title: Impact of Endoscopic Ultrasound Procedures in Various Pancreatobiliary Disorders in Indonesia Based on a Case Series in a Private Hospital.
abstract: BACKGROUND
  Endoscopic retrograde cholangiopancreatography (ERCP) is a common technique for assessing the pancreas and the biliary system; however, the potential complications have raised concern among endoscopists and patients. Recently, the need of endoscopic ultrasound (EUS) as an additional tool of assessment before the ERCP procedure has been increasing. The need of EUS in developing countries is still a matter of debate regarding the cost, investment, and training. Here, we report the significant impact of EUS on several unselected interesting cases of pancreatobiliary disorders.
  
  
  METHODS
  We selected several interesting cases from the patients who underwent EUS at our private hospital in Jakarta, Indonesia. The EUS procedures were performed by one experienced endosonographer and one EUS trainee who are very experienced with transabdominal ultrasound. The equipment was an Olympus JF UCT 180 EUS scope which was connected to an Aloka IPF-1701C ultrasound machine (Tokyo, Japan).
  
  
  RESULTS
  Five interesting cases were included from patients who underwent EUS due to pancreatobiliary disorders. The cases included recurrent pancreatitis due to pancreatic stone at the small branch that obstructed the main pancreatic duct, common bile duct (CBD) stone with insignificant duct dilatation, pancreatic head cancer with total obstruction at the distal CBD and portal vein infiltration, pancreas divisum in a young girl, and distal CBD mass that caused obstructive jaundice.
  
  
  CONCLUSIONS
  The EUS procedure has shown a significant impact in managing patients with pancreatobiliary diseases. In most developing countries, EUS needs to be evaluated further regarding the cost, investment, and training.
authors.affiliation: Hepatobiliary Division, Department of Internal Medicine, Cipto Mangunkusumo Hospital, Jakarta, Indonesia ; Digestive Disease and GI Oncology Center, Medistra Hospital, Jakarta, Indonesia.
authors.forename: C Rinaldi A
authors.initials: CR
authors.lastname: Lesmana
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore.
authors.forename: Khek Yu
authors.initials: KY
authors.lastname: Ho
authors.affiliation: Digestive Disease and GI Oncology Center, Medistra Hospital, Jakarta, Indonesia.
authors.forename: Laurentius A
authors.initials: LA
authors.lastname: Lesmana
keywords: Developing countries; Endoscopic retrograde cholangiopancreatography; Endoscopic ultrasound; Pancreatobiliary disorders