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Gastrointestinal endoscopy experience of surgical trainees throughout rural Africa

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Abstract

Background

Gastrointestinal endoscopy (GIE) is not routinely accessible in many parts of rural Africa. As surgical training expands and technology progresses, the capacity to deliver endoscopic care to patients improves. We aimed to describe the current burden of gastrointestinal (GI) disease undergoing GIE by examining the experience of surgical training related to GIE.

Methods

A retrospective review was conducted on GIE procedures performed by trainees with complete case logs during 5-year general surgery training at Pan-African Academy of Christian Surgeons (PAACS) sites. Cases were classified according to diagnosis and/or indication, anatomic location, intervention, adverse events, and outcomes. Comparisons were performed by institutional location and case volumes. Analysis was performed for trainee self-reported autonomy by post-graduate year and case volume experience.

Results

Twenty trainees performed a total of 2181 endoscopic procedures. More upper endoscopies (N = 1,853) were performed than lower endoscopies (N = 325). Of all procedures, 546 (26.7%) involved a cancer or mass, 267 (12.2%) involved a report of blood loss, and 452 (20.7%) reported pain as a component of the diagnosis. Interventions beyond biopsy were reported in 555 (25%) procedures. Esophageal indications predominated the upper endoscopies, particularly esophageal cancer. Trainees in high-volume centers and in East Africa performed more interventional endoscopy and procedures focused on esophageal cancer. Procedure logs documented adverse events in 39 cases (1.8% of all procedures), including 16 patients (0.8%) who died within 30 days of the procedure. Self-reported autonomy improved with both increased endoscopy experience and post-graduate year.

Conclusions

GIE is an appropriate component of general surgery residency training in Africa, and adequate training can be provided, particularly in upper GI endoscopy, and includes a wide variety of endoscopic therapeutic interventions.

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Funding

The authors wish to acknowledge the SAGES Education & Research Foundation for the grant, “Improving Surgical and Endoscopy Access and Training in East Africa,” which allowed for the completion of this project.

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Authors and Affiliations

  1. Department of Surgery, Tenwek Hospital, PO Box 39, Bomet, 20400, Kenya

    Robert K. Parker & Michael M. Mwachiro

  2. Department of Surgery, Alpert Medical School of Brown University, Providence, RI, USA

    Robert K. Parker

  3. Department of Endoscopy, Tenwek Hospital, Bomet, Kenya

    Michael M. Mwachiro & Stephen L. Burgert

  4. Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA

    Hillary M. Topazian

  5. Department of Surgery, AIC Kijabe Hospital, Kijabe, Kenya

    Richard Davis

  6. Department of Internal Medicine, Mbingo Baptist Hospital, Bamenda, Cameroon

    Albert F. Nyanga

  7. Department of Surgery, Bongolo Hospital, Lebamba, Gabon

    Zachary O’Connor

  8. Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA

    Mark D. Topazian

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  1. Robert K. Parker
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Contributions

All authors contributed to meet all four requirements of ICJME recommendations. Robert Parker, Hillary Topazian, Michael Mwachiro, Richard Davis, Albert Nyanga, Zachary Connor, Stephen Burgert, and Mark Topazian contributed to the concept and design of the project or to data acquisition, analysis, and interpretation. Robert Parker drafted the initial manuscript with Hillary Topazian, Michael Mwachiro, and Mark Topazian and each author Robert Parker, Hillary Topazian, Michael Mwachiro, Richard Davis, Albert Nyanga, Zachary Connor, Stephen Burgert, and Mark Topazian offered critical revisions for important intellectual content. All authors approved the final manuscript and accept responsibility. The corresponding author, Robert Parker, confirms that he had full access to the data and the final responsibility for the decision to submit for publication.

Corresponding author

Correspondence to Robert K. Parker.

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Disclosure

The authors, Robert Parker, Michael Mwachiro, Hillary Topazian, Richard Davis, Albert Nyanga, Zachary O’Connor, Stephen Burgert, and Mark Topazian have no conflicts of interest or financial ties to disclose.

Ethical approval

The study received ethical approval from the Tenwek Hospital Institutional Ethics Review Committee.

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Parker, R.K., Mwachiro, M.M., Topazian, H.M. et al. Gastrointestinal endoscopy experience of surgical trainees throughout rural Africa. Surg Endosc 35, 6708–6716 (2021). https://doi.org/10.1007/s00464-020-08174-3

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