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   Table of Contents - Current issue
July-December 2022
Volume 14 | Issue 2
Page Nos. 49-83

Online since Monday, December 26, 2022

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Teaching and pioneering endoscopic retrograde cholangiopancreatography at a tertiary center in Nigeria––Year 1 experience: The apprenticeship model––Is this a viable option for Africa? p. 49
Akwi W Asombang, Olusegun Isaac Alatishe, Adewale A Aderonmu, Afolabi M Owojuyigbe, Adeleye Dorcas Omisore, Germain Brissett, Bassey Etim, Dennis A Ndububa, Oluwasegun Ijarotimi, Emily Green, Kulwinder Dua
Background: Nigeria is a West African country with a population of 190 million. It has approximately 110 endoscopists, of whom two perform endoscopic retrograde cholangiopancreatography (ERCP), with approximately 100 total ERCPs performed over 15 years. There is a perceived need by Nigerian physicians to increase ERCP capacity. Aim: Develop and assess a 1-year ERCP training program in Nigeria using didactics and quarterly formal (“bolus”) hands on training sessions. Materials and Methods: An introductory conference including didactic and hands on sessions was hosted in March 2018. From this introductory conference, six participants were selected for a 1-year training program. The program involved quarterly, in-country, week-long hands-on ERCP sessions. Sessions were led by an experienced interventional gastroenterologist trained and practicing in USA. A multidisciplinary meeting was held on day 1 of each session. Digital communication was used to transmit program information and request patient referrals from medical doctors. Results: ERCP conference attendees included 15 surgical and medical endoscopists, 3 surgical trainees, 3 GI trainees, 6 nurses, 2 anesthesiologists, 1 interventional radiologist and 6 radiology technicians. Six physicians selected for the ongoing 1-year training program include 1 hepatobiliary surgeon, 2 gastroenterologists, 1 gastroenterology fellow and 2 surgical residents. One participant had prior formal ERCP training including 6 weeks hands-on training abroad. There were 109 referrals over 1 year, with an increasing trend over the year. The farthest referral site was almost 900 km away. Conclusion: There is need for ERCP capacity in Nigeria. ERCP is feasible and safe in Nigeria. Awareness amongst healthcare providers to the available procedure resulted in increased patient referral.
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Chronic liver disease in HIV patients: Determinants and clinical manifestations p. 55
Sarah Tonye Abere, Boma Oyan, Blessing Azukoye-Amadi, Enohor Edna Amachree
Background and Aim: Chronic liver disease (CLD) is a common cause of morbidity and mortality in medical wards of tertiary hospitals in Nigeria, and the etiology varies from viral hepatitis B and C, retroviral disease, alcoholic and non-alcoholic fatty liver disease, drug toxicity to several other causes. Liver diseases have also been recognized as a leading cause of death among HIV-infected persons. We aim to elucidate the pattern of clinical presentation of CLD in non-hepatitis B virus/hepatitis C virus patients who are HIV-seropositive with minimal alcohol consumption as well as to identify the prevalence and risk factors for CLD in the subjects. Materials and Methods: This was a retrospectively analyzed case–control study of 170 HIV-seropositive patients with age- and sex-matched controls seen at the medical outpatient department and wards of the University of Port Harcourt Teaching Hospital. Sociodemographic, anthropometric, clinical, and laboratory characteristics were extracted and were analyzed with SPSS version 21. Results: Sixty-three (37.1%) HIV patients had clinical manifestations of CLD with fatigue (51, 30%) and hepatomegaly (14, 8.2%) as the commonest symptom and sign, respectively. Chronic use of medications including highly active antiretroviral therapy (5.1 ± 1.6 years, P = 0.000) and herbal preparations (n = 20, 11.8%, P = 0.000) were the most significant determinants of CLD. Hypoalbuminemia and low CD4 counts were observed. Conclusion: CLD is common in HIV patients without viral hepatitis B and C. Early identification of risk factors and proper clinical evaluation can aid in its mitigation.
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Overuse of upper gastrointestinal endoscopy among young dyspeptic patients: A retrospective analysis in Karachi p. 60
Uzair Khawaja, Ramsha Naeem, Fahad Naeem, Mudassir Ahmed
Background: Dyspepsia, one of the most commonly encountered complaints across the world, can manifest as epigastric pain, burning sensations, bloating, or nausea. The primary aim of this study was to explore the prevalence of endoscopic findings in younger dyspeptic patients and compare these findings with those observed in aged people. Additionally, the research also aimed to assess the overuse of endoscopic procedures in these patients and to probably redefine standards for this invasive procedure in our setting. Materials and Methods: The study was a retrospective analysis of patients who had endoscopy for dyspepsia. The patients were categorized into low risk and high risk based on the age and the presence or absence of alarming features. The chi-square test was used to analyze the data. Results: The sample for this study includes 183 individuals with a mean age of 39.4 (±12.4); out of which 89 (%) were males and 94 (%) were females. Patients aged 45 years or older were at higher risk of having significant findings on endoscopy (18/51 patients, 35.3%) compared to patients younger than 45 years (20/132 patients, 15.1%; P = 0.003). Conclusions: Endoscopy in younger dyspeptic patients was found to have a low yield. Consequently, in these patients, approaches other than endoscopic that are less invasive or noninvasive should be considered for diagnosis and treatment before resorting to endoscopy.
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Alarm features for predicting significant endoscopic findings among patients with dyspepsia in Cameroon p. 65
Antonin Wilson Ndjitoyap Ndam, Winnie Bekolo, Yann-Chris Eng, Sandra Cheleu, Malika Monkouop Mapiemfu, Elie Claude Ndjitoyap Ndam
Introduction: Dyspepsia is the major indication for gastroscopy in sub-Saharan Africa. However, endoscopic devices are not available in rural areas, and the examination is invasive and expensive for the rural populations. The aim of this study is to assess the predictive value of some alarm features in the prediction of endoscopic findings among adult patients with dyspepsia in Cameroon. Materials and Methods: We carried out a retrospective study using all reports of patients who underwent gastroscopy for dyspeptic syndrome from July 1 to December 31, 2021 at the Yaoundé General Hospital, Cameroon. We documented the sociodemographic characteristics, clinical signs, the type of dyspepsia, and endoscopic findings. We also documented alarm features associated with significant pathology (presence of an ulcer and/or a malignant tumor) at the endoscopy. Results: Of the 310 gastroscopies, dyspeptic symptoms represented 226 indications (72.9%). There were 90 males (39.8%). The mean age was 46.4 ± 15.9 years (range 16–86). Signs associated with dyspepsia were gastrointestinal (GI) bleeding in 8 patients (3.5%), weight loss in 6 patients (2.7%), and persistent vomiting in 13 patients (5.8%). A significant endoscopy finding was observed among 53 patients (23.5%). On the univariate analysis, alarm features associated with a significant lesion were male gender (P = 0.004), persistent vomiting (P = 0.047), and marginally for GI bleeding (P = 0.072). On the multivariate analysis, only the male gender was significantly associated with the presence of a significant lesion (P = 0.024). Conclusions: Our results show that the male gender, GI bleeding, and persistent vomiting are alarm features associated with the presence of a significant lesion among patients with dyspepsia.
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A rare case of gastrointestinal stromal tumor in an unusual location Highly accessed article p. 69
Olaleke Oluwasegun Folaranmi, Olabode Ali Odetunde
Gastrointestinal stromal tumor (GIST) is the most common mesenchymal tumor of the gastrointestinal (GI) tract. They originate or differentiate toward the interstitial cells of Cajal, an integral part of the GI autonomic nervous system of the GI tract. GISTs are mostly seen arising from the muscularis mucosa or propria layer of the stomach or small intestine with just one case of gastric GIST reported arising from the serosal layer. We report the case of a 46-year-old woman who presented with progressive abdominal mass and abdominal pain. Computed tomography scan and intraoperative findings revealed a huge, well-circumscribed cystic mass arising from the anti-mesenteric border of the ileum. An impression of mesenteric desmoid tumor was made but diagnosed to be GIST on histological examination with immunohistochemistry. This report shows the importance of including GIST in the differentials when investigating serosal based tumors of the GI tract even when the radioimaging findings are inconsistent.
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Intestinal obstruction caused by rectal stricture secondary to endometriosis: A case report p. 76
Bello Bashir, Ibrahim Umar Abubakar, Akubo Jonathan Aroume, Faruk Emetuma
Introduction: Endometriosis is a common condition among women of the reproductive age group which manifests through variable symptoms. Intestinal involvement in endometriosis is quite common and can resemble several diseases such as Crohn’s disease, appendicitis, tubo-ovarian abscess or malignant tumour. Intestinal obstruction due to endometriosis is rare and pre-operative diagnosis is difficult because the clinical features are non-specific and can be easily confused. In a case of a patient without a history of endometriosis, diagnosis is complicated. Case Summary: The case under review is a 28-year-old female who presented initially to the gynae emergency unit with recurrent pelvic pains and subsequently developed intestinal obstruction and had surgery; pelvic adhesiolysis, Hartman’s procedure with histopathological confirmation of endometriosis. Conclusion: Despite being rare, intestinal endometriosis can lead to a series of presentations of acute abdomen requiring intervention as highlighted above, hence the need for vigilance and heightened suspicion
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Selected Abstracts Presented At The 14th Annual Scientific Conference Of Society For Gastroenterology And Hepatology In Nigeria, Kano, July 18–22, 2022 p. 79

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