SAGES Magazine

THE SOUTH AFRICAN GASTROENTEROLOGY REVIEW 2021 | VOLUME 19 | ISSUE 2 | 46 Appropriateness and Diagnostic yield of open access upper gastrointestinal endoscopy in South-Western Nigeria E Odeghe 1 , O Owoseni 2 , E Chukwudike 3 , O Adeniyi 1 , B Adigun 2 , G Oyeleke 1 , U Salami 1 , C Nwoko 1 , O Anomneze 1 University of Lagos, University Teaching Hospital 1 , Federal Medical Centre 2 , University of Calabar Teaching Hospital 3 Background: Recently, there has been greater availability of endoscopy services in Nigeria. The American Society of Gastrointestinal Endoscopy (ASGE) produced recommendations to guide its appropriate use. The aims of this study were to determine the frequency at which gastroscopy is performed for an ASGE- appropriate indication, and to determine the association of appropriateness with significant endoscopic findings (SEF). Methodology: This was a prospective study of all consecutively consenting patients who underwent gastroscopy at two centers in south- western Nigeria from August 2020 to March 2021. Indications were classified as either appropriate or inappropriate according to the ASGE guidelines, gastroscopic findings as either significant or not significant, patients as either young (< 60 years) or elderly, inpatients or outpatients, while referrals were classified as either from gastroenterologist or non- gastroenterologist. Results: Altogether, 185 patients were studied. The mean age (sd) was 44.7 (13.9), and 106 (57.3%) were females. Twenty six (14.1%) were inappropriate. The rates of inappropriate referrals were 2.8% for gastroenterologists, 20% for non-gastroenterologists, 17% in outpatients, 0% in inpatients, 16.5% in young people, 0% in the elderly, 16.5% in males, and 12.3% in females. Thirty-three percent had SEF. These were more frequent in appropriate than inappropriate (34.6% vs 23.1%) procedures, inpatients than outpatients (60.7% vs 28%), elderly than young (48% vs 30%), and males than females (42% vs 26%). SEF were present in 35% of referrals from gastroenterologists compared to 29% for other physicians. The most common appropriate indications were upper abdominal discomfort/ pain despite appropriate trial of therapy (53%), unexplained weight loss (29.7%) and melaena (17.3%). The sensitivity, specificity and AUROC of the ASGE guidelines were 35%, 77%, and 0.53. Conclusion: A large proportion of referrals from non-gastroenterologists were inappropriate. Proper education of physicians is advocated to promote more efficient utilization of this procedure. Introduction: Varices are tortuous veins formed as the result of portal hypertension. In Sudan 76% of bleeding oesophageal varices are due to schistosomal periportal fibrosis. The most serious complication of varices is bleeding, which could fatal. In Sudanese patients, where the most common cause of variceal bleeding is schistosomal periportal fibrosis, a super-added infection of Hepatitis B is deleterious. The aim of the study was to measure the percentage of hepatitis B virus in patients with variceal bleeding. Results: 384 patients with variceal bleeding presenting at a bleeding centre were sampled using systemic random sampling during the study period from January 2015 to December 2016. Sociodemographic and clinical data was collected from hepatitis B virus positive. 10.9% of patients with variceal bleeding were infected with hepatitis B virus, with 47.6% of them having a past medical history of schistosomiasis. There was a strong association between history of blood transfusion and having a history of schistosomiasis infection in those patients. Most patients originated from El- Jazeera state, and four fifths were or are married. In conclusion, as almost half of hepatitis B virus positive patients have past medical history of schistosomiasis, making them more likely to develop double liver pathology, of periportal fibrosis and cirrhosis, with complications of both diseases. There is a need to investigate this finding further. Hepatitis B virus and schistosomiasis co- infection in patients presenting with variceal bleeding at a centre for gastrointestinal bleeding in Sudan M Saad 1 , ABE Elhassan 1 , MSEMAM Ali 1 , AE Osman 2 , A Sidahmed 2 Faculty of Medicine, University of Khartoum 1 , University of Medical sciences and Technology 2 SAGES