The impact of introducing The impact of introducing diagnostic and therapeutic upper endoscopy in an ambulatory Surgery Center in Rural Eastern Uganda diagnostic and therapeutic upper endoscopy in an ambulatory Surgery Center in Rural Eastern Uganda

Abstract

Background: The availability of upper endoscopy (UE) is limited in many rural low- and middle-income countries (LMIC). Few studies have evaluated use of elective endoscopies to address esophago-gastric diseases in remote Eastern Uganda. Objective: This research assesses the impact of introducing UE on diagnosing gastrointestinal diseases endemic to the area. Methods: This is a retrospective, cross sectional, single center study evaluating patients who received elective UE from Kyabirwa Surgical Center in rural Eastern Uganda, between 2020 to 2022. Primary outcome variables were presenting symptoms, endoscopic diagnoses and respective treatments. Results: 350 endoscopies were performed for 333 patients, (1:1 male-to-female ratio, average age 48). Abnormalities were found on endoscopy in 73% of patients, revealing diagnoses of esophageal cancer (16.4%, N=64), gastritis (16.7%, N=65), hiatal hernia (8.7%, N=34), esophagitis (7.4%, N=29), ulcer (6.2%, N=24), and candidiasis (5.1%, N=20). Most patients presented with epigastric pain alone (40%, N=133) or dysphagia (39%, N=130). 51% of patients with dysphagia had esophageal cancer on endoscopy, of which 28.1% had an interval palliative stent placed. Conclusions: The introduction of UE into a rural LMICs is possible and can verify baseline prevalence of endemic upper gastrointestinal diseases. Confirmation of diagnosis by endoscopy can direct medical management and interventional therapy. Keywords: Diagnostic and therapeutic upper endoscopy; ambulatory surgery center; rural Eastern Uganda.