ACHALASIA

https://www.youtube.com/watch?v=ibHAdab7MAw

DYSFAGIA PASCA STROKE

Penemuan endoskopi laring dan esofagoskopi:
1.Oral/laryngeal candidiasis
2.Parese palatum molle
3.Parese (adduktor) N.recurrens(pita suara kiri)
4.Tidak ditemukan penyempitan /sumbatan/tumor intra/ekstra luminal esofagus

ORAL CANDIDIASIS

These pictures showed oral candidiasis as viewed by flexible endoscope (fiberscope) passed through nasal cavity in a male person with diabetes mellitus and chronic sore throat and dysphonia.

ARGON BEAM COAGULATION TO CONTROL POST BIOPSY BLEEDING

Biopsy for suspected malignant lesions pose a post-biopsy bleeding risk.
One of the techniques to control this situation is by giving prae-biopsy "bleed- reduction medication" and/or doing coagulation using electrical discharges("electrocoagulation").
Using laser as a technique to control  bleedings might be an option,however we have  to be aware of possible "rebleedings"  due to the broken/abnormal walls of the neovascularisation of the tumor ("neoangiogenesis") or of the "feeding vessels".
Using cryo-techniques might be another possibility to counter bleeding with a special treatment for the biopsy specimen.
One should mention the possibility of reducing distant metastasis by this technique(by blood-born or lymph- vessels).
Tumor debulking by laser and/or cryosurgery may help conventional tumor surgery.(by "down- staging")
Endoscopic photo of this case of nasopharyngeal cancer biopsy was completed by argon beam coagulation to control post-biopsy bleeding.

KENAPA HIDUNG DITUTUP BALON MERAH?

Hidung adalah bagian tubuh  yang memiliki peran penting baik dari  segi anatomi,fungsional dan lokasi yang begitu sentral di wilayah muka atau wajah seseorang.
Gambar pertama diatas menunjukkan betapa penting peran hidung dalam proses berkomunikasi bahkan bisa dikatakan sebagai " landmark" seseorang yang mempunyai nilai estetika yang tinggi.
Orang akan segera tertarik perhatiannya  pada seseorang yang memiliki bentuk hidung yang aneh atau kurang sempurna sehingga penderita  besar kemungkinan akan  rela menjalani operasi plastik atau estetik untuk membuat bentuk hidungnya menjadi sempurna dan  indah.
Foto  kedua  menggambarkan peran fungsional hidung sebagai alat  yang bisa mengalami gangguan penciuman ("anosmia") yang  disebabkan (antara lain) oleh adanya polip hidung. Pada kasus ini adanya polip pada rongga hidung (hanya) dapat diketahui dan dipastikan melalui pemeriksaan endoskopi lubang hidung.(endoskopi nasal atau rhinoskopi,baik dengan endoskop lentur ("fiberscope") ataupun endoskop kaku ("rigid endoscope").
Selanjutnya polip dapat ditanggulangi dengan pembedahan minimal invasif melalui "endoscope".

NASOPHARYNGITIS:INFLAMMATORY AND/OR PRE-MALIGNANT CONDITION?

From our daily experiences of nasopharyngoscopy, we may be confused of the endoscopy results of patients with clinical symptoms of upper respiratory infections or allergies/inflammatory conditions.
As our working place is in the South East Asia,we are aware of the possibility of malignant lesions of the upper airways.(i.a. nasopharyngeal cancer and/or malignant lymphoma.)
The possibility of viral infections is our highest awareness to refer of the high incidences of Epstein- Barr virus infections with its implication in nasopharyngeal (epithelial) cancers.
If we look into our daily works,we can say that most of the cases were infections/inflammatory.Some of the cases showed granulomatous lesions/polypoid lesions as shown in these endoscopic pictures.

NASOGASTRIC INTUBATION UNDER VISUAL CONTROL

Nasogastric intubation (for feeding in indicated patient) might be done under visual control.
The procedure is best done in endoscopy room with the adequate resources for the procedure.
Topical anaesthesia of the nasopharyngeal and oral cavity is preferred for the convenience of the patient before the procedure.
The patient is asked to make  swallowing movements while the operator passing  the tip of the tube into the esophagus.
The visual control is done to prevent the tube from false passing into the  respiratory tract(laryngeal inlet).The picture shows the procedure in awake patient with no sedation.

ENDOSKOPI PASCA CHEMORADIASI CA LARING

Gambar menunjukkan tampilan endoskopi penderita Ca laring pada seorang pria berusia 56 tahun yang telah setahun sebelumnya menjalani pembedahan dan kemoradiasi.Meskipun fungsi pita suara membaik dan suara penderita tidak serak lagi,masih nampak selaput lendir (mukosa) laring  kemerahan dan pembengkakan /fibrosis laring pasca radiasi yang  memerlukan observasi lebih lanjut.

ADENOD HYPERTROPHY

This is a case of young lady with anosmia.
Endoscopy nasopharynx showed adenoid hypertrophy as seen in this picture.
At the nasal cavity polypoid masses were seen  bilaterally but the polyp was more prominent at the right nasal cavity,protruding from the upper part of the choncha media.
Location : Endoscopy Clinic,Pelni Hospital,Jakarta
Date : 14 th November,2013

ACHALASIA

ACHALASIA (rat-tail appearance esophagogram with dilated proximal esophagus) and oral-esophageal candidiasis.(endoscopic view) in a male of 67 years old.Dysphagia lasted 3 weeks before hospitalisation.No history of diabetes mellitus.Conservative treatment.

NASAL ENDOSCOPY

This picture is presenting my personal assistant to attract attention of nasal endoscopy procedures.The procedure is sometimes needed to evaluate the internal condition of your nasal cavities.It is usually done when you have persistent clinical symptoms of nasal discharges or polypoid mass,especially with bloody mucous discharges or even epistaxis/bleeding nose.Sometimes you have (unilateral) tinnitus due to Eustahian tube's dysfunction or (unilateral) conductive hearing loss.
Nasopharyngeal endoscopy is usually done at the doctor's office and/or in the Endoscopy Unit of the hospital.Contact your ENT doctor when you think you need his/her consultation.

IN MEMORIAM :Dr.SUGIARTO WIBOWO

Dr.Sugiarto Wibowo baru-baru ini telah berpulang.
Pada saat endoskopi dengan fiberscope mulai berkembang sekitar tahun 1970,beliau adalah satu dokter yang menekuni pemeriksaan endoskop bagi pasien (terutama) di RS Husada,Jalan Mangga Besar,Jakarta Utara.
Bersama dengan sejumlah dokter lain yang tertarik menekuni endoskopi, didirikan PEGI (Perhimpunan Endoskopi Gastrointestinal Indonesia) disusul dengan PGI (Perkumpulan Gastroenterologi Indonesia).
Foto menunjukkan Dr.Sugiarto Wibowo(alm.,paling kiri) dan penulis(dikiri beliau) beserta sejumlah dokter dari Filipina,Taiwan,USA,Amerika Latin  yang sedang menjalani magang (fellowship) di Tokyo Women's Medical College tahun 1974.
Selamat jalan Dr.Wibowo.

POLIP BISA DITEMUKAN PADA ANOSMIA (KEHILANGAN DAYA PENCIUMAN)

Anosmia adalah keadaan dimana kita kehilangan daya penciuman,salah satu dari panca indra kita.
Sel -sel reseptor untuk penciuman berada dalam atap hidung kita.
Kehilangan penciuman bisa bersifat ringan dan sementara,namun ada juga bersifat berat dan lama/menetap.
Foto ini  dibuat melalui prosedur endoskopi ,menggunakan (fiber)" endoscope"( endoskop serat lentur) pada seorang wanita yang telah kira-kira setahun menderita gangguan penciuman.
Kelebihan endoskop serat lentur yaitu karena sifat lenturnya, alat ini bisa mengikuti perubahan/lekuk rongga alami pada struktur anatomi pasien sehingga   tidak/kurang mengganggu rasa nyaman pasien.
Gambar menunjukkan polip pada hidung yang tidak nampak pada pemeriksaan rhinoskopi biasa,namun terlihat jelas pada pemeriksaan dengan endoskop serat lentur.
Foto : dr.L.S.Handikin SpTHT
Lokasi : Klinik Endoskopi R.S.Pelni,Jakarta

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DYSPHONIA : CONSULT YOUR DOCTOR WHEN IT LAST MORE THAN 2 WEEKS.

There are some etiologies of dysphonia;inflammatory condition during viral infection/influenza,true vocal fold(s) paresis(neurologic problems),polyps or laryngeal cancer etc.
Consult your doctor when your hoarse voices last for more than 2 weeks.
The case shows hoarseness lasted for more than 10 years in a young lady,showing the stenotic glottic/subglotic inlet,sometime mistakenly diagnosed as asthmatic bronchitis.

SAFETY ENDOSCOPY IS THE MOST IMPORTANT THING

Preparation to do endoscopy is most important.
Check n re-check the right equipment,the right scope,the right accessories,the right patient(including the right supporting datas/medical records),the right procedures.
Safety is the most importance.
Beware of the possible uneven problem or reaction before,during and after endoscopy procedure.(fromThe Endoscopy Unit,Pelni Hospital.Jakarta).

A DIFFICULT CASE OF NASOPHARYNGEAL CANCER

A young male was suspected of primary liver cancer or hepatoma.The patient condition was getting poorer while the liver function deteriorating with icterus and anemia.

The PET/CT scan showed positive FDG uptake in the nasopharyngeal wall area.

Biopsy of the tumour showed positive for nasopharyngeal squamous cell carcinoma.
This case show the role of PET/CT scan to determine the location of primary tumor which is surprisingly found in the nasopharynx.

PLATELETE RICH PLASMA(PRP) FOR PROFUSE EPISTAXIS

PLATELETE RICH PLASMA (PRP) is a growing procedure in many medical situation.
This picture shows where a patient underwent  a succesful procedure of PRP to control  profuse nasal bleeding(epistaxis) following a nasal surgery(septoplasty and polypectomy).(Location:HCU,Private Hospital,Jakarta)

ENDOSCOPY OF NASOPHARYNX WITH MULTIPLE INFECTION

This picture shows multiple infection of nasopharynx with mucosal edema and hyperaemia and moderate mucous production.This most upper part of the respiratory tract has been naturally exposed to air pollution,dust,chemical substances,tobacco smokes,bio-particles etc.

NASOPHARYNGEAL CANCER