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Dadang Makmun
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Identification and Stenting of Malignant Obstructive Jaundice : Determining the Success Rates of ERCP Budi Tan Oto; Achmad Fauzi; Ari Fahrial Syam; Marcellus Simadibrata; Murdani Abdullah; Dadang Makmun; Chudahman Manan; Abdul Aziz Rani; Daldiyono Daldiyono
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 13, NUMBER 1, April 2012
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (245.041 KB) | DOI: 10.24871/131201219-22

Abstract

Background: Malignant and benign lesions may cause obstructive jaundice. The treatment of these conditions includes biliary stenting drainage, percutaneous transhepatic biliary drainage (PTBD), or surgical procedures. In advanced malignant jaundice, stent placement often turns out to be difficult. The aim of this study was to determine the success rates of malignant obstructive jaundice detection utilising endoscopic retrograde cholangiopancreatography (ERCP) and its stent placement procedure. Method: We conducted a retrospective study in 139 patients who undergone ERCP in Cipto Mangunkusumo Hospital between October 2004 and July 2008. Data was analyzed descriptively with SPSS version 17.0. Results: Of 139 study subjects, 131 (94.2%) of them had clinical obstructive jaundice (direct bilirubin indirect bilirubin level). There were 73 (55.7) male patients, with age range of 20-84 years. Among 114 patients with identified cause of obstruction, 57 (50%) patients had undergone stent placement; however, only 32 (56.1%) patients had successful stent placement. Our descriptive analysis showed that age and sex did not affect the stent success rates, and malignancy was showed to be a factor of stent failure. Conclusion: ERCP appears to be reliable enough for identifying the cause of obstructive jaundice in most patients. In this study, the achieved success rate of stent placement is more than 50%. Moreover, such rate is lower in the malignant obstructive jaundice than the non-malignant counterparts. Papillary carcinoma is the most frequent cause of malignant obstructive jaundice. Keywords: ERCP, obstructive jaundice, stenting, malignancy
Upper Gastrointestinal Abnormalities in Esophagogastroduodenoscopy Examination: Descriptive Study in PSUPAU Endoscopic Unit Julwan Pribadi; Sedijono Sedijono; Suryantini Suryantini; Marcellus Simadibrata; Ari Fahrial Syam; Murdani Abdullah; Achmad Fauzi; Dadang Makmun; Chudahman Manan; Daldiyono Daldiyono; Abdul Aziz Rani
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 9, ISSUE 3, December 2008
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/93200882-85

Abstract

Background: The Endoscopy Unit of Indonesian Air Force Central Hospital Dr. Esnawan Antariksa, Jakarta, Indonesia, has just been established in late 2004 and it is still in developing process. This study was aim to depict the profile of patients who underwent esophagogastroduodenoscopy procedure in the unit. Method: This study was a retrospective study that analyzed data in endoscopic registry of patients who underwent esophagogastroduodenoscopy (EGD) examination from September 2004 to December 2007. Result: Total of 108 patients underwent EGD examination, comprised of 66 (61%) males and 42 (39%) females, with average age of 45.4 years old (range 16-77 years old). The most frequent indication for EGD was dyspepsia 63%, followed by hematemesis-melena 26% and dysphagia 5.5%. Among patients with dyspepsia, EGD revealed organic abnormalities in 71% patients, with descriptions of erosive gastritis 35%, gastritis 18%, bile reflux 7%, esophagitis 5% and gastric ulcer 3%. Among patients with hematemesis-melena, EGD revealed abnormalities, which were described as erosive gastritis 48%, esophageal varices bleeding 22%, gastric ulcer 18%, caustic injury 4%, and esophagitis 4%. Conclusions: EGD is an important procedure to ascertain the occurence of organic abnormalities in patient with gastrointestinal symptoms and signs e.g. dyspepsia and gastrointestinal bleeding. More than half of patients with dyspepsia showed organic abnormalities. Among patients with hematemesis-melena, erosive gastritis is more common than variceal bleeding. Keywords: esophagogastroduodenoscopy, dyspepsia, upper gastrointestinal bleeding, hematemesis melena
Serial Cases of Combining ESWL and ERCP Procedures in Management Chronic Pancreatitis and Difficult Bile Duct Stones Achmad Fauzi; Nur Rasyid; Ari Fahrial Syam; Murdani Abdullah; Dadang Makmun; Marcellus Simadibrata; Chudahman Manan; Abdul Aziz Rani; Daldiyono Daldiyono
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 10, NUMBER 3, December 2009
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/1032009131-135

Abstract

Extracorporeal shock wave lithotripsy (ESWL) has an established role in the management of pancreaticductalcalculiandasfurthertreatmentmodalityforlargeordifficultcomplicatedcommon bile duct(CBD)stones. Combinedwithminimally invasive endoscopic procedure suchasendoscopic retrogradecholangio-pancreatography(ERCP),it has replaced open surgeryas theinitial form of therapy. ESWL has also proved to bean effective therapyin treating intrahepaticstones that are refractory toroutine endoscopic extraction.Inthese serialcaseswe presentthree caseswhichusing combinedESWLandERCP procedurestotreatchronicpancreatitispainandgiantCBDstonethat presentinggoodresultsonfollowupwithoutanycomplication.  Keywords:ESWL, ERCP,chronicpancreatitis, CBDstone
The Causes of Upper Gastrointestinal Bleeding in the National Referral Hospital: Evaluation on Upper Gastrointestinal Tract Endoscopic Result in Five Years Period Ari Fahrial Syam; Murdani Abdullah; Dadang Makmun; Marcellus Simadibrata; Dharmika Djojoningrat; Chudahman Manan; Abdul Aziz Rani; Daldiyono Daldiyono
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 6, ISSUE 3, December 2005
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/63200571-74

Abstract

Backgrounds: Gastrointestinal bleeding such as hematemesis or melena are common conditions in clinical practice and endoscopic service. The mortality rate due to gastrointestinal bleeding is relatively high. In this study, we evaluate the causes of hematemesis melena for the last 5 years and the factors associated with the bleeding. Methods: The study was done retrospectively. We obtained data from medical record of patients that performed endoscopy of upper gastrointestinal tract in Division of Gastroenterology, Department of Internal medicine, Cipto Mangunkusumo hospital (Jakarta, Indonesia) during the period of 2001 to 2005. Results: Of 4.154 patients who underwent upper gastrointestinal tract endoscopy from 2001 to 2005, we found that 837 patients (20.1%) were due to upper gastrointestinal bleeding. They were 552 male (65.9%) and 285 female patients (34.1%). Mean age of male patients was 52.7 ± 15.82 years, while for female patients was 54.46 ± 17.6 years. Of 837 patients who came due to hematemesis were 150 patients (17.9%), melena were 310 patients (37.8%), both melena and hematemesis were 371 patients (44.3%), 557 cases (66.5 %) due to non varices. Endoscopic results showed that 280 cases (33.4%) were due to esophageal varices. In general, this study had demonstrated that esophageal varices was the most frequent cause of upper gastrointestinal bleeding. We found 229 cases of esophageal varices were coincidence with portal hypertensive gastropathy. While ulcer was found in 225 cases (26.9%) and most of them were gastric ulcer (51.1%). Of gastrointestinal bleeding caused by esophageal varices, most were grade III in 138 cases (49.3%). The incidence of bleeding of bleeding were found more frequently in patients age group of 40 - 60 years (389 cases; 46.5%), 60 years (305 cases; 36.2%), 40 years (242 cases; 16.8%). The causes of bleeding in patients whose age 60 years, most were caused by ulcer (37.4%). In this study, we also found that cancer as the cause of gastrointestinal bleeding in 26 cases (3.1%). Gastrointestinal cancer comprised of gastric cancer in 15 cases (57.7%), duodenal cancer in 7 cases (26.9%), and esophageal cancer in 4 patients (15.4%). Conclusion: The most frequent cause of upper gastrointestinal bleeding was esophageal varices and usually had reached stage III. The non variceal cause of bleeding was gastric cancer. Upper gastrointestinal malignancy was also found to be the etiology of bleeding in this study. Keywords: upper gastrointestinal bleeding, endoscopy
Upper Gastrointestinal Malignancy among Dyspepsia Patients in Cipto Mangunkusumo Hospital Jakarta Ali Imron Yusuf; Ari Fahrial Syam; Murdani Abdullah; Dadang Makmun; Marcellus Simadibrata; Chudahman Manan; Abdul Aziz Rani
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 10, NUMBER 3, December 2009
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/103200992-95

Abstract

Background: Upper gastrointestinal (GI) malignancy was still a health problem in all over the world. The prevalence of the upper GI malignancy vary among Asian countries. Data from Indonesia was scarcely reported. The aim of this study is to determine the frequency of upper GI malignancy among dyspepsia patients who underwent esophagoduodenoscopy (EGD) procedure. Method: This is a retrospectives study from subject with dyspepsia that had underwent upper GI endoscopy at the Department of Internal Medicine Cipto Mangunkusumo hospital from January 2005 to December 2007. All complete data from medical report and histopathology appearance will be recorded. Results: Out of 2,116 subjects underwent endoscopy due to dyspepsia, 110 (5.19%) subjects was diagnosed as cancer. This upper GI malignancy consisted of gastric cancer in 63 (2.97%) cases, esophageal cancer 32 (1.51%) and duodenal cancer 15 (0.71%). The mean ages of the subjects was 53.36 ± 10.97 years, age less than 45 years was 20 (18.20%) subjects, more than 45 years was 90 (81.18%), male 71 (64.50%) subjects, female 39 (35.50%). Most of them had alarm signs 96 (87.30%). Histopathology finding showed adeno-carcinoma in 75 (68.20%) cases, signet ring cell carcinoma in 14 (12.70%), squamous cell carcinoma in 8 (7.30%), others in 13 (11.80%). Out of 59 gastric cancer, 48 (76.20%) cases was located at distal part while the rest 11 (17.50%) cases was located at the proximal gaster, and 4 (6.30%) in diffuse. By the ethnics founded Javanese 37 (33.60%) subjects, Betawinese 22 (20.00%), Sundanese 12 (10.90%) and Batak 13 (11.80%). Conclusions: Upper GI malignancy was found in five percent of subjects with dyspepsia who undergo colonoscopy. The three most frequent malignancies were gastric carcinoma, esophageal carcinoma, and duodenal carcinoma respectively. Most of gastric adenocarcinoma was located at distal stomach. Keywords: upper gastrointestinal malignancy, dyspepsia, endoscopy, alarm sign, histopathology
Factors Found on the First Variceal-Bleeding Episode in Liver Cirrhosis Patients with Portal Hypertension Arnold Hasahatan Harahap; Dadang Makmun; Irsan Hasan
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 11, NUMBER 1, April 2010
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/111201015-18

Abstract

Background: The dietary protein restriction that was commonly recommended to hepatic encephalopathy (HE) patients, often leads to malnutrition, whereas malnutrition can deteriorate cirrhosis prognosis. The aims of this study were to find out encephalopathy improvement that was measured by critical flicker frequency (CFF) test and nutritional status by measuring prealbumin level after L-Ornithine L-Aspartate (LOLA) treatment with adequate calories and protein intake in patients with HE. Method: Patients with liver cirrosis who visited Cipto Mangunkusumo hospital on June-October 2009 was evaluated by CFF test using HEPAtonormTM device. Encephalopathy was defined when CFF 39 Hz. Nutritional status was measured by the mid-arm muscle circumference (MAMC) and was stated as malnutrition when the MAMC was below the 15th percentile. Patients had been treated by 3 x 6 mg LOLA granules for 2 weeks, and adequate calories and protein intake with branched-chain amino acid (BCAAs) substitution. The change of encephalopaty was evaluated by the CFF test and the nutritional status by measuring prealbumin blood level. Results: There were 17 patients with liver cirrhosis who fulfilled the inclusion criteria. The mean CFF Result increased from 34.1 ± 2.5 Hz to 36.5 ± 2.9 Hz after LOLA treatment with the adequate calories and protein intake including BCAAs substitution, which was statistically significant (p 0.001) compared to before treatment. The prealbumin level also increased significantly compared before treatment, i.e. from 5.4 ± 2.1 mg/dL to 6.4 ± 2.6 mg/dL, p = 0.008. Conclusion: HE patients with malnutrition could be given adequate calorie and protein with BCAAs substitution to improve their nutritional  status,  and  LOLA  granules for the improvement of HE. Keywords: minimal hepatic encephalopathy, malnutrition, CFF, LOLA, prealbumin, BCAAs
Dyspeptic Syndrome in Urban Population of Jakarta Marcellus Simadibrata; Murdani Abdullah; Ari Fahrial Syam; Achmad Fauzi; Dadang Makmun; Chudahman Manan; Abdul Aziz Rani; Aan Santi; Ekowati Rahajeng
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 11, NUMBER 2, August 2010
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/112201066-70

Abstract

Background:  Dyspeptic syndrome is experienced by many patients who visit general practitioners and gastroenterologist. In Indonesia, a small number of epidemiological data about dyspeptic syndrome are available. The aim of this study was to obtain data on prevalence, characteristics and factors/lifestyle associated with dyspeptic syndrome in urban population of Jakarta. Method: The study was conducted by interview to 1,645 respondents representing the population of Jakarta in the year 2007 using the Steps WHO version 1.4 instruments. The selection of respondents was performed by multistage cluster random sampling, i.e. each municipality is represented by one district and each was represented by a number of villages and respondents interviewed at random. Dyspeptic syndrome is defined whenever there is one or more complaints of nausea, vomiting, belching, epigastric pain, no appetite, early satiety, bloating. Scoring was performed for each category of questions using wstep1 method prior to the analysis. Data analysis was performed with Chi-square test or t-test. Results: Of the 1,645 respondents, the prevalence of dyspeptic syndrome was 58.1%. The most apparent clinical complaint ranges consecutively, i.e. nausea 30.1%, epigastric pain 28.7%, bloating 23.8%, etc. Dyspeptic syndrome is significantly more often experienced by female respondents (p 0.001). Dyspeptic syndrome were more common in respondents who have less/no fruit (p 0.001) and vegetables (p = 0.049) intake. Dyspeptic syndrome is more common in respondents with anxiety and depression (p 0.001) also in respondents who consume non-steroidal anti-inflammatory drugs (NSAIDs) (p 0.001). Conclusion: Prevalence of dyspeptic syndrome in Jakarta urban population is 58.1%. Dyspeptic syndrome was more common in female, respondents who have less / no fruit and vegetables intake, in respondents who experienced anxiety and depression and respondents who consume NSAIDs. Keywords: dyspeptic syndrome, Jakarta, urban population, prevalence
Vasoactive Intestinal Peptide-Secreting Tumor Femmy Nurul Akbar; Dadang Makmun
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 10, NUMBER 3, December 2009
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/1032009120-124

Abstract

Vasoactive intestinal peptide-secreting tumor (VIPoma) is one of the tumors which cause “ watery diarrhea, hypokalemia, hypochlorhydria and acidosis syndrome” (WDHHA syndrome). These tumor caused by to non-insulin-secreting pancreatic islet tumor that associated with elevated vasoactive intestinal polypeptide (VIP) plasma level. VIP is a potent stimulator of gut cyclic adenosine monophosphate (cAMP) production, which leads to massive secretion of water and electrolytes mainly potassium. Over expression of VIP causes diarrhea and cancerous growth. The other clinical features of VIPomas such as hypercalcemia, abdominal discomfort, tetany, facial flushing are associated with the actions of VIP, which stimulate intestinal secretion, inhibit gastric acid secretion. VIP also regulates the synthesis, secretion, and action of neuroendocrine hormones such as secretin, glucagon, prostaglandin E, somatostatin and pentagastrin as well as cytokines and chemokines. Diagnosis is based on clinical, laboratory test show elevation VIP level, electrolyte and acid base imbalance also imaging such as CT scan or magnetic resonance imaging (MRI) which shows primary tumor in the pancreas and metastasis especially in the liver. Somatostatin receptor scintigraphy may be useful in identifying extrapancreatic VIPomas, i.e. the sympathetic chain, colon, bronchus and occult or distant metastases. Initial treatment is to correct volume, electrolyte, and acid-base abnormalities with intravenous normal saline, potassium chloride, and, sodium bicarbonate. Somatostatin or long acting ocreotide is effective in reducing serum VIP levels and promptly controlling diarrhea. Interferon alpha and glucocorticoid may be useful for reducing symptoms. Surgical resection depends on staging of pancreatic tumor.   Keywords: VIPoma, WDHHA syndrome, VIP, non insulin secreting pancreatic islet tumor
Hematochezia in Young Patient Due to Crohn’s Disease Anna Mira Lubis; Marcellus Simadibrata; Dadang Makmun; Ari F Syam
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 7, ISSUE 2, August 2006
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/72200654-56

Abstract

Crohn’s disease encompasses a spectrum of clinical and pathological patterns, affecting the gastrointestinal (GI) tract with potential systemic and extraintestinal complications. The disease can affect any age group, but the onset is most common in the second and third decade. Lower GI bleeding is one of its clinical features. Surgical intervention is required in up to two-thirds of patients to treat intractable hemorrhage, perforation, obstruction or unresponsive fulminant disease. We reported a case of Crohn’s disease in young male who suffered from severe lower GI bleeding (hematochezia) as the clinical features. Lower GI endoscopy revealed ulceration at the distal ileum surrounded by fibrotic tissue as a source of bleeding and a tumor mass at mesocolon. Upper GI endoscopy was unremarkable. Histopathologyc examination concluded multiple ulceration with chronic ischemic condition, appropriate to Crohn’s disease. The patient underwent emergency surgical intervention (subtotal colectomy and ileustomy), and his condition was improved.   Keywords: hematochezia, young male, Crohn’s disease, surgery
Hospital-based Survey on Knowledge and Attitude toward Colorectal Cancer Screening among Indonesian Population Murdani Abdullah; Achmad Fauzi; Ari Fahrial Syam; Dadang Makmun; Marcellus Simadibrata; Chudahman Manan; Joseph JY Sung; Abdul Aziz Rani
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 10, ISSUE 2, August 2009
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/102200951-55

Abstract

Background: Several western countries have recommended colorectal cancer (CRC) screening, however the yield of CRC screening is still low. The acceptability of CRC screening is influenced by people’s knowledge and attitude. This study was conducted to evaluate the knowledge and attitude of Indonesian people toward CRC screening. Method: Adult Indonesian population aged 19–65 years was recruited in this hospital-based survey. Knowledge and attitude toward CRC screening were assessed by using structured questionnaires consisting of nine chapters. Result: There were 614 respondents recruited in this study. Most respondents (36.2%) incorrectly pointed out abdominal pain or pain around anus as the symptom of bowel cancer. Regarding CRC risk factors, eating fruits or vegetables rarely was the most frequent answer (28.5%) encountered. Only one-third (28%) of respondents mentioned colonoscopy as the Method for CRC screening. There were 38.1% of respondents who believed that CRC screening test might be harmful to the body. Up to 70.8% of the respondents agreed and strongly agreed that CRC screening test might cause physical discomfort. Two fifth (41.5%) of respondents believed that CRC screening test was embarrassing. More than half (58.8%) of respondents were afraid of having the CRC screening test. The test was too expensive according to 79.5% of respondents. Conclusion: The knowledge on CRC symptoms, risk factors, and screening tests is still low among Indonesian population. Our study result indicates that the lack of knowledge and the discouraging attitude among Indonesian population will be the major barriers to implement CRC screening in Indonesia.   Keywords: colorectal cancer, screening, knowledge, attitude
Co-Authors Aan Santi Abdul Aziz Rani ACHMAD FAUZI Adang Bachtiar Adi Winarto Ahmad Fauzi Ali Imron Yusuf Anna Mira Lubis Ari F Syam Ari Fahrial Syam Arnold Hasahatan Harahap Bambang Sutopo Bona Adhista Budi Tan Oto Chudahman Manan Daldiyono Daldiyono Daldiyono Hardjodisasto Dasril Nizam Deddy Gunawanjati Dharmika Djojoningrat Dondin Sajuthi Ekowati Rahajeng Elli Arsita Ening Krisnuhoni Erni Sulistiawati Femmy Nurul Akbar Indra Marki Irsan Hasan Irsan Hasan Jeffri Gunawan Joseph JY Sung Julwan Pribadi Kaka Renaldi Katharina Setyawati Laurentius Aswin Pramono Lianda Siregar Marcellus Simadibrata Moch Ikhsan Mokoagow Mohammad Adi Firmansyah Murdani Abdulah Murdani Abdullah Novie Rahmawati Zirta Nur Rasyid Nurul Akbar Paulus Kusnanto Riahdo Saragih Rolan Sitompul Sedijono Sedijono Seri Mei Maya Ulina Steven Sumantri Suryantini Suryantini Tjahjadi Robert Tedjasaputra