<![CDATA[Background: Functional Endoscopic Sinus Surgery (FESS) is only indicated for nasal polyps (NP) cases which not responsive to maximal medical treatment. Objectives: To find proportion of NPs responsive to maximal medical treatment protocol consisted of office based endoscopic simple polypectomy followed by a 6-week intranasal steroid. Subjects who failed the treatment protocol underwent FESS and followed up until 12 months. The difference of gene expression profile was also evaluated based on their different clinical responses. Method: An experimental study of pre and post self-control to evaluate patients with naïve bilateral nasal polyps who had underwent endoscopic simple polypectomy under local anesthesia followed by intranasal steroid for six weeks. Microarray examination validated by real time RT-PCR was performed to determine the difference of gene expression profile before and after protocol treatment. Result: There were 16 responsive subjects (55.17%) to protocol treatment and 13 unresponsive subjects (44.83%) that subsequently underwent FESS. Twelve months follow up showed recurrent nasal polyps in 5 subjects (17.24%) and no recurrence in 8 subjects (27.6%). F5 gene expression was the determinant in response to protocol treatment, with Exp B=0.042 and p=0.04. Nagelkerke R square value of 49.9% showed the equation of F5 as determinant of reponsiveness.Conclusion: Clinical research of endoscopic simple polypectomy followed by intranasal steroid before FESS intervention in bilateral NP obtained evidence in biomolecular level to gain deeper understanding of how resolution of chronic inflammation happened. Keywords: nasal polyps, endoscopic simple polypectomy, functional endoscopic sinus surgery, F5 gene Abstrak : Latar belakang: Indikasi Bedah Sinus Endoskopik Fungsional (BSEF) pada polip hidung adalah kegagalan respons adekuat setelah terapi medikamentosa maksimal. Tujuan: Mengetahui proporsi penderita polip hidung yang responsif terhadap protokol terapi medikamentosa maksimal dengan polipektomi sederhana endoskopik serta terapi steroid intranasal selama 6 minggu. Pasien yang tidak responsif, menjalani terapi BSEF dan ditindak-lanjuti selama 12 bulan. Juga dievaluasi perbedaan profil ekspresi gen yang mempengaruhi perbedaan respons klinis tersebut. Metode: Desain penelitian adalah eksperimental dengan kontrol sendiri pra dan pasca intervensi polipektomi sederhana endoskopik dan terapi steroid intranasal selama 6 minggu pada penderita polip hidung bilateral. Pemeriksaan microarray yang divalidasi dengan pemeriksaan real time RT-PCR, dilakukan untuk mengetahui perbedaan profil ekspresi gen sebelum dan sesudah protokol terapi. Hasil: Sesudah protokol pengobatan terdapat 16 subjek (55,17%) menunjukkan respons terapi baik, dan 13 subjek (44,83%) dengan tanda klinis menetap atau memburuk, dan selanjutnya menjalani terapi BSEF. Tindak-lanjut selama 1 tahun pasca BSEF pada 13 subjek, didapatkan polip rekurens pada 5 subjek (17,24%) dan tidak ada polip 8 subjek (27,6%). Ekspresi gen F5 adalah variabel yang bermakna dengan nilai Exp B = 0,042 dan p = 0,04. Nilai Nagelkerke R square sebesar 49,9% menunjukkan kekuatan gen F5 sebagai determinan respons kesembuhan. Kesimpulan: Penelitian klinik dengan melakukan tindakan polipektomi sederhana endoskopik dilanjutkan terapi steroid intranasal sebagai terapi lini pertama pada polip hidung sebelum intervensi BSEF, mendapatkan bukti pada tingkat molekuler untuk dapat lebih memahami terjadinya proses resolusi inflamasi kronik. Kata kunci: polip hidung, polipektomi sederhana endoskopik, bedah sinus endoskopik fungsional, gen F5,]]>
