Colonoscopy Practice in Lagos, Nigeria: A Report of an Audit

Abstract

Background. Colonoscopy effectiveness depends on the quality of the examination. Community-based report of quality of colonoscopy practice in a developing country will help in determining standard and also serve as a stimulus for improvement in service. Aim. To review the quality of colonoscopy practice and document pattern of colonic disease including polyp detection rate in Lagos, Nigeria. Method. A protocol that captured the patients' demographics, indication, and some quality indices of colonoscopy was developed and sent to all the identified colonoscopy units in Lagos to complete for all procedures performed between January 2011 and June 2012. All data were collated and analyzed. The quality indices studied were compared with guideline standard. Results. Twelve colonoscopy centers were identified but only nine centers responded. The gastroenterologist/endoscopists were physicians (3) and surgeons (5). Six hundred and seven colonoscopy procedures were performed during this period (M : F = 333 : 179) while the sex was not disclosed in 95 subjects. The examination indications were lower GI bleeding (24.2%), altered bowel habits (9.2%), lower abdominal pain (9.1%), screening for CRC (4.3%) and unspecified (46.8%). Conscious sedation was generally used while bowel preparation (good in 81.4%) was done with low residue diet and stimulant laxatives. Caecal intubation rate was 81.2%. Common endoscopic findings were haemorrhoids (43.2%), polyps/masses (13.4%), diverticulosis (11.1%), and no abnormality (23.4%). Polyp was detected in 6.8% of cases. Conclusion. Colonoscopy utilization is low, and the quality of practice is suboptimal; although limited resources could partly explain this, however it is not clear if the low rate of polyp detection is due to missed lesions or low population incidence.

Pioneering Video Colonoscopy In Calabar, South-South, Nigeria: A Six-Month Prospective Study.

“…It is the gold standard for the diagnosis of large bowel diseases because it is possible to visualize the entire large bowel up to the caecum with good bowel preparation, appropriate expertize and facility [1][2][3][4][5][6][7] . Colonoscopy is the only major advancement in the diagnosis of colonic disease since the performance of the first barium enema in 1905 4. There are several indications for colonoscopy ranging from lower GI bleeding, change in bowel habit, suspected colorectal cancer, anaemia of unknown origin etc.…”

“…Colonoscopy is the only major advancement in the diagnosis of colonic disease since the performance of the first barium enema in 1905 4. There are several indications for colonoscopy ranging from lower GI bleeding, change in bowel habit, suspected colorectal cancer, anaemia of unknown origin etc. [1][2][3][4][5][6][7] . The aim of this study was to determine the indications, demographic characteristics and endoscopic findings of patients undergoing colonoscopy in the only private endoscopy facility offering this service in Calabar ,South-South, Nigeria.…”

“…With appropriate expertize, good bowel preparation and patient comfort, colonoscopy is a safe procedure with very high yield [1][2][3][4] . Although colonoscopy is the gold standard for making the diagnosis of colorectal cancer, it is however, highly underutilized in Nigeria and sub-Saharan Africa 3,5,6 owing largely to it's poor availability, high cost and lack of appropriate expertize.…”

“…Although colonoscopy is the gold standard for making the diagnosis of colorectal cancer, it is however, highly underutilized in Nigeria and sub-Saharan Africa 3,5,6 owing largely to it's poor availability, high cost and lack of appropriate expertize. Colorectal cancer continues to be a burden worldwide , with increasing incidence in different parts of the world 3,5,6,8,9 .…”

“…Colorectal cancer continues to be a burden worldwide , with increasing incidence in different parts of the world 3,5,6,8,9 . Onyekwere et al 12 cited a recent study in Ibadan ,South West, Nigeria, with an 81% increase in the incidence of colorectal carcinoma over a period of two decades 12 .Screening colonoscopy especially where fecal occult blood is positive is an important diagnostic tool that can reverse the current trend of late presentation of patients with colorectal carcinoma [1][2][3][4][5][6][7]10 .…”