First Year Gastrointestinal Endoscopy Profile in Singkawang West Borneo 2017 – 2018

Background: Gastrointestinal endoscopic examination which is included in the referral system of the Badan Penyelenggara Jaminan Sosial (BPJS) has been available at St Vincentius Hospital Singkawang and already been conducted by internist since March 2017 to diagnose upper and lower gastrointestinal diseases. The gastrointestinal endoscopic examination unit serves referrals from Singkawang and its 3 surrounding districts (Sambas, Bengkayang, and Mempawah) that close to the Malaysian border. The purpose of this study is to determine the patients' profile from Singkawang, Sambas, Bengkayang and Mempawah Districs who underwent gastrointestinal endoscopic examination at St Vincentius Hospital from March 2017 to April 2018.Method: This is a retrospective descriptive study by using secondary data of patient's medical records at St Vincentius Hospital Singkawang in March 2017 - April 2018. Every patient is included as a sample (total sampling). Total numbers are consisted of 308 patients including 230 esophagogastroduodenoscopies and 78 colonoscopies.Result: The results of this study showed that majority of patients were more likely to undergo esophagogastroduodenoscopy (EGD) (75%) than colonoscopy (25%). Males, age group of 51-70 years old and Malay ethnic are the groups of patients who have the most upper and lower gastrointestinal disorders. The prominent finding of esophagogastroduodenoscopy was erosive gastritis (64%), whereas internal hemorrhoids was the most common finding in colonoscopy (67%); if internal hemorrhoids was excluded, colon mass became the most common finding disorder.Conclusion: Patient were mostly male, age group between 51 – 70 years old and Malay. The most common finding in colonoscopy (67%); if internal hemorrhoids was excluded, colon mass shifted forward as the top finding disorder.


INTRODUCTION
Endoscopy had changed the way of gastroenterology approach the diagnosis, clinical findings and therapy of gastrointestinal disorders. 1,2 Gastrointestinal endoscopy examination covered by social insurance administration organization has been available at St Vincentius Hospital Singkawang and operated by an internist since March 2017 to support diagnosis of upper and lower gastrointestinal tract disorders. This endoscopy unit has received patient referrals from Singkawang and its surrounding districts: Sambas, Bengkayang, and Mempawah which are situated close to border of Malaysia. According to the data from the 2016 census, the population of Singkawang was 211,508, Sambas was 526,327, Bengkayang was 242,788 and Mempawah was 255,132. 3 Endoscopy unit necessity is increasingly surging up to 26.2 % in Indonesia based on data from Digestive Endoscopy Center at Cipto Mangunkusumo Hospital. The data showed increasing number of patients in 2010 to 2011 from 1825 patients to 2303 patients including for gastrointestinal diagnostic purposes or therapeutic procedures. 4 The purpose of this study is to determine patient profile of Singkawang, Sambas, Bengkayang, and The variables we studied here consisted of gender, age, ethnic and findings of gastrointestinal endoscopy.
The data obtained is then processed and analyzed with Microsoft Excel 2016 software. Finally, the descriptive research data would be presented in the form of text, tables or figures.
Singkawang is highly populated with Chinese ethnic. Comparing in China, erosive gastritis cases were mostly found in Chinese population. 7 Ethnic group with esophagitis were mostly found in Malay ethnic. The result somewhat diverts with Syam AF et al at Cipto Mangunkusumo Hospital Jakarta 2015 which showed that Javanese became the ethnic group who suffered esophagitis in Jakarta. 8 The ethnic most suffered from gastric ulcers was Malay. This finding was different with Syam AF et al in 2015 which mentioned that incidence of gastric ulcers were more common among Papuan, Bugis and Bataknese ethnic than in Javanese, Chinese and Dayaknese. 9 The most common Forrest classification occurred was Forrest III. This was similar with Groenen MJM et al study in Netherland. 10 Forrest III was more common in Singkawang and its surrounding areas because EGD at St. Vincentius Hospital was majorly conducted after treatment of the acute phase of gastric ulcer.
The top common findings of EGD biopsy findings were gastric and duodenal acute and chronic inflammation, followed by Helicobacter pylori and malignancy. This finding was similar with Yulida E et al showed that female were fewer than male. 12 The most common age group with Helicobacter pylori were 51-80 years old. This finding also different with Uwan WB et al study in Pontianak, where the most common age of Helicobacter pylori was < 55 years old. 12 The most common findings of ethnic group who suffered Chinese and Indians compared to the Malay ethnic. 13 Age group mostly underwent colonoscopy was 61-70 years old and the most common ethnic population who underwent colonoscopy was Malay compared to Chinese. The top common findings of colonoscopy were internal hemorrhoids, followed by colon mass, IBD and colon polyps. Our study diverted with the Riss S et al between 2008 -2009, 308 patients (38.93%) from 976 patients who involved in colorectal cancer screening were found to have internal hemorrhoids. 14 The ethnic group who mostly suffered with colon mass in this study was Malay. Pantow RP et al study The completion rate of colonoscopy examination at St. Vincentius Hospital conducted by the internists was 73%. There are 57 patients successfully reached the terminal ileum without any problems either from anatomical colon or equipment. The remaining 21 patients failed to reach the terminal ileum with various factors such as mass obstruction, patient demand and disturbances from the colonoscopy devices. The complication during and after colonoscopy was zero.

DISCUSSION
There were 75% of total sample who underwent EGD and in this result was in accordance with Kaminang GA et al in Manado 2016 which mentioned that patients were more likely to have EGD. 5 Male became the most gender who had EGD than female. This finding was in agreement with Agustian H study that was done in Cipto Mangunkusumo Hospital Jakarta 2015. 6 Malay becomes the most frequent ethnic to have EGD in comparison with Chinese contrary to common believe in Singkawang. It may be due Malay ethnicity patient's population in Singkawang, Sambas, Bengkayang and Mempawah who suffered from gastrointestinal complains. The result differs with Cipto Mangunkusumo Hospital Jakarta 2015 which showed that Javanese became the ethnic group who underwent EGD in Jakarta. 6 Three major findings of EGD were erosive gastritis, esophagitis and gastric ulcer. These findings were similar with study at Cipto Mangunkusumo Hospital, Jakarta in 2015, where gastritis and erosive gastritis was the most major finding of EGD. 6 Erosive gastritis in this study was most likely found in Malay despite the common assumption that in Manado 2017 showed that Minahasa ethnic as the most ethnic suffered from colorectal adenocarcinoma. 15 These findings were different from our research which may be due to differences in the proportion of ethnic in Manado and Singkawang. Colon mass biopsy from March 2017 to April 2018 found that there were 11 patients with carcinoma (22%). Pantow RP et al also reported colorectal cancer profile in 2017 in Prof. Dr.
R. D.Kandou General Hospital and Siloam Hospital, Manado that found 41 cases of colorectal cancer (48.2%). 15 IBD were mostly found in age group 51-60 years old. This finding had similarity with Pratama N et al study in Jakarta. 16 Malay was common ethnic group with IBD in our study which diverted from Wang YR et al in 2013 in the United States. It showed that there are 316 patients with IBD and more common in Caucasians than Asia. 17 To date, there are still no data about ethnic prevalence of IBD in Indonesia for us to compare. The most common finding of IBD in this study was pancolitis, this was similar with Pratama N et al. 16 Malay was common ethnic group with colon polyps. The reason why colon polyps were mostly found in Malay ethnic probably due to subject ethnicity dominated with Malay. The most common predilection of colon polyps in this study was in the rectum and sigmoid. This was similar to the theory that the most frequent distribution of colon polyp was in the sigmoid and rectum colon. 18 The completion rate of colonoscopy in Singkawang was 73% from 78 patients. The completion rate of colonoscopy in our study was still in accepted range of the literature whose colonoscopy completion rate varies from 55-98% . 19

CONCLUSION
Upper and lower gastrointestinal disorders in Singkawang, Sambas, Bengkayang and Mempawah according to patient's profile data who underwent endoscopy at St Vincentius Hospital were mostly found in male, age group between 51-70 years old and Malay ethnicity. Gastrointestinal endoscopy findings in esophagogastroduodenoscopy were mostly erosive gastritis and internal hemorrhoids in colonoscopy examination whereas internal hemorrhoid was excluded, colon mass became prominent as prominent disorder found in colonoscopy. The novelty of this study shows that Malay ethnicity becomes the ethnicity most suffered by upper and lower gastrointestinal disorders according to endoscopy profile compared with other studies outside Singkawang, Sambas, Mempawah and Bengkayang.