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All Journal The Indonesian Journal of Gastroenterology, Hepatology and Digestive Endoscopy
Ho, Khek Yu
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Medicine & Pharmacology

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A Rare Case Of Acute Pancreatitis Cause by Newly Diagnosed Graves’ Disease: A Successful Therapeutic Option Abubakar, Azzaki; Yusuf, Fauzi; Maghfirah, Desi; Gunawan, Andrie; Zufry, Hendra; Edward, Meutia Nailan; Ho, Khek Yu
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 26, No 2 (2025): VOLUME 26, NUMBER 2, AGUSTUS, 2025
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/2622025195-200

Abstract

Acute pancreatitis is a frequent disorder whose severity level varies from mild to life-threatening. This condition is characterized by abrupt inflammation of the pancreas. A 53-year-old male was having upper right abdominal pain and epigastric pain which began four hours after hospitalization. This case highlights the complexities of managing acute pancreatitis in a patient with Graves' disease, where hyperthyroidism may worsen pancreatitis and vice versa. Graves' disease is an autoimmune disorder causing hyperthyroidism, which can complicate pancreatitis management, particularly when treated with methimazole, which has been associated with acute pancreatitis. This case suggests a potential link between untreated Graves' disease and idiopathic acute pancreatitis. In patients presenting with unexplained pancreatitis, evaluation for hyperthyroidism may be warranted. The novelty of this case lies in the exclusion of all conventional etiologies and the possible role of autoimmune thyroid disease in pancreatic inflammation.
Management of Complex Biliary Cases in A Tertiary Referral Setting: Real World Lessons and Their Role in Shaping Future Clinical Strategies Lesmana, Cosmas Rinaldi Adithya; Paramitha, Maria Satya; Pratiwi, Yulia Estu; Ho, Khek Yu; Lesmana, Laurentius Adrianto
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 25, No 1 (2024): VOLUME 25, NUMBER 1, April, 2024
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/25120242-10

Abstract

Background: In the era of laparoscopic procedure, innovative non-surgical approaches have emerged for managing biliary tract disorders. Techniques such as therapeutic endoscopic retrograde cholangiopancreatography (ERCP) and interventional endoscopic ultrasound (EUS) are increasingly being utilized. However, a clear consensus on a stepwise approach to managing difficult biliary disorders remains elusive. Therefore, this study was performed to evaluate the impact of endoscopic approach management on the outcomes of complex biliary cases.Methods: A retrospective study was conducted using an endoscopy database over two-year period. The characteristics of the study subjects, including demography and clinical data, were presented descriptively. The technical success rate was defined as the completion of the procedure performed on the patients. A bivariate analysis was conducted to evaluate the outcomes of therapy.Results: Sixty-one subjects with similar proportions in malignant (44.3%) and non-malignant (55.7%) etiologies in this retrospective database study were considered as complex biliary cases. Among them, 16.4% underwent a combination of therapeutic ERCP and EUS in one session based on the complexity of the case. Additionally, 8.2% of the subjects underwent ERCP with additional single operator cholangioscopy procedure. One subject (1.6%) underwent a rendezvous ERCP procedure through a percutaneous approach, while 4.9% underwent EUS-guided biliary drainage procedure. This study revealed no significant association between all mortality outcomes and baseline characteristics of the patients. Furthermore, there were no significant associations between mortality and the need for re-intervention, post-procedural pain, or the occurrence of acute pancreatitis.Conclusion: Complex biliary cases require a good clinical approach algorithm to decide which procedure comes first based on a comprehensive evaluation consisting of the patient’s factor, expertise, cost, and the risk of complications.
Co-Authors Azzaki Abubakar, Azzaki C Rinaldi A Lesmana Edward, Meutia Nailan Fauzi Yusuf, Fauzi Gunawan, Andrie Hendra Zufry, Hendra Lesmana, Laurentius Adrianto Maghfirah, Desi Paramitha, Maria Satya Pratiwi, Yulia Estu