Bridging the gap in gastrointestinal healthcare in a resource-limited setup: Feasibility study of weekend endoscopy services in Southwest Ethiopia.

Abstract

Background and study aims: Endoscopy is essential for diagnosis and management of gastrointestinal disorders. However, its accessibility in Africa is limited by the need for extensive training and costly equipment. This study aimed to assess the feasibility of a weekend outreach endoscopy service led by a trained gastroenterologist in southwest Ethiopia, where endoscopy services were previously unavailable.

Patients and methods: A weekend outreach endoscopy service was launched in 2019 at a primary hospital in Jimma City, located 360 km from Addis Ababa. Procedures were performed using the Fujinon EPX-2500-HD system. Demographic data, endoscopy findings, and histology results were documented electronically. Findings were compared with those from four Ethiopian referral hospitals offering full-time endoscopy services.

Results: A total of 2165 esophagogastroduodenoscopies (EGDs) were performed with a diagnostic yield of 93.3%. The most common indications for EGD were dyspepsia (53.7%) and dysphagia (17.0%). Patients who underwent endoscopy for alarm symptoms as an indication had a 77% to 83% chance of having a major finding compared with those with dyspepsia without an alarm symptom (24%). Squamous cell carcinoma (40.2%), adenocarcinoma (29.6%), and chronic nonspecific inflammation (16.2%) were the predominant histologic findings among those who had a biopsy (n = 425).

Conclusions: The study demonstrates the feasibility and effectiveness of a weekend outreach endoscopy service led by a trained gastroenterologist in a rural Ethiopian setting. The unexpectedly high prevalence of upper gastrointestinal disorders, including cancers, and the long duration of symptoms before endoscopy likely reflect delayed diagnoses due to limited access to endoscopy. Moreover, presence of alarm symptoms predicted major endoscopic findings. Expanding endoscopy services, increasing public awareness, and further research into risk factors and preventive strategies for these diseases are recommended.