Bandung, Indonesia
| | - Nenny Agustanti
- Division of Gastroentero-Hepatology, Department of Internal Medicine, Faculty of Medicine, Hasan Sadikin General Hospital, University of Padjadjaran, Bandung, Indonesia
| | - Siti Aminah Abdurachman
- Division of Gastroentero-Hepatology, Department of Internal Medicine, Faculty of Medicine, Hasan Sadikin General Hospital, University of Padjadjaran, Bandung, Indonesia
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Bestari MB, Palungkun IG, Hernowo BS, Abdurachman SA, Nugraha ES. Low-Stage Gastric MALT Lymphoma Causing Life-Threatening Upper Gastrointestinal Bleeding. Case Rep Gastroenterol 2019; 13:376-384. [PMID: 31616232 PMCID: PMC6792433 DOI: 10.1159/000502795] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 08/15/2019] [Indexed: 12/27/2022] Open
Abstract
Gastric mucosa-associated lymphoid tissue (MALT) lymphoma is an uncommon tumor of the stomach that only comprises around 1–6% of all tumors of the stomach. Non-Hodgkin lymphoma more commonly affects the lymph nodes and may spread to the spleen and bone marrow, whereas extranodal non-Hodgkin lymphoma is less common. Primary gastric lymphoma is further divided based on histologic features; one of the types is MALT lymphoma, which is strongly associated with Helicobacter pylori infection. The first sign of the disease is usually mimicking gastritis. However, in the case reported here, the first sign of gastric MALT lymphoma was massive gastrointestinal (GI) bleeding with hemodynamic instability in a 75-year-old male. The patient came to the emergency department and was immediately resuscitated, intubated, and admitted to the intensive care unit. Urgent endoscopy (<6 h) was done to identify the source of bleeding, which were oozing ulcerated polypoid masses; endoscopic hemostasis was done, which successfully stopped the bleeding. However, the next day, rebleeding occurred and a second endoscopic hemostasis was performed. The bleeding stopped and the patient showed gradual improvement. The biopsy result of a gastric MALT lymphoma of grade IE1 with H. pylori infection warranted a treatment regimen for Helicobacter eradication. The patient recovered, with follow-up endoscopy at 3 months, at 6 months, and yearly thereafter with no sign of recurrence. This case shows that gastric MALT lymphoma, even at a low stage (1E1), can cause life-threatening upper GI bleeding that requires aggressive resuscitation and urgent endoscopy.
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Affiliation(s)
- Muhammad Begawan Bestari
- Division of Gastroenterohepatology, Department of Internal Medicine, Hasan Sadikin General Hospital-Faculty of Medicine, University of Padjadjaran, Bandung, Indonesia
| | | | - Bethy Suryawathy Hernowo
- Department of Anatomic Pathology, Hasan Sadikin General Hospital-Faculty of Medicine, University of Padjadjaran, Bandung, Indonesia
| | - Siti Aminah Abdurachman
- Division of Gastroenterohepatology, Department of Internal Medicine, Hasan Sadikin General Hospital-Faculty of Medicine, University of Padjadjaran, Bandung, Indonesia
| | - Eka Surya Nugraha
- Division of Gastroenterohepatology, Department of Internal Medicine, Hasan Sadikin General Hospital-Faculty of Medicine, University of Padjadjaran, Bandung, Indonesia
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Bestari MB, Joewono IR. Aspirin vs. P2Y12 Inhibitor Rivalry: Which One Can be Continued During Gastrointestinal Bleeding. Acta Med Indones 2019; 51:282-286. [PMID: 31699954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Dual antiplatelet therapy (DAPT) is the mainstay of secondary prevention treatment for acute coronary syndrome (ACS) and ischemic stroke, especially after coronary intervention. DAPT consists of aspirin and P2Y12 receptor inhibitor (e.g. clopidogrel), and the use of DAPT has been increased over time. The most serious and common adverse effect is gastrointestinal bleeding. Guidelines in managing such condition are available among Gastroenterologist Societies and Cardiologist Societies. Most guidelines are consistent with each other to continue the use of aspirin while withholding P2Y12. However, European Society of Cardiologist (ESC) guideline in 2017 recommends P2Y12 receptor inhibitor as the preferred antiplatelet for patient with upper gastrointestinal bleeding. This review will look on the guidelines and other supporting evidence for the justification on the antiplatelet of choice.
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Affiliation(s)
- Muhammad Begawan Bestari
- Division of Gastroenterohepatology Department of Internal Medicine Faculty of Medicine - University of Padjadjaran Hasan Sadikin General Hospital Bandung - Indonesia.
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Bestari MB, Laksono B. Current Guidelines on Antithrombotic Management in Patients Undergoing Gastrointestinal Endoscopy. Acta Med Indones 2019; 51:86-92. [PMID: 31073113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Endoscopic procedure is commonly used to make diagnosis or therapy. Endoscopy has risk on the procedure or after the procedure. Patient with antithrombotic therapy, both antiplatelet and/or anticoagulant, for underlying diseases has higher risk for bleeding and thromboembolic events in this procedure. The physician should consider risk and benefit for adjusting the antithrombotic therapy, in addition to minimize bleeding and thromboembolic events. For low risk procedure, adjustments in antithrombotic therapy usually not necessarily needed. For high risk procedure, there are several adjustments based on the type of medication and patient's condition in specific. European Society of Gastrointestinal Guidelines Endoscopy (ESGE) and British Society of Gastrointestinal (BSG); American Society of Gastrointestinal Endoscopy (ASGE); and lastly Asian Pacific Association of Gastroenterology (APAGE) and Asian Pacific Society for Digestive Endoscopy (APSDE) have published guidelines to help physician to make decisions regarding antithrombotic therapy management during endoscopy. This article compares and contrasts the approach of each guideline, in design to help the decision-making process. However, each patient's clinical condition may differ from one to another and should be considered carefully in making a final decision.
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Affiliation(s)
- Muhammad Begawan Bestari
- Division of Gastroenterohepatology Department of Internal Medicine Faculty of Medicine - University of Padjadjaran Hasan Sadikin General Hospital Bandung - Indonesia.
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Singh R, Jayanna M, Wong J, Lim LG, Zhang J, Lv J, Liu D, Lee YC, Han ML, Tseng PH, Namasivayam V, Banerjee R, Uedo N, Chan WK, Ho SH, Chen SY, Bhatia S, Funasaka K, Ando T, Wu J, Lesmana C, Tam W, Wang WL, Chang CY, Jung HY, Jung KW, Bestari MB, Yao K, Chong VH, Sharma P, Ho KY. Narrow-band imaging and white-light endoscopy with optical magnification in the diagnosis of dysplasia in Barrett's esophagus: results of the Asia-Pacific Barrett's Consortium. Endosc Int Open 2015; 3:E14-8. [PMID: 26134765 PMCID: PMC4423324 DOI: 10.1055/s-0034-1377610] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Accepted: 06/24/2014] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE The advent and utility of new endoscopic imaging modalities for predicting the histology of Barrett's esophagus (BE) in real time with high accuracy appear promising and could potentially obviate the need to perform random biopsies where guidelines are poorly adhered to. We embarked on evaluating the performance characteristics of white-light endoscopy with magnification (WLE-z), narrow-band imaging with magnification (NBI-z) and a combination of both modalities. DESIGN This was a prospective online study with 28 endoscopists from 11 countries (Asia-Pacific region) participating as assessors. In total, 35 patients with BE were assessed using 150 slides from WLE-z and NBI-z randomly arranged using a simple classification with corresponding histology. The overall Accuracy (Acc), Sensitivity (Sn), Specificity (Sp), Positive Predictive Value (PPV), and Negative Predictive Value (NPV) of WLE-z, NBI-z and a combination of both were calculated. RESULTS The overall Acc for WLE-z and NBI-z images was 87.1 % and 88.7 %, respectively. When images from the two modalities were placed side by side, the Acc increased to 90.3 %. The Sn, Sp, PPV, and NPV of WLE-z were 48 %, 92 %, 45 %, and 93 % while with NBI-z, these improved to 89 %, 89 %, 56 %, and 98 %, respectively. When both imaging modalities were viewed together, they improved further to 93 %, 90 %, 61 %, and 99 %. CONCLUSION The high NPV (99 %) when both WLE-z and NBI-z were used simultaneously indicates that areas with regular appearance that are diagnosed with confidence can effectively be left alone and not biopsied when performed at a skilled resourced center. This approach could potentially lead to a paradigm shift of how patients with BE are assessed.
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Affiliation(s)
- Rajvinder Singh
- Lyell McEwin Hospital, Adelaide, Australia,University of Adelaide, Adelaide, Australia,Corresponding author Rajvinder Singh, MBBS MRCP MPhil FRACP AM FRCP Clinical Associate ProfessorHead of EndoscopyLyell McEwin Hospital & University of AdelaideAdelaideAustralia+61-8-81829837
| | | | - Jennie Wong
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Lee Guan Lim
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jun Zhang
- Division of Gastroenterology, The Second Affiliated Hospital, Xi’an Jiaotong University, Xi’an, China
| | - Jing Lv
- Division of Gastroenterology, The Second Affiliated Hospital, Xi’an Jiaotong University, Xi’an, China
| | - Dong Liu
- Division of Gastroenterology, The Second Affiliated Hospital, Xi’an Jiaotong University, Xi’an, China
| | - Yi-Chia Lee
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Ming-Lun Han
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Ping-Huei Tseng
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | | | - Rupa Banerjee
- Asian Institute of Gastroenterology, Hyderabad, India
| | - Noriya Uedo
- Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
| | - Wah Kheong Chan
- Division of Gastroenterology and Hepatology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Shiaw Hooi Ho
- Division of Gastroenterology and Hepatology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Shi-yao Chen
- Institute of Endoscopy, Zhongshan Hospital, Shanghai, China
| | - Shobna Bhatia
- Department of Gastroenterology, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Kohei Funasaka
- Department of Endoscopy, Nagoya University Hospital, Nagoya City, Aichi, Japan
| | - Takafumi Ando
- Department of Gastroenterology, Nagoya University Graduate School of Medicine, Nagoya City, Aichi, Japan
| | - Justin Wu
- Institute of Digestive Disease, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Cosmas Lesmana
- Department of Internal Medicine and Gastroenterology, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - William Tam
- Lyell McEwin Hospital, Adelaide, Australia,University of Adelaide, Adelaide, Australia
| | - Wen-Lun Wang
- Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohshiung, Taiwan
| | - Chi-Yang Chang
- Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohshiung, Taiwan
| | - Hwoon-Yong Jung
- Department of Gastroenterology, Asan Medical Center, Seoul, Korea
| | - Kee Wook Jung
- Department of Gastroenterology, Asan Medical Center, Seoul, Korea
| | | | - Kenshi Yao
- Department of Gastroenterology, Fukuoka University, Chikushi Hospital, Fukuoka, Japan
| | - Vui Heng Chong
- Department of Gastroenterology, RIPAS Hospital, Brunei Darussalam
| | - Prateek Sharma
- Division of Gastroenterology and Hepatology, Veterans Affairs Medical Centre and University of Kansas School of Medicine, Kansas City, MO, United States
| | - Khek-Yu Ho
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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