Therapeutic Gastrointestinal Endoscopy in Nigeria: giant stride in a resource poor setting

Olusegun Alatise, MD, Anthony Arigbabu, MD, Oladejo Lawal, MD, Adewale Adisa, MD, Augustine Agbakwuru, MD

Department Of Surgery, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria

Introduction: Gastrointestinal endoscopy started in Ile-Ife, Nigeria in the early 1970s. Essentially the endoscopy unit provides an open access diagnostic endoscopy service to patients from many states in Nigeria. Recently, the unit acquires skills and facilities for therapeutic endoscopy. We report on the successes and challenges of establishing routine therapeutic endoscopy in Ile-Ife.

Patients and Methods: All cases of the gastrointestinal endoscopy performed at Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria from January 2007 and June 2012 were reviewed. Data obtained include age, sex, indications, endoscopic findings, Rockail score for those that had upper gastrointestinal bleeding, therapeutic procedure performed. Data were analyzed using SPSS version 16.0.

Results: Over the study period, 2075 cases of gastrointestinal endoscopy were performed. Of these, upper gastrointestinal endoscopy accounted for 1705(82.2%) while lower colonoscopy accounted for 370(17.8%). Gastrointestinal endoscopy perform per year has risen from 166 cases in 2007 to 540 in 2012. Male to female ratio was 1.3: 1. Therapeutic gastrointestinal endoscopy procedures performed in 2007 were only injection sclerotherapy for varices and hemorrhoids. By 2012, the therapeutic procedures performed on regular bases include injection sclerotherapy, variceal and hemorrhoidal band ligation, heater probe coagulation of bleeding ulcers, percutaneous endoscopy gastrostomy, balloon dilatations of esophageal stricture and achalasia, polypectomy, stenting, endoscopic retrograde cholangiopancreatography. Similarly, both Resident doctors and Nurses were trained on principle of endoscopic practice and care during the study period. Challenges encountered in establishing routine therapeutic endoscopy include cost of the accessories and lack of prompt referrals for therapeutic procedures. Local adaptation of sclerosing agents and accessories were utilized to reduce the cost of treatment.

Conclusion: Therapeutic endoscopic practice in Nigeria is challenging but feasible. It requires adequate training, courage and perseverance on the part of an endoscopist to achieve the feat.

Session: Poster Presentation

Program Number: P666