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THE SOUTH AFRICAN GASTROENTEROLOGY REVIEW 2022 | VOLUME 20 | ISSUE 1 | 48 during endoscopy and this might be responsible for high prevalence of “normal findings” in patients. In our study, 11.3% of the gastroscopies and 33.3% of the colonoscopies were normal and “normal endoscopies” represented the third most common endoscopic finding in our cohort. Our prevalence of a normal gastroscopy was much lower than what was shown in another South African study conducted at a regional hospital (Prince Meshiyini Memorial Hospital -PMMH) in KwaZulu-Natal (11.3% vs. 25.7%, respectively). Their findings were attributed to the fact that (10.7%) of the patients were given proton pump inhibitors (PPIs) prior to undergoing the endoscopy procedure. Another possible explanation for the high prevalence of normal endoscopic findings could stem from the fact that resource constraints might have resulted in endoscopy being deferred which meant that more patients might have been initiated onto PPIs while still in the waiting process 12 These studies showed some similarities in that the commonest occurring symptom was epigastric pain (57.7%) although this was higher than what we showed in our study (35.3%). The other similarity noted between the PMMH study and ours, was with the most common endoscopic finding, that of gastritis (51% vs. 47.18%. respectively), followed by normal examination (25.7% vs. 11.6%, respectively). In the PMMH study, upper gastrointestinal (UGI) bleed was the second most common reason for endoscopy compared to heartburn and dysphagia shown in our study. (21.6% vs. 19.67%, respectively). 12 We demonstrated a higher prevalence of peptic ulcer disease (ranging from perforated gastric ulcer to healed ulcers) when compared to the PMMH study (9% vs. 2,6% respectively). This could be attributed to the fact that the PMMH patient cohort was being prophylactically initiated onto PPIs prior to endoscopy. Another study, which enrolled 184 patients, conducted at the Mbarara University Teaching Hospital situated in Uganda, showed closer similarities to ours with epigastric pain being the most common presenting complaint (51.6% vs. 47.6%, respectively) followed by dysphagia (13.6% vs. 19.6%, respectively). Like our study, they also demonstrated that gastritis was the most common gastroscopy finding (47.1% vs. 40.2%), this especially in the older than 40 years cohort (50.9% vs 94%). In this age group, we also showed like them that oesophageal cancer (22.7% vs 87%) and gastric cancer (11.8% vs 1.3%) were common. A Zambian retrospective study that was conducted over seven years between 2008-2015 showed similarities to our study with regards to the most common colonoscopy finding being that of haemorrhoids (26% vs. 23.8%, respectively). They showed findings of a normal colonoscopy in 16% of cases almost half of what we showed in our study (33.3%). Suggestions put forth in the Zambian study was to have the colonoscopy requests screened by a surgeon to minimize unnecessary requests. They also experienced the same challenge with poor bowel preparation of patients undergoing colonoscopy (12% vs. 21.4%, respectively) which resulted in no definitive diagnosis being made. 13 Another retrospective study of colonoscopies performed at Charlotte Maxeke Academic Hospital in Johannesburg between the 01 January 2008 and 31 March 2010 found, unlike results our study, that the commonest finding was that of a normal colonoscopy (38.12% vs. 16%, respectively). They also demonstrated a much higher findings of polyps (28.18%) and diverticular disease (23.15%) which was not the case in our study. This could possibly be explained by the different demographics between the provinces. 12 A retrospective study done in New York between 2012- 2017 demonstrated that there were similar indications and findings for endoscopies in both HIV-positive and -negative patients. When compared to our study, there were some similarities noted in commonest symptoms in both HIV negative and HIV positive patients, being epigastric pain (22.6% vs 9.3%) respectively. There was a however a difference noted with the second commonest symptom with heartburn in HIV negative patients (3%) and dysphagia in HIV positive patients (4.3%). We, like the New York study showed similar findings in overall in gastroscopy results in both HIV negative and HIV positive patients. The commonest gastroscopy finding was that of diffuse gastritis (16.3% vs 10.3%) followed by oesophagitis in both groups, (5.6% vs 3.6%) and hiatal hernia (5.3% vs 2.3%) respectively. HIV positive patients also had duodenitis (7, 2.3%) as a common finding. Worldwide oesophageal cancer is the eight most common cancer and ranks fifth in terms of mortality. In South Africa, squamous carcinoma of the oesophagus (SCO) is the most common form of oesophageal cancer and is often associated with late referral and at an advanced stage on presentation. Our findings concur with these, where we showed that oesophageal cancer was found in (13.6%) patients, which was also higher than findings of gastric ulcer (7.6%) and gastric cancer (7.1%). We found that the majority of oesophageal cancer was confirmed to be squamous type on histology which differed from findings in developed countries where adenocarcinoma is the most common form of oesophageal carcinoma. 13 . Our histological findings of SCO was higher than findings of gastritis which was (4.6% vs. 2.63%). This can be explained by the fact that biopsy was mostly done in patients who had oesophageal stricture with suspicious lesions compared to those patients who had gastritis. In contrast to our results, a Ugandan study found that the commonest histological finding was that of gastritis (2.68% vs. 40.2%), normal in (2.3% vs. 28%) and oesophageal cancer (4.6% vs. 25%). A study done in KwaZulu-Natal, South Africa, at the Inkosi Albert Luthuli Central Hospital described the risk factors for oesophageal cancer as male gender, smoking, alcohol consumption low socio-economic status and poor dental health. These patients had presented with dysphagia (99.4%) and loss of weight (95.5%). 19 In our study, patients found to have oesophageal carcinoma also had presented mainly with dysphagia, hoarse voice and loss of weight with the majority of these patients being in the 60–90-year age group. Complications related to endoscopy are rare but important, ranging around 1.35% in developed countries. The major complications include cardio-pulmonary complications, complications related to sedation, infections, perforations and bleeding. 9 Cardio-pulmonary complications are responsible for 50% of the mortality and mortality related to endoscopic procedures. These complications may result from hypoxaemia which may be related to the procedure itself, the sedation, or the combined effect 10 . Bacteraemia associated with endoscopy may be due to contaminated endoscopy equipment, improper cleaning and disinfection procedures, as well as problems related to equipment designs. 10 In our study only one patient (0.29%) experienced a complication related to a reaction to sedation. This low prevalence of complication was likely due to the fact that trained staff was performing the procedure. A possible limitation to our study remains that CASE SERIES