Esophagogastroduodenoscopy in a public referral hospital in Lilongwe, Malawi: spectrum of disease and associated risk factors

LL Wolf, R Ibrahim, C Miao, A Muyco… - World journal of …, 2012 - Wiley Online Library
LL Wolf, R Ibrahim, C Miao, A Muyco, MC Hosseinipour, C Shores
World journal of surgery, 2012Wiley Online Library
Background Esophagogastroduodenoscopy (EGD) is a valuable tool for diagnosing and
treating upper gastrointestinal disease. Prioritizing the use of EGD in resource‐limited
settings must be customized to local populations to maximize population benefit from the
examination. Methods Cross‐sectional, retrospective review of EGD reports was conducted
at Kamuzu Central Hospital (KCH), Lilongwe, Malawi. Esophageal tumors were defined as
obstructive or nonobstructive and esophageal varices were graded on a scale of I to IV …
Abstract
Background
Esophagogastroduodenoscopy (EGD) is a valuable tool for diagnosing and treating upper gastrointestinal disease. Prioritizing the use of EGD in resource‐limited settings must be customized to local populations to maximize population benefit from the examination.
Methods
Cross‐sectional, retrospective review of EGD reports was conducted at Kamuzu Central Hospital (KCH), Lilongwe, Malawi. Esophageal tumors were defined as obstructive or nonobstructive and esophageal varices were graded on a scale of I to IV. Descriptive statistics were calculated and logistic regression performed for each disease state compared with all other reports.
Results
A total of 1,034 cases were reviewed (56% male; mean age (standard deviation), 44 (17) years). The most common indications were dysphagia (37%), hematemesis (21%), and epigastric pain (16%). The most common diagnoses were normal (36%), esophageal cancer (27%), and esophageal varices (17%). Eighty‐six percent of esophageal tumors were obstructive and 45% of esophageal varices were grade III or IV. Normal examinations were more likely to be female, younger, and present with dyspepsia. Esophageal cancers were more likely to be male, older, present with dysphagia, and present from districts outside Lilongwe. Esophageal varices were more likely to present with hematemesis.
Conclusions
EGD is a limited resource at KCH; patient selection should be guided by patient age and indication. The high burden of esophageal cancer and varices in Malawi suggests that therapeutic endoscopy would be beneficial.
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