Ascites describes the condition of pathologic fluid accumulation in the peritoneal cavity. Cirrhosis is the most common cause of ascites worldwide, with a half of cirrhotic patients developing ascites within 10 years of diagnosis. The “underfill” and “overflow” theories have traditionally been used to explain the pathogenesis of ascites in cirrhosis. However, with advances in hemodynamic and neurohumoral studies, it has been shown that neither of these theories fully explains the pathophysiologic mechanisms involved. The key roles of portal hypertension and vasodilators such as nitric oxide (NO) in the process of ascites formation have now been recognized. This led to the proposal of the peripheral arterial vasodilatation theory which includes components of both the “underfill” and “overflow” theories. Recently, the role of gut bacteria in the pathogenesis of ascites has been demonstrated. Bacterial translocation is now known to be a key event preceding the onset of ascites. Bacterial DNA and endotoxin have been shown to stimulate NO synthesis. This led to the proposal of a modified version of the vasodilatation hypothesis, “the systemic inflammation hypothesis,” which proposes that translocated bacteria or their products stimulate the release of proinflammatory cytokines which in turn stimulate NO synthesis. Cardiac dysfunction (cirrhotic cardiomyopathy) has also been described in cirrhosis and is believed to contribute to the reduction in effective circulating volume which stimulates renal sodium and water retention. Initial treatment measures include salt restriction and diuretics. Drugs known to reduce glomerular perfusion or directly toxic to the kidneys must be stopped. Initial therapeutic paracentesis should be done in those presenting with tense ascites. There is no need for albumin infusion if the amount of fluid removed is less than 5 liters. For those with refractory ascites, beta-blockers should be stopped. Treatment options include aquaretics; serial large-volume paracentesis with albumin infusion or midodrine in place of albumin; transjugular intrahepatic portosystemic shunt; peritoneovenous shunt; low-flow ascites pump; and liver transplantation.

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Colorectal cancer (CRC) is a major public health issue in Nigeria. The incidence is rising, and majority of the patients diagnosed with CRC, die of the disease burden. CRC is an ideal cancer for screening and early detection. It has been well documented that screening for CRC, by a variety of methods, leads to a sustained reduction in mortality from the disease in two ways: increased detection of early stage with more curable cancer and detection and removal of adenomas, which are known precursors to CRC. Screening has also been shown to be cost-effective in terms of quality-adjusted life-years gained compared to nonscreening. CRC screening can be approached as an organized program or on an opportunistic basis. Opportunistic screening is the only option in systems that lack the resources, infrastructure, and framework needed for an organized approach. A myriad of CRC screening tests exist, which can be divided into two main categories namely biological sample-based tests, which include fecal, blood, and urine tests, and colonic structure-based tests, which include flexible sigmoidoscopy, colonoscopy, and imaging studies such as computed tomography colonography, magnetic resonance imaging colonography, and double-contrast barium enema. The recommendation for CRC screening includes offering patients the opportunity to select test, based on their preference, affordability, and test availability. This decision-making process is personalized and requires an understanding between the patient and doctor. This guideline reviews the available evidence and makes recommendation on the screening method for CRC in Nigeria.

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Background: Achalasia is a rare disease. The present standard treatment is laparoscopic Heller's myotomy. Some centers still use thoracoscopy, thoracotomy, or laparotomy. Newer approaches such as the per-oral endoscopic esophagomyotomy are being evaluated. Objectives: The objective of the study was to review the diagnostic procedures for achalasia cardia and the therapeutic approaches being used in the study centers and to evaluate the dysphagia and reflux esophagitis outcomes and the occurrence of operative complications. Methods: This is a retrospective study over 10 years (2008–2017) from three centers in Nigeria. The clinical and operative records were reviewed. The route and outcome of modified Heller's myotomy for achalasia cardia were reviewed. Results: The total number of cases was 16. The male-to-female ratio was 1:1, and age ranged from 3 to 55 years. Diagnosis was done by clinical features and barium swallow test. Two of the 16 cases were done via the laparotomy approach, while the remaining 14 were achieved via a left thoracotomy. Only in one case was fundoplication done. Perioperative mortality was zero. Overall long-term dysphagia and reflux outcomes were satisfactory. Conclusion: Clinical and radiological features are predominantly used to diagnose achalasia; esophageal manometry was not available. Surgery was predominantly done by the thoracotomy approach, with occasional fundoplication.

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Background: Liver disease is a major cause of morbidity and mortality globally. Its pattern varies with different geographical locations and these variations are determined by lifestyle, environmental, and genetic factors. This study determined the pattern, clinical presentations, risk factors, and determinants of morbidity and mortality in patients with liver disease admitted into a tertiary hospital in Ile-Ife, Nigeria, over a 5-year period; 2013–2017. Methods: Case records of patients admitted into the medical wards of Obafemi Awolowo University Teaching Hospital, Ile-Ife, with a diagnosis of liver disease were retrieved and information relating to demographics, risk factors, and types of liver disease as well as the results of relevant investigations, duration, and outcome of admission was extracted. Data were entered into SPSS version 20 and analyzed using frequencies and percentages which are presented in tabular form. Results: A total of 5,155 patients were admitted, liver diseases accounted for 324 (6.3%) of medical admissions within the period, with hepatocellular carcinoma (HCC) accounting for 52.8%, liver cirrhosis (LC) – 27.2%, acute hepatitis – 10.38%, metastatic liver disease – 4.1%, autoimmune hepatitis – 1.7%, DILI – 0.7%, liver abscess – 1%, abdominal tuberculosis – 1.4%, and unclassified etiology – 1.76%. A total of 139 cases were HBsAg positive, 64 took alcohol, 67 took herbs, while 57 took self-prescribed medications. Mortality among all patients admitted through the emergency compared with the medical clinic was 81.9% versus 18.1%. Elevated creatinine, coagulation disorder, hypoalbuminemia, and hypokalemia contributed to mortality. Conclusion: HCC and LC accounted for the majority of liver diseases in hospitalized patients with high mortality among all patients admitted through the emergency department and those with elevated creatinine, coagulopathy, and low potassium and albumin. Major etiologic factors were hepatitis B virus infection, alcohol, and self-prescribed medications.

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Background: Percutaneous endoscopic gastrostomy (PEG), a gastrointestinal access, is one of the means of ensuring the sustenance of enteral feeding in patients who cannot swallow or eat. The procedure of PEG in the University of Benin Teaching Hospital (UBTH) is new with increasing acceptance by the clinicians and patients as it reduces morbidity and fosters early discharge home. Aims/Objectives: The aim of this study is to identify the need and usefulness for PEG, audit the process in its initial introduction, and document patient outcomes. Patients and Methods: This was a prospective study done over a 4-year period (2015-2018) and included all consecutive patient referred for PEG in the endoscopic suite of UBTH. Patient demographics, indication for PEG, outcome of the procedure, and complications were entered into a pro forma and the data analyzed. Results: A total of 17 patients had PEG over a period of the study. The male-to-female ratio was 2:1. The age range was 35–94 years, with a mean age of 68.6 years. Cardiovascular accident was the most common indication for PEG (64%; 10 patients), whereas intracranial tumors were 12% (2 patients), and other indications, namely severe head injury, dementia, and sepsis were 6% (1 patient) each. All patients had a successful procedure. Surgical site infection occurred in one patient, whereas another patient had extrusion of the PEG tube 1 month after the procedure. Conclusion: PEG is a safe procedure. The authors advocate the routine use of PEG in patient who cannot eat, especially in a subset of cardiovascular accident patients to sustain adequate nutrition while reducing the morbidity associated with nasogastric intubation and hospitalization.

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Materials for this review were obtained mainly through online search of relevant websites, survey of gastroenterologists in Nigeria, and personal communication with some leaders in various locations. Endoscopy became a reality because of the desire of medical practitioners over the centuries to look inside hollow organs to make accurate diagnosis and to treat such illnesses. From rudimental equipment in antiquity, endoscopy developed rapidly in the nineteenth century. Initial practitioners in Nigeria were foreign trained and were located in the first-generation teaching hospitals. The advance was slowed down with the downward trend of the economy in the 1990s and the early 2000s. Progress has picked up now due mainly to the establishment of more tertiary hospitals, training of specialists at the postgraduate colleges, and the influence of the professional body, Society for Gastroenterology and Hepatology in Nigeria. Endoscopy has contributed to help us define more precisely the epidemiology of diseases of the gastrointestinal (GI) tract in Nigeria, including peptic ulcer disease, Helicobacter pylori, reflux disease, GI bleeding, and disease of the lower gastrointestinal tract. It has provided means for treating many diseases locally, without the need for surgery. For endoscopy to grow rapidly, we must use our training center regularly, persuade our administrators to see the need for providing equipment and facilities, bring along our support staff by providing relevant training, maintain collaboration with foreign partners, and influence equipment suppliers to provide better services to us though replacement agreements and establishment of competent repair facilities in Nigeria.

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Background: The prevalence of nonalcoholic fatty liver disease (NAFLD) in India varies from 9 to 35%. NAFLD is one of the most common causes of chronic liver disease worldwide. Liver biopsy, which is the gold standard for diagnosing NAFLD is an invasive procedure with potential adverse effects and large inter- and intra-observer variability. Hence, various noninvasive markers are being explored to assist in the diagnosis of NAFLD. Fibroscan measures liver stiffness through estimation of the velocity of propagation of a shear wave through liver tissue. Very few studies have addressed the accuracy of fibroscan versus liver biopsy. Objectives: To grade liver fibrosis in the patients and compare fibrosis score by fibroscan with that of liver biopsy in NAFLD. Materials and Methods: An observational study of 72 subjects who had presented with fatty liver on ultrasound and further subjected to fibroscan at the outpatient department of gastroenterology and have undergone liver biopsy (gold standard) for confirmation in the Department of Pathology, Ramaiah Medical College. The study was done from January 2017 to December 2018. After routine processing, liver biopsies were categorized into four subgroups depending on the fibrosis score such as F1 (perivenular fibrosis), F2 (periportal fibrosis), F3 (bridging fibrosis), and F4 (cirrhosis) and was compared with fibroscan scoring, which was based on the degree of fibrosis. Results: Our study revealed that in the subgroup of NAFLD patients with F1, F2, F3 fibrosis on biopsy, the mean fibroscan values were 11.84 ± 9.23, 16.98 ± 18.85, 21.93 ± 5.85, respectively, which overestimate the fibrosis score (2.5–7.5 Kpa), (7.6–10 Kpa), (10.1–13 Kpa), respectively, and in F4 fibrosis, the mean fibroscan value was 33.41 ± 17.39 and in concordance with the fibrosis score (>13 Kpa). Conclusion: Fibroscan overestimates the fibrosis score in the early stages of NAFLD, whereas, it has high accuracy in detecting advanced fibrosis and cirrhosis. Hence, it can be concluded that transient elastography is a good adjunctive tool in NAFLD patients with advanced fibrosis.

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Hepatocellular carcinoma (HCC) is the most common primary cancer of the liver. The burden of HCC is highest in the sub-Saharan Africa, South-East Asia and China. The recognized risk factors for HCC are chronic hepatitis B virus and hepatitis C virus infection, dietary aflatoxin, and alcoholic liver disease among others. HCC typically presents with symptoms related to the primary tumor; abdominal pain, weight loss, and abdominal swelling. Extrahepatic spread is present in up to 15% of patients with HCC at the time of diagnosis and may be the primary presentation. The most common site of extrahepatic metastasis by several authors is the lungs. Bone metastases in HCC are not as rare as previously reported and the most frequent site is the spine. Bone metastasis is mainly osteolytic and may result in pathologic fractures, hypercalcemia, and reduced quality of life. Spinal metastasis of HCC is recognized as a terminal stage of the disease and considerably worsens the prognosis. Presented is a case of a 35-year old man who came to the hospital primarily with metastatic spinal cord compression syndrome with paraplegia and was found to have advanced HCC. He succumbed to the disease within one month of presentation. While Pott's disease of the spine and metastatic prostatic tumor are the most common causes of nontraumatic myelopathy in sub-Saharan Africa, HCC should always be considered in the differential diagnosis of any patient with vertebral disease of uncertain origin.

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Background: Evaluation of patients who present with diarrhea and constipation requires a good knowledge of what constitutes normal defecation frequency and stool form. This study was designed to determine the normal defecation frequency and normal stool form in adult rural and urban dwellers in Southeast Nigeria. Materials and Methods: This was an observational, descriptive, cross-sectional, questionnaire-based study of adults in rural and urban settings in Southeast Nigeria. Defecation frequency was recorded as number of bowel motions per week, while stool form was determined with the use of the Bristol stool scale. Variables included in the questionnaire were age, sex, occupation, level of education, use of alcohol, cigarette smoking, use of kolanut, use of coffee, and body mass index. Data were analyzed with SPSS v 23. Results: There were 670 participants (61.6% females and 56.7% rural dwellers). The 25 and 75 percentiles of the stool form were Bristol types 3 and 4, while the 25 and 75 percentiles of defecation frequency were 7 and 14. Defecation frequency was higher in males than females (P = 0.006), while stool form was significantly affected by age (P = 0.001), sex (P = 0.041), and place of abode (P = 0.001). Conclusion: In Southeast Nigeria, normal defecation frequency is between 7 and 14 bowel motions per week, while normal stool forms are Bristol types 3 and 4. Age, sex, and place of abode significantly affect defecation frequency and stool form.

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Helicobacter pylori infection remains a major health concern around the world as untreated infection can lead to gastric cancer. The burden of H. pylori infection in Nigeria is high (87.7%) with the northern part of the country having a higher prevalence compared to other regions of the country. Methods comprising invasive and non-invasive approach are widely used around the country for the diagnosis of H. pylori infection. However, data on use of culture which gives the advantage of antimicrobial susceptibility testing is limited. Treatment and management of H. pylori in Nigeria is becoming difficult as the rate of resistance to antibiotics is on the rise. This review highlights key findings on the incidence, diagnosis and treatment of H. pylori infection in Nigeria.

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Background and Objective: Hepatocellular carcinoma (HCC) is a common rapidly growing tumor with poor outcomes and hence requires precise, accurate, and timely diagnosis for early intervention. Although it may be suspected clinically and by imaging investigation such as ultrasound scan (USS) of the liver, there are insufficient data correlating these two modalities with histological diagnosis. This study aims at determining the relevance of liver biopsy in the diagnostic confirmation of HCC in clinically suspected Nigerian patients. Materials and Methods: This is a retrospective cross-sectional study of 105 clinically diagnosed Nigerian patients with HCC who had liver biopsy between January 1, 2001 and December 31, 2017 at the GIT/liver Unit of UCH, Ibadan. After securing the appropriate ethical clearance from the UI/UCH Ibadan ERC, relevant data were collected from patients' Pathology Departmental records and analyzed using appropriate statistical instruments. Results: There were 105 cases of clinically diagnosed HCC patients, 45 of which had imaging (USS/or computerized tomography scan) diagnosis. The mean age of the patients was 44 ± 14.8 years, ranging from 0.25 to 85 years. They consisted of 69 males and 36 females with M:F ratio of 1.9:1. Histological diagnosis was not ascertained in 8 cases (7.6%), while 97 cases (92.4%) had varied diagnoses. Malignant neoplasms, benign neoplasms, liver dysplasia, and nonneoplastic liver diseases were established in 74.1%, 2%, 9.6%, and 14.5% of cases, respectively. Primary liver cancers accounted for 62.8% of cases and included HCC (59.8%), cholangiocarcinoma (1%), hepatoblastoma (1%), and NHL (1%). The sensitivities of clinical and USS diagnoses were 100% and 93%, respectively. The positive and negative predictive values for USS were 65.1% and 0%, respectively. The overall clinical and USS diagnostic accuracies for HCC were 59.8% and 62.2%, respectively. Conclusion: The clinical accuracy for the diagnosis of HCC among clinically suspected and USS diagnosed HCC is limited in comparison to histological diagnosis by liver biopsy. Hence there should be the utilization of liver biopsies for confirmation of HCC in such suspected Nigerian patients.

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Background: There are few publications on the histopathological spectrum of cancer arising from the colon and rectum in this country. Knowledge of the spectrum of findings from colorectal cancer (CRC) biopsies will help reveal the type of cancers, the most common grade and the most prevalent anatomical distribution, the demographical distribution as well as the association of clinical symptoms with various conditions. This will inform interventions to be made. Methodology: The study employed a retrospective design with data and archived slides extracted from the Department of Pathology, Komfo Anokye Teaching Hospital, January 2009–September 2018. The slides were reviewed to establish diagnoses on colorectal biopsies. Results: A total of 237 CRC cases were reviewed, and the mean age was 54.61 ± 17.62 years, with the modal age being 75 years. The age ranges from 5 to 91 years, with the age group of 50–59 years recording the most with 22.36%. The male-to-female ratio is 1:1.09. Rectal cancers were relatively more common constituting 48.10% of the cases compared to colonic cancers, which contributed 45.57% of the cases, and rectoanal cancers recorded 6.33% of the cases. Adenocarcinoma was the most common cancer type constituting 209 (88.19%) cases and squamous cell carcinoma accounting for 21 (8.86%) cases. There were 4 neuroendocrine cancers representing 1.62% of the cases and 2 non-Hodgkin's lymphomas contributing to 0.84% of the cases, with sarcoma contributing a single case (0.42%) of the total number of cancers. Conclusion: CRC incidence is on the ascendency and continues to pose major health risk in this sub-Sahara African population. Females were at slightly increased risk and frequently located in the rectum, with most being high-grade CRCs.

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Kaposi sarcoma (KS) was the first AIDS defining malignancy described, and it commonly involves the skin, although visceral lesions exist. Visceral KS lesions are easy to miss, especially when symptoms are atypical or suggestive of another condition. This is a case of KS of the stomach in an HIV/AIDS patient presenting with symptoms, suggestive of bleeding peptic ulcer disease.

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Introduction: Dyspepsia is a common symptom worldwide and has been reported to account for a considerable proportion of general practice and gastroenterology consultation. It could be subclassified as structural, functional, or uninvestigated dyspepsia. Uninvestigated dyspepsia refers to dyspeptic symptoms in persons whom no diagnostic investigations have been performed. The aim of this study is to determine the prevalence and sociodemographic characteristics of patients with Rome III features of dyspepsia. Materials and Methods: It was a cross-sectional descriptive study where all patients who presented with any of the Rome III features of dyspepsia and had no diagnostic investigations done to ascertain the cause of the dyspepsia during the study period were recruited as test subjects. The controls were age- and sex-matched asymptomatic hospital staff. Results: A total of 130 test subjects and 65 controls were recruited and used for the data analysis. More females were recruited among the test subjects than males with a ratio of 1.4:1, respectively. The most common age group was the fifth decade of life, and the proportion of patients with symptoms of dyspepsia thereafter reduced with increasing age. Epigastric pain (95.4%) was the most prevalent feature of dyspepsia. Early satiety accounted for 15.4%, while the least prevalent was postprandial distress. Heartburn was the most common symptom associated with Rome III features of dyspepsia. Conclusion: Epigastric pain was found to be the most prevalent Rome III feature of dyspepsia, while heartburn is the most associated symptom.

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Background and Aim: Colorectal cancer (CRC) is known to be a major cause of morbidity and mortality worldwide. It is believed that CRC develops from adenomas or benign adenomatous polyps. Information concerning this premalignant condition in Nigeria is still relatively scarce. The aim of this study was to describe the clinicopathologic features of colorectal polyps seen in patients who had colonoscopy at the University College Hospital, Ibadan, Nigeria. Patients and Methods: This was a descriptive cross-sectional study carried out at the Endoscopy Unit of the University College Hospital, Ibadan, Nigeria. Colonoscopy was performed on the patients after bowel preparation. Polyps were characterized by their colonic location, size in millimeter, and histopathological diagnosis. The data were analyzed using SPSS version 17.0. Results: The patients comprised 65 (58.0%) males and 47 (42.0%) females. The mean age was 60 ± 12.5 years, with majority being in the age range of 51–60 years. The most common indication for colonoscopy was hematochezia. The location of the polyps was as follows: 41 (36.6%) in the rectum, 30 (26.8%) in the sigmoid colon, and 22 (19.6%) each in the transverse and descending colon. In 51 (45.5%) patients, polyps were <5 mm in size; 5–10 mm in 48 (42.9%) patients; and >10 mm in 13 (11.6%) patients. The most frequent histological diagnosis was adenomatous polyp. Conclusion: Polyps were found more commonly in males and in individuals aged 50 years and above. The most common location is the rectosigmoid colon, and the polyps are majorly adenomatous. Our findings suggest the need for colonoscopy service to be made more widely available across the country so as to contribute to reduction in CRC incidence among Nigerians.

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Background: The long-term outcomes of Helicobacter pylori infection ultimately depend on the distribution and extent of gastritis. Three main types of gastritis phenotypes which include pangastritis, antral-predominant gastritis, and corpus-predominant gastritis have been observed. Corpus predominant gastritis is more common in the parts of Asia with a high prevalence of gastric adenocarcinoma. This study was conducted to determine the prevalence of H. pylori-associated gastritis phenotypes in a South-western Nigerian population, a sub-Saharan African population. Materials and Methods: The study was a cross-sectional prospective study which included 267 dyspeptic patients who had esophagogastroduodenoscopy at a tertiary health institution in South-west Nigeria. Five gastric biopsies were taken from each subject, and standard histologic examination was performed on the specimens. Both biopsy sampling and histologic examination followed the Updated Sydney System recommendations. The data generated were statistically analyzed. Continuous variables were presented as means ± standard deviation, whereas associations between the categorical variables were determined by the Pearson Chi-square test or Fisher's exact test. P ≤ 0.05 was considered statistically significant. Results: The mean age was 46.1 (±15.4) years while the age range was 16–84 years. There were 160 (59.9%) female and 107 (40.1%) male participants. All participants had histological gastritis, whereas 79 (29.6%) were positive for H. pylori by histology. H. pylori infection was significantly associated with peptic ulcer disease. Among those who had H. pylori infection, 51 (64.6%) had pangastritis, 26 (32.9%) had antral-predominant gastritis, while 2 (2.5%) had corpus-predominant gastritis. The relationship between H. pylori infection and the gastritis phenotypes showed no statistical significance. Conclusion: The prevalence of corpus predominant gastritis was low in our study population.

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Background: Colorectal cancer (CRC) is common in Africa including Nigeria contrary to popular opinion. Screening for CRC is cost-effective and reduces morbidity and mortality. Aim: The aim of the study was to assess the practice of CRC screening among gastroenterology practitioners in Nigeria. Methods: This was a questionnaire-based cross-sectional descriptive study conducted among gastroenterology practitioners attending their annual conference in 2016. Data were analyzed using SPSS version 20. Results: A total of 65 respondents completed the questionnaire. The mean age was 37.68 years. Majority (95%) of the respondents practised in tertiary hospitals. Screening for CRC was practised by 54% of the respondents, with colonoscopy and guaiac fecal occult blood test being the preferred screening modalities. Indications for screening were mostly symptom based with varied protocols and outcomes. Conclusion: The practice of CRC screening among gastroenterology practitioners in Nigeria is variable. There is a need to formulate national guidelines and colonoscopy quality control tools to improve awareness and standardize practice.

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Arterioportal fistula (APF) is a rare and potentially fatal cause of portal hypertension. In this case report, we present an unwonted case of a Nigerian with this disorder. As well, this article documents details of successful therapy for such a large APF with transcatheter arterial embolization which was carried out locally. This study is thus a first-of-its-kind for our African subregion. We hope that this article will help to highlight the role and significance interventional radiology services and expertise in an emerging health-care system as the one seen in West Africa – particularly as it relates to its benefits in the field of hepatology.

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A case report of a 7-year-old girl who presented with a 4-year history of painless progressive abdominal swelling that became painful 2 weeks before presentation. Examination revealed a girl in painful distress with distended abdomen and a tender palpable firm right upper quadrant abdominal mass measuring 28 cm × 22 cm with well-defined borders. Abdominal ultrasound scan showed a cystic liver mass filling the abdomen which was multilocular. Liver function tests show mildly elevated liver enzymes and mild prolongation of the prothrombin time. She had repeated aspiration of the cyst content in various peripheral hospitals with transient relief of symptoms. She thereafter had abdominal exploration through a right upper transverse incision and was found to have a cystic mass involving segments V, VI, and VII of the right lobe of the liver measuring 30 cm × 26 cm. Marsupialization of the cyst was done and an incisional biopsy of the cyst wall was taken. Histology of the cyst wall showed a mesenchymal hamartoma of the liver (MHL). The aim of this study is to highlight the clinical features, diagnosis, treatment, and differential diagnosis of MHL

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Evaluation of colorectal pathologies by colonoscopy is increasingly reported from different centers across Nigeria. However, a comprehensive review of current colonoscopy practice across the country is yet to be documented. To report on colonoscopy practice, the detection rate, site(s), and geographic distribution of colorectal polyps in Nigeria, a systematic search was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The search databases comprised MEDLINE, African Journal Online, and Google Scholar. The eligibility criteria included publications on flexible lower gastrointestinal endoscopies (LGIEs) performed on Nigerian population over a 20-year period from January 2002 to 2022. Relevant data on study characteristics, demographics of study patients, indication(s), complications of polypectomy, quality metrics for colonoscopy, polyp morphology size, location, and histopathology were extracted and analyzed. Twenty-one observational studies were included comprising 5821 patients who underwent LGIE with an age range of 2–101 years and an M: F of 1.8:1. The polyp detection rate (PDR) was 8.5% in North-West Nigeria, and the mean value ranged from 11.3% [95% confidence interval (CI) 7.0–15.6] in South-West Nigeria to 38.0% (95% CI 165.3–241.3) in South-South Nigeria. The rectosigmoid segment had the highest frequency of polyps [43% (358/828)], and adenomatous, inflammatory, hyperplastic, and malignant polyps were the frequent histology reported: 221 (26.7%), 174 (21.0%), 38 (4.6%), and 13(1.6%), respectively. Summarily, a large disparity exists in PDR among endoscopists in Nigeria. The training of Nigerian endoscopists on techniques to enhance caecal intubation rate, polyp detection, and comprehensive documentation of quality metrics in colonoscopy studies are recommended.

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