Prophylactic antibiotics reduce bacteriaemia and seem to prevent cholangitis and septicaemia in patients undergoing elective ERCP. In the subgroup of patients with uncomplicated ERCP, the effect of antibiotics may be less evident. Further research is required to determine whether antibiotics can be given during or after an ERCP if it becomes apparent that biliary obstruction cannot be relieved during that procedure.

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Endoscopic retrograde cholangiopancreatography (ERCP) involves cannulation of the ampulla of Vater and has diagnostic as well as therapeutic capabilities, but the number of non-therapeutic ERCPs is decreasing with time. 1 Endoscopic sphincterotomy, stone extraction and stenting are not without complications. The most widely recognised of these include bleeding, which occurs in 0.7 -2% of patients, perforation (0.3 -0.6%), pancreatitis (7%), cholangitis (1%) and cholecystitis (0.2 -0.5%). Procedure-related mortality is approximately 0.2%. 2 Review of international guidelines regarding the use of prophylactic antibiotics with ERCP shows that routine use of antimicrobials is recommended for biliary obstruction and pancreatic pseudocysts. However, several studies, including a meta-analysis, fail to show any benefit. [3][4][5][6] We set out to assess the current antibiotic prescribing practice among South African endoscopists who perform ERCPs, and then review international guidelines and relevant studies. MethodsOur audit of South African endoscopists who perform ERCPs took the form of a questionnaire. This was distributed at the Hepato-Pancreatico-Biliary Association of South Africa Congress held during October 2007 in Johannesburg, and was also sent to all members of the South African Gastro-Enterology Society via email. The questionnaire was anonymous. Endoscopists were questioned regarding their years of experience, the monthly volume of ERCPs they perform, and their indications for antibiotic prophylaxis (for diagnostic biliary ERCP, diagnostic pancreatic ERCP, therapeutic biliary ERCP and therapeutic pancreatic ERCP). Respondents were also asked to indicate their antibiotic of preference and the number of doses administered. The results were then tabulated for comparison, and the chisquared test was used to calculate p-values. A p-value of 0.05 was considered significant.A Pubmed search was performed from 1978 to March 2008 using the search terms Cholangiopancreatography-Endoscopic-Retrograde Antibiotic-Prophylaxis, random* or control* or blind* or meta-analys*, all subheadings. An Internet search was also performed to identify recommendations from various international gastrointestinal societies. ResultsThirty-nine endoscopists (22 surgeons, 16 medical gastroenterologists and 1 radiologist) responded to our questionnaire. Most had more than 6 years of experience (30/39) and performed more than 10 ERCPs per month (22/39). Approximately half of the endoscopists (19/39) were aware of ERCP antibiotic protocols, either the American Society of Gastro-Enterology (ASGE) or UK National Health Service (NHS) recommendations. The results are depicted in Table I. 'Always' implied that the endoscopist used antibiotic prophylaxis with each patient, 'selected' implied specific indications, and 'never' implied no use of antibiotic prophylaxis.

Abstract:Background: Levels of endoscopic demand and capacity in West Africa are unclear. Objectives: This paper aims to: 1. describe the current labor and endoscopic capacity, 2. quantify the impact of a mixed-methods endoscopy course on healthcare professionals in West Africa, and 3. quantify the types of diagnoses encountered. Methods: In a three-day course, healthcare professionals were surveyed on endoscopic resources and capacity and were taught through active observation of live cases, case discussion, simulator experience and didactics. Before and after didactics, multiplechoice exams as well as questionnaires were administered to assess for course efficacy. Also, a case series of 23 patients needing upper GI endoscopy was done. Results: In surveying physicians, less than half had resources to perform an EGD and none could perform an ERCP, while waiting time for emergency endoscopy in urban populations was at least one day. In assessing improvement in medical knowledge among participants after didactics, objective data paired with subjective responses was more useful than either alone. Of 23 patients who received endoscopy, 7 required endoscopic intervention with 6 having gastric or esophageal varices. Currently the endoscopic capacity in West Africa is not sufficient. A formal GI course with simulation and didactics improves gastrointestinal knowledge amongst participants.

BACKGROUND. Total esophagectomy specimens from 4 patients given preoperative high dose rate intraluminal hrachytherapy (HDRILBT) of 20 Gray (Gy) in 2 fractions of 10 Gy each week were reviewed for radiation changes. METHODS. In all patients, preoperative biopsy specimens showed moderate to poorly differentiated squamous cell carcinoma with minimal to negligible keratin production. The esophagectomy specimens were sampled at the resection margins, the edge of irradiated length, 1 cm from the proximal and distal edge of visible tumor, the center of the tumor, and the lymph nodes.

Colonoscopy is regularly used for investigation of bowel pathology and has become the gold standard for screening and diagnosis of colorectal cancer (CRC). [1] The procedure has diagnostic and therapeutic benefits, such as direct visualisation of the entire colon and removal of precancerous polyps, which is associated with a lowered risk of CRC. [2] Colonoscopy is a skill-intensive procedure and poses a risk to the patient, even if performed by a trained endoscopist in an appropriate setting. [1] Therefore, there is a need for standardised practice and regular audit of endoscopists to ensure consistent, high-quality care. [3] Based on the 'adenoma-carcinoma sequence' hypothesis for developing CRC, screening and surveillance colonoscopy aim to detect and remove polyps, particularly adenomatous polyps, with the intention of reducing the incidence of CRC. [4] Therefore, the polyp detection rate (PDR) and adenoma detection rate (ADR) are two key indicators of the quality of endoscopy. Other measurable This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.

GuidelineTigecycline, the first of a new class of broad-spectrum antibiotics (the glycylcyclines), has been licensed in South Africa for the parenteral treatment of adult patients with complicated intraabdominal infections (cIAIs) and complicated skin and soft-tissue infections (cSSTIs).This article serves as a summary of the guideline on the appropriate use of tigecycline, published in mid

According to GLOBOCAN, colorectal cancer (CRC) is the third most common cancer and the fourth most common cause of cancerrelated death, with 1.85 million new cases diagnosed worldwide in 2018. [1,2] The incidence of CRC appears to be increasing in emerging low-and middle-income countries (LMICs) owing to socioepidemiological transitions, including dietary changes, with countries in sub-Saharan Africa (SSA) reporting a notable increase in colorectal, breast and prostate cancer. [3,4] South Africa (SA) is no exception-the incidence of CRC is increasing steadily, and it was the sixth leading cause of cancer-related death in 2018. [1] It is noteworthy that apart from increasing incidence, the average age of CRC patients at the time of diagnosis in SSA is ~10 years younger than that observed in high-income countries (HICs). [5,6] In addition, other non-communicable diseases (NCDs), including diabetes and respiratory and cardiovascular disease, are on the rise, with the prevalence in SA being reported as two to three times higher than in HICs. [7] While there are no published data on comorbidity with CRC from SSA, many CRC cohorts from HICs describe a considerable comorbidity burden that adversely affects short-(30-day) and long-This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.