Hasil Pencarian  ::  Simpan CSV :: Kembali

"Latar Belakang: Sedasi yang efektif adalah terjaganya kedalaman sedasi dan analgesia serta mengendalikan pergerakan pasien selama prosedur ERCP berlangsung. Propofol merupakan obat anestetik sedasi yang tidak memiliki efek analgesia dan memiliki efek depresi kardiovaskular dan respirasi yang tergantung dosis. Penambahan ketamin dosis kecil diharapkan dapat menurunkan kebutuhan dosis propofol dalam mempertahankan kedalaman sedasi dan analgesia serta kestabilan hemodinamik dan respirasi. Penelitian ini akan membandingkan keefektifan sedasi antara campuran ketamin dan propofol (ketofol) konsentrasi 1:4, dan propofol - fentanil pada prosedur ERCP. Metode: Penelitian ini merupakan penelitian uji klinis acak tersamar ganda pada 36 pasien yang menjalani prosedur ERCP, dengan usia 18-60 tahun, ASA I-III, BMI 18-30 kg/m 2, yang dibagi menjadi dua kelompok yaitu kelompok KF (n=18) dan kelompok PF (n=18). Kedua kelompok obat menggunakan metode infus kontinyu dengan syringe pump. Kedalaman sedasi diukur dengan menggunakan Ramsay Sedation Scale (RSS). Hasil: Dari hasil penelitian didapatkan rerata konsumsi propofol permenit kelompok campuran ketamin propofol (ketofol) ( 93,71±11,82) lebih rendah bermakna secara statistik dibandingkan kelompok propofol fentanil (141,18±19,23) (p<0.05). Jumlah median kebutuhan fentanil pada kelompok ketofol ( 0,00(0-25)) lebih rendah bermakna dibandingkan kelompok propofol fentanil (25,00 (25-50)) (p<0.05). Mula kerja dan waktu pulih pada kelompok propofol fentanil (3,00(2-4)) dan (5,00(2-15)) lebih cepat dibandingkan kelompok ketofol (4,50(2-5)) dan (15,00 (5-20)) (p<0.05). Kejadian hipotensi pada kelompok ketofol 1,00 (5,56%) tidak berbeda bermakna secara statistik dengan kelompok propofol fentanil 3 (16,67%) (p=0,603). Tidak didapatkan kejadian desaturasi dan mual/muntah pada kedua kelompok. Kesimpulan: Campuran ketamin propofol (ketofol) efektif dalam menjaga kedalaman sedasi dan analgesia serta memiliki efek samping yang minimal.

---

Background: The effectiveness of sedation is the ability of the drugs to maintain the depth of sedation and analgesia as well as to control the patient movement during the ERCP procedure. Propofol is a sedation agent that has no analgesia effect and has cardiovascular and respiratory depressant effect which is dose dependent. The addition of small dose of ketamin is expected to reduce the dose required to maintain hemodinamic and respiratory stability. This study will compare the effectiveness of sedation between the used of 1:4 of ketamin propofol mixtures (ketofol) and propofol fentanyl in ERCP procedure.

Methods: This study is a double blind randomised clinical trial in 36 patients who underwent ERCP procedure, aged 18-60 y.o, ASA I-III, BMI 18-30 kg / m2, which is divided into two groups: KF (n = 18) and the PF group (n = 18). Both group is using continuous syringe pump infusion. The depth of sedation was measured by using Ramsay Sedation Scale (RSS).

Results: From the results, the average consumption of propofol per minute of group propofol ketamine mixtures (ketofol) (93.71 ± 11.82) was significantly lower than fentanyl propofol group (141.18 ± 19.23) (p <0.05). The median fentanyl consumption of ketofol group (0.00 (0- 25)) was significantly lower than fentanyl propofol group (25.00 (25-50)) (p <0.05). The onset and the time to recover in fentanyl propofol group (3.00 (2-4)) and (5.00 (2-15)) were faster than ketofol group (4.50 (2-5)) and (15.00 (5-20)) (p <0.05). The incidence of hypotension in group ketofol 1.00 (5.56%) was not significantly different from fentanyl propofol group 3 (16.67%) (p = 0.603). There were no desaturation events or nausea/vomiting in both groups.

Conclusion: The mixture of ketamine propofol (ketofol) is effective in maintaining the depth of sedation and analgesia and has minimal side effects."

"Endoscopic ultrasonography (EUS) has evolved from an obscure method of investigation in the 1980s to a distinct endoscopy subspecialty with interventional and therapeutic capabilities. The art of interpreting EUS images is a skill every endoscopist needs to master. This book helps to meet that need as it is concise, simple to read, and amply illustrated, and describes the technique in a step-by-step manner. Many high-resolution EUS images of diseases are included, and literature reviews are kept short and concise while separate discussions and illustrations are devoted to radial and linear techniques. The book can be used as a reference handbook in the endoscopy room, yet contains all of the relevant information required to perform EUS, interpret images, and reach a diagnosis. Important pathological conditions are thoroughly discussed using representative EUS images, pointing out salient differentiating features, and relevant literature reviews are included. The section on interventional EUS deals with advanced interventional or therapeutic procedures, and potential complications and methods to avoid them are discussed. "

"ABSTRAKLatar belakang:Bayi laringomalasia primer memiliki komorbiditas yang tinggi akibat silent aspiration. Hingga saat ini, belum diketahui prevalensi disfagia dan data mengenai gambaran fungsi menelan bayi laringomalasia primer. Tujuan penelitian: Mengetahuiprevalensi disfagia dan gambaran fungsi menelanpada bayi laringomalasia primersertamengetahui kesesuaian antara SEES dan FEES.Metode: Penelitiancross-sectional yang bersifat deskriptifdan analitik komparatif terhadap 34subjek bayi laringomalasia primersecara konsekutif di RS Dr. Cipto Mangunkusumoperiode Januari-Maret 2020. Hasil:Prevalensi disfagiapada bayi laringomalasiaprimersebanyak 9 dari 34 subjek (26,5%). Gejala disfagia pada bayi< 6 bulan tersering adalah regurgitasi dan apneasaat menyusu (5/6), sedangkan pada bayi>6 bulan adalah terdengar banyak lendir di tenggorok (3/3). Komorbid terbanyak adalah kelainan genetikdan PRGE(3/9). Komplikasi terseringadalah pneumonia aspirasi (6/9). Pada pemeriksaan awal FEES, kontrol postural terganggu(7/9) merupakantanda yang paling sering ditemukan. Pada pemeriksaan FEES, preswallowing leakagedidapatkan pada konsistensi puree, tim saring, dan tim kasar. Pada pemeriksaan SEES dan FEES, residu, penetrasi,dan aspirasipalingbanyak didapatkan pada konsistensi susu. Silent aspirationdidapatkan pada4 dari 9subjek dengan disfagia. Pemeriksaan SEES memiliki kesesuaian dengan FEES berdasarkanuji McNemarpadaparameter ada tidaknya penetrasi, residu, dan aspirasi.Kesimpulan:Prevalensi disfagia pada bayi laringomalasia primersebanyak 9 dari 34 subjek(26,5%), penetrasi dan aspirasi didapatkan pada konsistensi air dan susuterutama pada bayi< 6 bulan, dan SEES memiliki kesesuaian dengan FEESdalam menilai fungsi menelanberdasarkan parameter ada tidaknya residu, penetrasi, dan aspirasi.

---

Background:Silent aspiration is oftenunrecognized comorbidity in infants with congenital laryngomalacia with serious medical consequence. However, prevalence of dysphagia and characteristic of dysphagia ininfants with congenital laryngomalacia is still unknown. Aim: To find the prevalence and the overview of swallow function in infants with congenital laryngomalacia and also to know the conformity between SEES and FEES in assessing swallow function. Methods:This is a descriptive cross-sectional and comparative analytic study involving 34 infants with congenital laryngomalacia who came consecutivelytoDr. Cipto Mangunkusumo Hospitalon January-March 2019. Results: The prevalence of dysphagia was 9 out of 34 subjects (26,5%).Dysphagia symptom in infants<6 months was regurgitation and apneawhile bottle/breast feeding (5/6). Meanwhile, in infants>6 monthswaswet sounding voice (3/3). The comorbidities found mostly were geneticanomaly and GERD(3/9). The complication mostly was aspiration pneumonia (6/9). In pre-FESS examination, poor postural controlwas dominant(7/9). In FEES examination, preswallowingleakagewas found in puree, soft steam porridge, and rough steam porridge. In FEES and SEES examination, residue, penetration, and aspirationwas mostly found inthick liquid. Silent aspiration was found in 4 out of 9subjects with dysphagia. SEES has a conformity to FEES based on McNemar test in the presence of residue, penetration, and aspiration. Conclusion: The prevalence of dysphagia in infants with congenital laryngomalaciawas9 out of 34 subjects(26,5%). In FEES examination, penetration,and aspiration were found mostly in thin liquid, <6months of age predominantly.SEES has a conformity to FEES based on presence of residue, penetration, and aspiration in assessing swallow function."

"Latar Belakang : Tingkat akurasi EUS FNA dalam diagnosis lesi pankreas diduga dipengaruhi oleh berbagai macam faktor. Penelitian mengenai faktor yang mempengaruhi keberhasilan EUS FNA belum pernah dilakukan di Indonesia. Penelitian ini dilakukan untuk mengetahui faktor-faktor yang mempengaruhi keberhasilan EUS FNA untuk diagnosis lesi pankreas pada populasi Indonesia.Metode : Penelitian ini merupakan studi potong lintang dari data rekam medis pada januari 2012-Juli 2022 atau total seluruh subjek yang dilakukan EUS FNA karena lesi pankreas di PESC RSCM. Pasien dengan data tidak lengkap dan lesi peripankreas tidak diikutkan. Karakteristik dasar subjek penelitian ditampilkan dalam bentuk tabel. Analisis bivariat menggunakan uji chi square dilakukan dengan masing-masing variabel bebas terhadap keberhasilan diagnostik EUS FNA untuk menghitung nilai odds ratio (OR). Variabel dengan nilai p< 0,25 pada analisa bivariat dimasukkan ke analisa multivariat dengan regresi logistik.Hasil : Sebanyak 201 pasien dengan lesi pankreas yang menjalani pemeriksaan EUS FNA diikutkan dalam penelitian. Angka keberhasilan diagnostik EUS FNA pada lesi pankreas adalah sebesar 77,11%. Ukuran lesi ³3 cm diasoasikan dengan peningkatan keberhasilan diagnosis EUS FNA berdasarkan analisis bivariat (OR 2,46; IK95 1,25-4,86; p= 0,008). Analisis multivariat menunjukan bahwa ukuran lesi ³3 cm (OR 18,95; IK95 4,77-75,29; p = 0,000),  lokasi lesi di korpus (OR 2.82; IK95 1.03-7.77; p= 0,04) dan ukuran jarum 22G (OR 7.49; IK95 1.87-29.97; p= 0.004) diasoasikan dengan peningkatan keberhasilan diagnosis. Kesimpulan : Ukuran lesi, lokasi lesi dan ukuran jarum, merupakan faktor yang mempengaruhi keberhasilan diagnostik EUS FNA pada lesi pankreas.

---

Background: Diagnostic accuracy of EUS FNA in diagnosing pancreatic lesion are affected by several factors. Clinical study regarding these factors had not been done in Indonesia. This study aims to study factors affecting the diagnostic yield of EUS FNA in diagnosing pancreatic lesion in Indonesian population. 

Method: This study is a cross-sectional study of medical record data in January 2012-July 2022 or a total of all subjects who underwent EUS FNA due to pancreatic lesions at PESC RSCM. Patient with incomplete data and peripacreatic lesion was excluded. Clinical characteristics of sample is presented in a table. Bivariat analysis was conducted with chi square test between independent factors and diagnostic success of EUS FNA to obtained the odds ratio (OR). Factors with p-value above 0,25 are included for multivariat analysis using logistic regression.  

Result: A total of 201 patients underwent EUS FNA was included in this study. Success rate of diagnosing pancreatic lesion using EUS FNA was 77,11%. Lesion size ³3 cm increased the odds for diagnostic success based on bivariat analysis (OR 2,46; 95% CI 1,25-4,86; p = 0,008). Multivariate analysis showed that the lesion size ³ 3 cm (OR 18.95; CI95 4.77-75.29; p = 0.000), the location of the lesion in the corpus (OR 2.82; CI95 1.03-7.77; p = 0.04) and needle size 22G (OR 7.49; CI95 1.87-29.97; p= 0.004) was associated with an increase in diagnostic yield.

Conclusion: The size of the lesion, the location of the lesion and the size of the needle, are factors that influence the diagnostic yield of EUS FNA in pancreatic lesions"

"Latar Belakang: Obesitas diketahui memiliki berbagai macam komplikasi dalam jangka panjang, salah satunya yaitu gangguan motilitas lambung dan perlambatan pengosongan lambung. Hal ini memiliki implikasi yang cukup serius khususnya pada kondisi perioperatif dimana perlambatan pengosongan lambung meningkatkan risiko aspirasi cairan lambung ke saluran napas. Dibutuhkan penilaian isi konten lambung secara riil menggunakan ultrasonografi untuk menilai volume residual lambung perioperatif. Tujuan: Menganalisis posisi pemeriksaan yang optimal dan metode pengukuran ultrasonografi lambung yang terbaik serta membandingkan volume residual lambung berdasarkan pemeriksaan ultrasonografi dua jam pasca pemberian cairan maltodextrin 12,5% antara populasi obesitas dan non obesitas. Metode: Sebanyak 53 subjek berpartisipasi pada penelitian ini pada periode Desember 2023 hingga Maret 2024. Desain penelitian ini adalah potong lintang perbandingan volume residual lambung antara populasi obesitas dan non obesitas yang dianalisis dengan uji Mann-Whitney. Hasil: Tidak didapatkan perbedaan hasil pengukuran diameter CSA antrum lambung dengan metode elipsoid ataupun dua dimensional. Terdapat perbedaan bermakna antara posisi pemeriksaan RLD dibandingkan berbaring dalam menilai volume residual lambung (p < 0,05). Median volume residual lambung dua jam pasca konsumsi cairan karbohidrat pada kelompok obesitas berat yaitu 1,93 (0,56-3,39) ml/KgBB dengan batas aman risiko aspirasi yaitu <1,5 ml/KgBB. Kesimpulan: Pemeriksaan ultrasonografi lambung terbaik dilakukan pada posisi RLD dan dapat menggunakan metode elipsoid ataupun dua dimensional. Terdapat peningkatan volume residual lambung dua jam pasca konsumsi cairan karbohidrat yang melebihi batas aman risiko aspirasi pada kelompok obesitas berat.

---

Background: Obesity is known to have various long-term complications, one of which is delayed gastric emptying. This condition has quite serious implications, especially in perioperative conditions which can increases the risk of aspiration of gastric fluid into the airway. Gastric content assessment using ultrasonography is needed to assess perioperative gastric residual volume. Objective: To analyze the optimal examination position, the best gastric ultrasound measurement method and to compare the gastric residual volume two hours after administration of 12.5% maltodextrin fluid in obese and non-obese populations. Method: A total of 53 subjects participated in this study during the December 2023 to March 2024. This was a cross-sectional comparative study of gastric residual volume between obese and non-obese populations analyzed using the Mann-Whitney test. Results: There were no differences in the results of measuring the CSA diameter of the gastric antrum using the ellipsoid or two-dimensional method. There was a significant difference between the RLD examination position compared to supine position in assessing gastric residual volume (p < 0.05). The median residual volume of the gastric antrum two hours after consuming carbohydrate fluids in the severely obese group was 1.93 (0.56-3.39) ml/KgBW which exceed the safe limit for aspiration risk (<1.5 ml/KgBW). Conclusion: The best gastric ultrasound examination is carried out in the RLD position and can use both ellipsoid and two-dimensional method. There was significant increase in gastric residual volume two hours after carbohydrate fluids administration which exceeded the safe limit for risk aspiration in the severely obese group."

"Introduction: In 2010, the American Venous Forum developed a Venous Clinical Severity Score (VCSS) scoring system to assess the severity of Chronic Venous Insufficiency (CVI), where this system was said to be more comprehensive than the CEAP system. However, VCSS validation was still lacking. The purpose of this study was to examine VCSS for reflux and leg vein diameter based on ultrasonography. Method: This study was a cross-sectional diagnostic test on women workers with standing work positions of 114 people (228 limbs) in Jakarta. VCSS assessment and ultrasound examinations were carried out on all subjects. The relationship between VCSS with reflux and leg vein diameter was analyzed using an odds ratio with a 95% confidence interval. Results: From 228 examined limbs, the VCSS score of 0-3 was 18.4%, and the score of ≥4 was 81.6%. Reflux was found in 21.9% of the limbs. There was a significant relationship between VCSS and reflux in leg veins. The diameter of the great saphenous vein was between 2.1-12.2 mm, the femoral vein was 7.1-17 mm, the popliteal vein as 3-11.4, and the small saphenous vein was 1.7-7mm. When VCSS was analyzed for association with venous diameter, a significant relationship was found. VCSS sensitivity compared with reflux based on USG was 78%, specificity was 98.31%, positive predictive value was 92.86%, and the negative predictive value was 93.86%.Conclusion: From the results of this study, it was concluded that the VCSS score could be used as a method for assessing chronic venous insufficiency. Although VCSS is was to assess the severity of the chronic venous disease, VCSS can also be used for screening because it shows a good relationship with the reflux and venous diameter of the limbs based on ultrasound."

"Latar belakang. Endoscopic retrograde cholangio pancreatography ERCP merupakan tindakan yang dapat menimbulkan rasa tidak nyaman dan nyeri pada pasien, sehingga diperlukan obat sedasi yang adekuat. Propofol dan ketamin adalah dua obat sedasi yang sering digunakan. Penambahan ketamin pada propofol dapat melawan efek depresi pernapasan dan kardiovaskular dari propofol. Kombinasi propofol dan ketamin ketofol telah digunakan sebagai obat sedasi pada berbagai prosedur medis. Namun, evaluasi efektivitas berbagai konsentrasi ketofol terkait perubahan hemodinamik, waktu pulih, dosis, dan efek samping belum banyak diteliti. Penelitian ini bertujuan untuk membandingkan efektivitas sedasi ketofol rasio 6:1 dengan rasio 4:1 pada ERCP.Metode. Penelitian ini merupakan uji klinis acak tersamar tunggal terhadap pasien yang menjalani ERCP di PESC RSCM pada bulan Maret-Mei 2017. Sebanyak 58 pasien diambil dan dirandomisasi menjadi dua kelompok. Kelompok K61 n=29 mendapat infus kombinasi propofol:ketamin 6:1, sedangkan kelompok K41 n=29 mendapat infus kombinasi propofol:ketamin 4:1. Kedalaman sedasi diukur menggunakan skor sedasi Ramsay. Analisis data menggunakan uji-t tidak berpasangan atau Mann-Whitney.Hasil. Rerata kebutuhan propofol antara ketofol 6:1 125,49 30,49 mcg/kg/mnt dan ketofol 4:1 121,28 28,94 mcg/kg/mnt tidak berbeda bermakna. Waktu pulih ketofol 6:1 6,55 0,5-19 mnt lebih cepat dibandingkan ketofol 4:1 11,37 4,9-20,53 mnt

---

Background. Endoscopic retrograde cholangiopancreatography ERCP is a painful procedure that requires analgesic and sedative. Propofol and ketamine are common drugs that are used as sedative in ERCP. The addition of ketamine to propofol may counteract the cardiorespiratory depression caused by propofol. Ketofol, a combination of propofol and ketamine has been used as sedative in various medical procedures. However, evaluation of the effectiveness of different concentration of ketofol in procedural operation regarding changes in hemodynamic, recovery time, doses, and adverse effects was not yet studied. This study was conducted to compare the effectiveness of ketofol ratio of 6 1 with ratio of 4 1 in ERCP.

Methods. This was a randomized, single blinded study in patients underwent ERCP in PESC RSCM during March May 2017. There were 58 subjects who were randomized into two groups. K61 group n 29 received an infusion of ketofol ratio of 6 1, whereas K41 group n 29 received an infusion of ketofol ratio of 4 1. Sedation level was measured with Ramsay sedation score. Data were analyzed by t test or Mann Whitney test.Results. The average requirement of propofol between K61 125,49 30,49 mcg kg min and K41 121,28 28,94 mcg kg min was not significantly different. Recovery time of K61 6,55 0,5 19 min was faster compare to K41 11,37 4,9 20,53 min . There were no desaturation and emergence delirium recorded in both groups. Hypotension was recorded in one patient in each group. Hypersalivation only reported in one patient 3.4 in K61 group, whereas in K41 group there were five patients who were reported have hypersalivation. The incidence of nausea vomiting in K61 group was 6 20.7 and in K41 group was 11 37.9 . The level of postoperative pain in both groups was not significantly different.

Conclusion. Ketofol 6 1 was not more effective than ketofol 4 1 because the requirement of the drugs between both groups was not different, however ketofol 6 1 has faster recovery time and fewer adverse effects."

"Latar Belakang. Striktur bilier ditemukan pada 70-90% kasus keganasan pankreatobilier dan menimbulkan morbiditas dan mortalitas yang tinggi terutama pada stadium lanjut yang unresectable. Pada stadium tersebut, tata laksana paliatif bertujuan untuk meningkatkan kualitas hidup pasien dan memperbaiki kesintasan. Tata laksana paliaitf yang dapat dilakukan adalah dengan pemasangan sten bilier perendoskopik dan operasi pintas saluran bilier. Sehingga, perlu diketahui perbedaan kesintasan satu tahun pasien dengan striktur bilier maligna yang mendapatkan terapi paliatif dengan prosedur biliodigestive double bypass dan pemasangan sten bilier perendoskopik di RSCM. Tujuan. Mengetahui perbedaankesintasan antara pasien striktur bilier distal maligna yang menjalani prosedur double bypass dan prosedur pemasangan sten bilier per endoskopik.Metode. Penelitian dilakukan dengan metode kohort retrospektif dengan subyek penelitian pasien striktur bilier maligna distal yang menjalani prosedur pemasangan sten perendoskopik atau prosedur double bypass di RSCM pada periode 1 Januari 2015 – 31 Desember 2019 dan dilakukan pengamatan selama 1 tahun sejak pasien menjalani prosedur tersebut. Kesintasan dinilai dengan metode Kaplan-Meier dan dilanjutkan dengan analisis multivariat terhadap faktor-faktor yang dinilai dapat menjadi faktor perancu.Hasil. Penelitian ini berhasil mengumpulkan 119 subjek pada kelompok sten endoskopik dan 39 subjek pada kelompok double bypass. Pada pengamatan kesintasan satu tahun, didapatkan median kesintasan 93 hari pada kelompok sten endoskopik dan 140 hari pada kelompok double bypass [HR 0,871 (IK95% 0,551-1,377; p = 0,551)]. Tidak ditemukan perbedaan kurva kesintasan pada kedua kelompok. Pada analisis multivariat, didapatkan Charlson Comorbidity Index, usia, dan bilirubin adalah variabel perancu.Kesimpulan. Tidak terdapat perbedaan kesintasan antara pasien striktur bilier distal maligna yang menjalani prosedur double bypass dan prosedur pemasangan sten bilier perendoskopik. Usia, CCI 34, dan kadar bilirubin merupakan faktor perancu terhadap kesintasan kesintasan antara pasien striktur bilier distal maligna yang menjalani prosedur double bypass dan prosedur pemasangan sten bilier per endoskopik.

---

Background. Biliary strictures are observed in 70-90% of cases of pancreatic malignancy and cause high morbidity and mortality, especially in advanced, unresectable stage. At this stage, palliative management aims to improve the patient's quality of life and survival. Palliative management can be done is by placing an endoscopic biliary stent and biliary tract bypass surgery. Thus, it is necessary to know the one-year survival of patients with malignant biliary stricture who received palliative therapy with billio-digestive double bypass procedures and perendoscopic biliary stent placement in RSCM. Objective. To determine the survival between patients with distal malignant biliary stricture who underwent a double bypass procedure and an endoscopic biliary stent placement procedure.

Methods. This is a restrospective cohort study with the subjects being patients with distal malignant biliary strictures who underwent endoscopic stenting procedures or double bypass procedures at RSCM in the period 1 January 2015 – 31 December 2019 and was observed for one year since the patient underwent the procedure. Survival was done using the Kaplan-Meier method and followed by multivariate analysis using the cox regression test.

Result. We collected 119 subjects in the endoscopic stent group and 39 subjects in the double bypass group. After one year, median survival was 93 days in the endoscopic stent group and 140 days in the double bypass group [HR 0,871 (95%CI 0,551-1,377; p = 0,551)]. In multivariate analysis, it was found that Charlson Comorbidity Index, age, and bilirubin were confounding variables.

Conclusion. There was no difference in survival between patients with malignant distal biliary stricture who underwent a double bypass procedure and an endoscopic biliary stent procedure. Age, CCI 4, and bilirubin levels were confounding factors for survival among patients with malignant distal biliary stricture who underwent a double bypass procedure and an endoscopic biliary stent placement procedure."

"Latar Belakang. Keganasan merupakan etiologi utama ikterus obstruktif selain batu. EUS memiliki nilai diagnostik yang lebih baik dibandingkan MRCP dalam mendeteksi batu saluran empedu. Di Indonesia, belum ada penelitian yang membandingkan EUS dan MRCP pada kasus keganasan saluran bilier dan pankreas. Nilai diagnostik ini penting untuk meningkatkan kecepatan dan ketepatan diagnostik sehingga dapat diambil tatalaksana yang paling sesuai.Tujuan. Mengetahui nilai sensitivitas dan spesifisitas EUS dibandingkan MRCP pada pasien ikterus obstruktif karena keganasan.Metode. Studi observasional analitik dengan mengumpulkan data rekam medik pasien usia > 18 tahun di RSCM yang terdiagnosis ikterus obstruktif diduga karena keganasan tahun 2014-2018 dan telah dilakukan pemeriksaan EUS dan atau MRCP sebelum dilakukan ERCP (baku emas). Dilakukan identifikasi hasil EUS, MRCP, dan ERCP, kemudian dilakukan analisis dengan IBM SPSS Statistic 20 untuk uji diagnostik.Hasil Utama. Terdapat 54 subyek yang memenuhi kriteria inklusi dan eksklusi, dimana 53,7% di antaranya adalah laki-laki dengan rerata usia 56,48 ± 11,37 tahun. Tumor kaput pankreas merupakan jenis keganasan yang paling banyak dijumpai (50%) berdasarkan pemeriksaan ERCP. Nilai sensitivitas, spesifistas, NDP, NDN, RKP, RKN, dan akurasi untuk EUS masing-masing adalah 96%, 60%, 96%, 60%, 2.40, 0.07, dan 93%. Untuk MRCP, nilai masing-masing adalah 90%, 40%, 94%, 29%, 1.50, 0.26, 85%. Sedangkan nilai AUC dari EUS adalah 78% (IK95% 51%-100%), p = 0,041. Untuk MRCP, nilai AUC yang diperoleh adalah 64,9% (IK95% 36,2%-93,6%), p = 0,276.Simpulan. EUS memiliki nilai sensitivitas dan spesifisitas yang lebih baik dibandingkan MRCP pada pasien ikterus obstuktif karena keganasan.

---

Background Malignancy is the main etiology of obstructive jaundice besides stones. EUS has a better diagnostic value than MRCP in detecting bile duct stones. In Indonesia, there are no studies comparing EUS and MRCP in cases of biliary and pancreatic malignancies. This diagnostic value is important to improve the speed and accuracy of the diagnostic so that the most appropriate treatment can be taken.Methods Analytic observational study by collecting medical records of patients aged> 18 years in RSCM diagnosed with obstructive jaundice suspected due to malignancy in 2014-2018 and EUS and / or MRCP examination before the ERCP (gold standard) was performed. EUS, MRCP, and ERCP results were identified, then an analysis was performed with IBM SPSS Statistics 20 for diagnostic tests.Results There were 54 subjects who met the inclusion and exclusion criteria, of which 53.7% were men with an average age of 56.48 ± 11.37 years. Pancreatic head tumor is the most common type of malignancy (50%) based on ERCP examination. The sensitivity, specificity, PPV, NPV, LR+, LR-, and accuracy values for EUS are 96%, 60%, 96%, 60%, 2.40, 0.07, and 93%, respectively. For MRCP, the values are 90%, 40%, 94%, 29%, 1.50, 0.26, 85%, respectively. AUC value for EUS is 78% (CI95% 51%-100%), p = 0.041. Meanwhile, AUC value for MRCP is 64,9% (CI95% 36,2%-93,6%), p = 0.276.Conclusion: EUS has better sensitivity and specificity values than MRCP in obstructive jaundice patients due to malignancy."