American Society for Gastrointestinal Endoscopy guidelines for appropriate use of colonoscopy: are they suitable for African patients?

Abstract

This study investigates the appropriateness and diagnostic yield of colonoscopy referrals in an African setting using the American Society of Gastrointestinal Endoscopy guidelines: a prospective, descriptive, cross-sectional hospital-based study. A total of 311 patients were included in the study; 228 referrals (73.3%) were considered appropriate and clinically significant pathology was found in 157 patients, giving an overall diagnostic yield of 50.5%. Diagnostic yield in those with appropriate referrals was 58.8% and 27.7% (P = 0.004) in those with inappropriate referrals. In our setting these guidelines are useful in improving diagnostic yield and reducing the rate of inappropriate referrals for colonoscopy. However, patients above the age of 50 presenting with lower gastrointestinal symptoms should undergo a colonoscopy even if the indication was inappropriate, especially in countries which are not implementing colorectal cancer screening programmes for average risk patients.

Pattern of Colorectal Polyps among Sudanese Patients: a Single Centre Experience

“…Appropriateness and diagnostic yield of colonoscopy referrals in an Africa was studied in Sudan and they found that part of the symptomatic patients (per rectal bleeding) have polyps. This study found that 50% of polyps presented with rectal bleeding [6].…”

“…Lower GI endoscopies in form of colonoscopy and flexible sigmoidoscopy for symptomatic patiets was the gold standard method for diagnosis [6]. In our study Narrow band imaging (NBI) was used in 7.5% (n=9) and in these patients the type of polyps was found to be invasive carcinoma 2.5% (n=3), carcinoma in situ 0.8% (n=1) and high dysplasia 10.8% (n=13).…”

“…In this study the most common presenting complain were per rectal bleeding, mucus per rectum, alter in bowel habits and abdominal pain and to a lesser extent presented with symptoms of anemia, anorexia, weight loss and abdominal distension respectively. Studies have described that most common presentation and they found that per rectal bleeding and mucus per rectum are the most common presenting symptoms, while abdominal pain and distension were founded less frequent [8,9,6].…”

Presentation and anatomical distribution of diverticular disease in four hospitals in Sudan

“…Diverticular disease (DD) was thought to be more prevalent in the western world especially the white populations, but the recent increase in incidence among the immigrants from Africa who reside in the west for more than ten years may indicate that the westernization of the lifestyle could be the cause for this change in DD epidemiology [ 1 , 23 , 24 ]. In Africa, the Middle East and Asia the prevalence is less [ 14 - 18 , 25 - 27 ]. In this study the prevalence of DD was 7.5% (104/1393) among all patients who underwent a colonoscopy to investigate gastro-intestinal symptoms which is comparable to a prevalence of 7.4% that reported previously in Saudi Arabia [ 27 ].…”

“…The percentage of males in our study is 77.1% and females were 22.9% which is consistent with previous studies from Africa, the USA and Europe [ 16 , 19 , 27 ]. Risk factors for colonic diverticulosis include: low fibre diet, increased age, smoking, obesity, lack of exercise and certain medications (NSAIDs, anticoagulants and corticosteroid) [ 1 , 15 , 19 , 25 , 27 , 28 ]. Sixty one patients were found to have one or more medical comorbidity in this study.…”