Endoscopy helps in fighting liver disease

By Maria Kegel

JAKARTA (JP): Endoscopy is providing new solutions in the fight against liver disease, and in a country where up to one in five people are believed to have hepatitis B antibodies, medical authorities hope to make the procedure more accessible despite a lack of funding.

New advances in endoscopy have raised hopes among members of the medical community here that they will be better able to treat those suffering from cirrhosis, jaundice, liver abscess, cancer and hepatitis B and C. Chronic hepatitis is the most common liver ailment in Indonesia.

"Even though we are limited by availability of apparatus here, it does not mean that it's stopping us from familiarizing ourselves with the progress of endoscopy in developed countries," Dr. H. M. Sjaifoellah Noer, the head of the Hepatology Division in the Department of Internal Medicine at Cipto Mangunkusumo Hospital, said during a seminar on Saturday.

The seminar, made possible by the members of the endoscopy team at Mitra Keluarga Jatingara Hospital in Jakarta, with support from the Indonesian Society of Gastro-Intestinal Endoscopy, also featured speakers from Japan and Germany.

An endoscope is an instrument for visualizing the interior of a hollow organ, and is used for the diagnosis or intervention of organ systems.

It not only enables the internal observation of the body, but also aids in treatment.

"If you see bleeding, you can insert an instrument through the scope, as there are small channels, allowing the doctor to coagulate or inject the area," Sjaifoellah said.

"In one step, you can do many things, such as cut out polyps, view the area, administer an injection in case of bleeding, or intervene."

He said it was also useful for cytology and taking tissue samples.

The liver secretes bile and causes important changes in many of the substances contained in the blood, such as by converting sugars into glycogen, which it stores up until required, and by forming urea for urine.

For liver diseases, endoscopy is used for complications of upper or lower gastrointestinal bleeding, or problems in the biliary tract, which affects the liver.

Endoscopy is also necessary to evaluate the complications of chronic liver disease, such as dyspepsia, jaundice and gastrointestinal tract bleeding.

"Bleeding may be a complication of the shrinkage of the liver, otherwise known as cirrhosis."

In Indonesia, cirrhosis is usually caused by chronic hepatitis B and C, whereas in developed countries cirrhosis often results from alcoholism or drug abuse. Hepatitis B is transmitted in blood, saliva, semen and other bodily fluids; hepatitis C is found in blood.

He said an average of between 5 percent and 7 percent of the population were carriers of hepatitis B, while in some places this figure was 15 percent.

He said patients were usually over 35 years of age and very seldom was cirrhosis, a long-standing chronic infection, found in those younger than 35.

The hepatitis B virus is usually contracted by close contact in unsanitary conditions, and people are advised not to share items which may contain blood, such as toothbrushes and razors.

He said a survey conducted in several areas found that the more educated people were and higher their socioeconomic level, the lower the rate of hepatitis B infection.

"In remote areas where the lifestyle is more traditional, in which big families live in one big house, such as in Kalimantan and small areas in Java, contamination is more prevalent."

Origin

Endoscopy first arrived in the country in 1975, and there are 12 training centers in major cities around the archipelago.

"An organization was formed and we have developed an ability to disseminate the information to all of our staff at these training centers."

Sjaifoellah was among those involved with the start of endoscopy in Indonesia a few years after he returned from his studies in the United States in 1971.

But not all the endoscopy centers can certify graduates. He said only four centers, those in Medan, Jakarta, Bandung and Surabaya, were able to grant certification.

"Not every center has the equal support of instruments. For example, we can't do ERCP at all the centers," he said, referring to the Endoscopy Retrograde Cholangio Pancreatography procedure, which lets an observer view the biliary tract.

Obstruction of the biliary tract is a symptom of jaundice and colicky pain of the upper abdominal area, he said.

In a case of jaundice, the ERCP procedure is needed to evaluate the disturbances in the biliary tract, as a stone or inflammation, tumor of the pancreas or pancreatitis of unknown etiology.

"The main challenge we face in extending endoscopy is the expense of it. The instruments are very expensive, the apparatus for cutting, coagulation -- it's all expensive here."

He also said equipment repairs were costly and maintenance expenses posed another problem.

"That's why Mitra Keluarga Jatinegara Hospital is one of the private hospitals that took the initiative to have this endoscopy center on site," he said.

"It's a kind of investment. It's a necessity for the people, otherwise what can they get out of it."