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All Journal The Indonesian Journal of Gastroenterology, Hepatology and Digestive Endoscopy Jurnal MedScientiae

Nenny Agustanti

Division Of Gastroenterology And Hepatology, Department Of Internal Medicine, Faculty Of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Bandung

Author-ID : 221744

Biochemistry, Genetics & Molecular Biology Health Professions Medicine & Pharmacology Nursing Public Health

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The Effectiveness of Emergency Endoscopic Retrograde Cholangiopancreatography in Patients with Severe Acute Cholangitis Muhammad Begawan Bestari; Nenny Agustanti; Yelica Rachmat; Dolvy Girawan; Ali Djumhana; Juke Roslia Saketi; Siti Aminah Abdurachman
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 11, NUMBER 3, December 2010
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/1132010128-131

Background: The aim of this study was to assess the frequency, indications, yield and outcome of emergent endoscopy retrograde cholangiopancreatography (ERCP) in severe acute cholangitis patients. Method: Records of all cholangitis patients undergoing ERCP were reviewed over a six months period. Indications, findings, therapeutic interventions and survival were analyzed. Indications for urgent drainage were temperature greater than 38ºC, increasing abdominal pain, jaundice and any organ involvement. Results: Of 80 ERCPs, 19 (23.75%) were severe acute cholangitis patients underwent emergency ERCP. The common bile duct was the duct of interest in all patients and was cannulated in 100%. The most common findings were choledocholithiasis (42.1%) and pancreatic head cancer (42.1%), followed by cholangiocarcinoma (10.5%) and papil vater carcinoma (5.3%). There were 12 (63.2%) septic shock patients with systolic blood pressure less than 90 mmHg and heart rate greater than 90 beats/minute who required inotropic drugs. Endoscopic biliary drainage was performed using 8.5 F biliary stent (73.7%) or common bile duct (CDB) stones removal (26.3%). The overall 30 days mortality was 0. Conclusion: Emergency ERCP in severe acute cholangitis is associated with improvement of clinical and some laboratory parameters without a complication of acute pancreatitis. In cases of chIoledocholithiasis, it can be performed with stone extraction as well as stent insertion Keywords: severe acute cholangitis, emergent ERCP, endoscopic stenting in difficult hilar biliary stricture

Role of Radial Endoscopic-ultrasound (EUS) to Establish Diagnosis of Undetermined Causes of Obstructive Jaundice: A Case Series Eka Surya Nugraha; Dolvy Girawan; Nenny Agustanti; Yudi Wahyudi; Muhammad Begawan Bestari
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 20, No 3 (2019): VOLUME 20, NUMBER 3, December 2019
Publisher : The Indonesian Society for Digestive Endoscopy

Identification the causes of obstructive jaundice are challenging. Recent radiologic imaging techniques improve diagnostic yield to determine jaundice causes. However, small lesions particularly in pancreas or periampullary area that lead to jaundice, often unrecognize with conventional radiologic imaging. Radial endoscopic-ultrasound (EUS) is the most sensitive modality to identify the lesions-related obstructive jaundice, remarkably in the lack of high-resolution radiologic facilities. We presented four cases of obstructive jaundice, without obvious obstruction causes from conventional radiologic imaging or abdominal ultrasound. All patients underwent radial EUS, pancreatic head mass revealed in 2 patients, and distal stenosis of the common bile duct without evidence of mass was found in 2 other patients. The masses size were 16 mm and 39 mm in diameter. Due to linear EUS and EUS guided fine needle were unavailable in our center, confirmation biopsy was undone. Three patients were performed endoscopic retrograde cholangiopancreatography (ERCP) for dilatation and inserting stents, and one patient referred to the surgeon. In conclusion, radial EUS aided to diagnose the definite causes of jaundice despite in the less-equipped of high-resolution radiologic imaging.

Reliability of Hepatus® for Evaluating Liver Fibrosis in Chronic Hepatitis B Jessica Cynthia Febryani; Muhammad Begawan Bestari; Haryono -; Dolvy Girawan; Nenny Agustanti; Yudi Wahyudi; Siti Aminah Abdurachman
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 23, No 2 (2022): VOLUME 23, NUMBER 2, August 2022
Publisher : The Indonesian Society for Digestive Endoscopy

Abstract BackgroundAmong non-invasive strategies available for liver fibrosis assessment, transient elastography is widely used, as it is non-invasive and can be repeated. Hepatus® (Mindray, China) is one novel instrument for measuring liver stiffness that is now available in the market with lower price than its precursor, FibroScan® (Echosens, Paris). MethodIn this cross sectional study, CHB patients in single center were recruited consecutively in October 2021-December 2021. The patients were examined for LSM with two transient elastography instruments in one visit. The first instrument was Hepatus® (Mindray, China) and the second one was FibroScan® (Echosens, Paris). Both measurements were done by the same operator. ResultsA total of 68 CHB patients were enrolled in this study. Median score of LSM by Hepatus® and FibroScan® were 7.6 (5.92-11.88) and 7.35 (5.63-11.80) respectively. Spearman rank analysis for correlation showed a significant correlation between the results of the two instruments ( r= 0.8, p 0.05). The number of patients with significant fibrosis (≥8 kPa) identified by Hepatus® and FibroScan® were 28 (41%) and 29 (43%) respectively. McNemar test yielded no significant difference of the results (p= 1.000), and Cohen’s kappa measure of agreement showed moderate agreement (κ = 0.789 and p 0.005). ConclusionHepatus® identified similar number of significant fibrosis patients with FibroScan®, with the results of liver stiffness measurement between the two instruments correlated significantly. Hepatus® has a potential as an alternative tool for measuring liver stiffness with a more economic price. KeywordsHepatus®, FibroScan®, transient elastography, liver fibrosis, CHB

Correlation between Serum Albumin and Fasting Blood Glucose Level in Patients with Liver Cirrhosis Nenny Agustanti; Ali Djumhana; Siti Aminah Abdurachman; Soetodjo NMN
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 15, No 3 (2014): VOLUME 15, NUMBER 3, December 2014
Publisher : The Indonesian Society for Digestive Endoscopy

Background: Liver cirrhosis is a pathological condition describes the end-stage of liver fibrosis. On liver damage may occur impaired glucose metabolism such as insulin resistance and glucose intolerance. The correlation between chronic liver diseases with impaired glucose metabolism has been known as hepatogenous diabetes. Albumin levels were significantly affected by poorly controlled blood glucose seen from the high HbA1c. This study aims to determine correlation of serum albumin level and fasting blood glucose level in patients with liver cirrhosis.Method: This cross-sectional study was conducted in 52 patients with liver cirrhosis in Gastroentero-hepatology Clinic and Inpatients, Hasan Sadikin Hospital. The study was conducted from February to June 2013. History taking, physical examination and laboratory tests including liver function tests and fasting blood glucose were performed. Data were analyzed using Spearman rank test for the correlation.Results: There were 31 (59.6%) males and 21 (40.4%) females with mean age 53.4 ± 12.8 years. The mean serum albumin was 2.7 ± 0.5 g/dL and median fasting blood glucose was 100 (66-195) mg/dL. Etiology of liver cirrhosis was hepatitis B virus infection 28 (51.9%), hepatitis C virus infection 16 (30.8%) and non viral hepatitis B and C infection 9 (17.3%). Severity of cirrhosis scored using child turcotte pugh (CTP) which was 43 (82.7%) of CTP B and 9 (17.3%) of CTP C. There was statistically significant correlation between albumin level and fasting blood glucose with ρ = -0.630 and p 0.01.Conclusion: In patients with liver cirrhosis have low serum albumin level correlates with high fasting blood glucose. Keywords: cirrhosis, albumin, fasting blood glucose

The COVID-19 with Gastrointestinal Symptoms: A Case Report Eka Surya Nugraha; Davin Takaryanto; Susantina Prodjosoewojo; Nenny Agustanti
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 21, No 2 (2020): VOLUME 21, NUMBER 2, August 2020
Publisher : The Indonesian Society for Digestive Endoscopy

The COVID-19 mostly manifested as fever and pulmonary symptoms, but recent evidence demonstrated the frequent gastrointestinal symptoms in particular moderate to severe disease. Here, we present a case of a 51-years old man with confirmed COVID-19 diagnosis who was admitted with profuse acute diarrhea and nausea. He previously had a mild fever, cough, and shortness of breath. Administration of oseltamivir, levofloxacin, and chloroquine sulfate exaggerated vomiting, nausea, and increased serum level transaminase. After withdrawal, the gastrointestinal symptoms were relieved gradually. Adequate supportive treatment and fluid therapy ceased diarrhea and led to the negative result of the nasal swab RT-PCR COVID-19 after seven days.

Antiviral Treatment and One-Year Follow-Up of Chronic Hepatitis B Patients in Bandung: An Observational Study Eka Surya Nugraha; Stefanie Hadi Supriami; Nur Atik; Nenny Agustanti; Yudi Wahyudi; Dolvy Girawan; M Begawan Bestari; Siti Aminah Abdurachman
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 23, No 2 (2022): VOLUME 23, NUMBER 2, August 2022
Publisher : The Indonesian Society for Digestive Endoscopy

Background: Hepatitis B Virus (HBV) is a health problem that has chronically infected 257 million globally. Appropriate therapy is immensely needed to prevent disease progression to cirrhosis and hepatocellular carcinoma (HCC). Moreover, routine monitoring is required to assess the efficacy of the given treatment. This study aims to describe the treatment and its follow-up outcomes among chronic HBV patients after one year of therapy in Bandung.Method: This was a cross-sectional descriptive study with a data sampling method obtained from assessing the medical records of treated chronic HBV outpatients at the Gastrohepatoenterology Clinic of Hasan Sadikin Hospital Bandung from 2018 to 2020. Laboratory findings before and after one year of therapy were further assessed.Results: Out of 107 patients treated, the proportion of tenofovir was 72.90%, telbivudine 16.80%, lamivudine 8.40%, and interferon group 1.90%. There were 52.30% of patients who did follow-up visits after one year of therapy. The therapeutic outcome rate was evaluated among total patients with the criteria of decreasing AST (91.18%) and ALT levels (93.10%) levels, reduction of HBV-DNA values (100%), and HBeAg seroconversion (14.29%).Conclusion: The most given therapy among chronic HBV outpatients was tenofovir. The follow-up rate of patients after one year of treatment was 52.30%. Overall, antiviral therapies produced decreases in liver laboratory parameters, HBV-DNA, and HBeAg.

Gut Microbiota in Human Immunodeficiency Virus Infection Rudi Wisaksana; Guntur Darmawan; Nenny Agustanti; Dolvy Girawan
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 20, No 1 (2019): VOLUME 20, NUMBER 1, April 2019
Publisher : The Indonesian Society for Digestive Endoscopy

Human microbiota, majority presents in human gastrointestinal tract, plays crucial role in body physiological functions, such as immune system. Human immunodeficiency virus (HIV) infection impairs gut barrier and alter the microbiota ecosystem, called dysbiosis. Different phase of HIV infection demonstrates different composition of gut microbiota. Antiretroviral treatment might improve the CD4 level, however, it inconsistently restore the gut ecosystem. Some studies in prebiotic and probiotic revealed the potential effect in reducing inflammation and restoring gut microbiota.

Reduction of Liver Fibrosis After Treatment with Elbasvir/Grazoprevir in Patients with Hepatitis C Infection in Chronic Kidney Disease on Hemodialysis, a Quasi-Experimental Study Bayu Laksono; Nenny Agustanti; Rudi Supriyadi; Muhammad Begawan Bestari; Siti Aminah Abdurachman
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 22, No 1 (2021): VOLUME 22, NUMBER 1, April 2021
Publisher : The Indonesian Society for Digestive Endoscopy

Background: Approximately 5-60% of hemodialysis patients have comorbid of hepatitis C virus (HCV) infection. The survival rate of hemodialysis patients HCV is lower than those without HCV due to the risk of liver fibrosis and cardiovascular disease. The combination of Elbasvir and Grazoprevir is the drug of choice for these patients with HCV genotype 1 and 4 which mainly inherited in populations in Indonesia. However, a high cost is required for this genome testing. Eradication of HCV might reduce liver fibrosis. One of the methods to evaluate liver fibrosis is by using APRI score. The aim of this study is to assess liver fibrosis using APRI score after Elbasvir/Grazoprevir therapy completion.Method: This was a quasi-experimental study without a control group which conducted during April-November 2019 in Dr. Hasan Sadikin Hospital, Bandung. Patients with reactive anti HCV, detected HCV RNA without genotype test, and sustained virological response (SVR) 12 achieved were included. APRI score and HCV RNA tests were performed before and after 12 weeks end of therapy (SVR12). The data were analyzed using paired T-test at a 95% confidence level.Results: Approximately 30% of hemodialysis patients had HCV infection. A total of 37 HCV patients in the hemodialysis unit were given Elbasvir/Grazoprevir for 12 weeks. The APRI score before and after 12 weeks after therapy were 0.336 and 0.270 (p = 0.002) respectively.Conclusion: The combination of Elbasvir/Grazoprevir might reduce the degree of liver fibrosis based on APRI score from 0.336 to 0.270 in HCV patients with chronic kidney disease on hemodialysis

Decreased in Liver Fibrosis in Patients with HCV/HIV Coinfection After Treatment with Sofosbuvir/Daclatasvir Andreas Jonathan; Rudi Wisaksana; Nenny Agustanti
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 20, No 2 (2019): VOLUME 20, NUMBER 2, August 2019
Publisher : The Indonesian Society for Digestive Endoscopy

Background: Hepatitis C Virus (HCV)/Human Immunodeficiency Virus (HIV) co-infection increases the progression of liver fibrosis to advanced liver disease and death. The aim of this study is to determine whether decreased of liver fibrosis occur in HCV/HIV coinfection patients after therapy with Sofosbuvir/daclatasvir. Method: This study used a quasi-experimental study design without a control group. The study subjects were HCV/HIV coinfection patients who received Sofosbuvir / daclatasvir therapy in the Gastroentero-Hepatology Clinic of Dr. Hasan Sadikin Hospital. In this study measurement of liver fibrosis was carried out by using AST to Platelet Ratio Index (APRI) and Fibrosis-4 Index (FIB-4) before therapy and when SVR-24 was achieved.Results: The study involved 29 subjects. Most of the research subjects were men, with an average age of 40.38 years (SD 3.48). From the results of this study, we found a decrease in APRI scores and FIB-4 index when HCV / HIV coinfection patients, that were treated with Sofosbuvir/ Daclatasvir, achieved SVR 24. The median of APRI scores before therapy and after SVR-24 was decreased from 0.41 to 0.28 (95% CI: 0.01 - 0.23, p-value 0,01) and the median of FIB-4 Index before therapy and after the SVR 24 was decreased from 0.94 to 0.81 (95% CI: -0, 04 - 0.35, p-value 0.28).Conclusion: This study concluded that therapy using Sofosbuvir / Daclatasvir in HCV / HIV coinfected patients has very good effectiveness and can reduce liver fibrosis.

Primary Biliary Cirrhosis Irvan Nugraha; Guntur Darmawan; Emmy Hermiyanti Pranggono; Yudi Wahyudi; Nenny Agustanti; Dolvy Girawan; Begawan Bestari
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 19, No 3 (2018): VOLUME 19, NUMBER 3, December 2018
Publisher : The Indonesian Society for Digestive Endoscopy

Primary biliary cirrhosis (PBC) is an inflammatory disease or chronic liver inflammation, with slow progressive characteristic and is an unknown cholestatic liver disease and commonly happen in middle-aged women. The incidence of PBC is 0.03 – 5.8 per 100,000 people per year, prevalence of 1.91-40.2 per 100,000 people and continues to increase. Based on the American Association for Study of Liver Disease criteria, the diagnosis of PBC is made in the presence of two out of three criteria, which are increase of alkaline phosphatase, positive antimitochondrial antibodies (AMA), and histopathology examination.We reported a case which is very rarely found; a 47-year-old women with the chief complaints of decrease consciousness and jaundice. In physical examination, there were anaemic conjunctiva, icteric sclera, hepatosplenomegaly, palmar erythema, and liver nails. In the patient, there was no evidence of obstruction in imaging with two-fold increase of alkaline phosphatase and positive AMA test. Patient was hospitalised to slow down the progression of the disease and to overcome the signs (e.g. pruritus, osteoporosis and sicca syndrome).

Co-Authors Ade Zuhrotun Ali Djumhana Ali Djumhana Ali Djumhana Andini, Dinda Andreas Jonathan Andreas Jonathan Anna Tjandrawati Bayu Laksono Begawan Bestari Davin Takaryanto Davin Takaryanto Dewi, Sumartini Dolvy Girawan Eka Surya Nugraha Emmy Hermiyanti Pranggono Enny Rohmawaty Guntur Darmawan Guntur Darmawan Guntur Darmawan Haryono - Haryono Haryono Hermin Aminah Usman Hesti Lina Wiraswati Hikmat Permana Irvan Nugraha Jessica Cynthia Febryani Juke Roslia Saketi Juke Roslia Saketi Kusumawati, Maya M Begawan Bestari Muhammad Begawan Bestari Muhammad Begawan Bestari Nanny N. M. Soetedjo Nugraha, Irvan Nur Atik Pranggono, Emmy Hermiyanti Rasdianto, Devi Novianto Rini Hendriani Ritonga, Ervita Rosdianto, Aziiz Mardanarian Rudi Supriyadi Rudi Wisaksana Rudi Wisaksana Rudi Wisaksana Saragih, Winda A. M. Savira Ekawardhani Siti Aminah Abdurachman Siti Aminah Abdurachman Siti Aminah Abdurachman Siti Aminah Abdurachman Siti Aminah Abdurachman Siti Aminah Abdurachman Soetodjo NMN Soetodjo NMN, Soetodjo Stefanie Hadi Supriami Susantina Prodjosoewojo Usman, Hermin A. Wijaya, Muhammad Palar Yelica Rachmat Yoga Windhu Wardhana Yudi Wahyudi Yudi Wahyudi Yudi Wahyudi Yudi Wahyudi Yudi Wahyudi

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