Endoscopy Services for Acute Gastrointestinal Bleeding in Low- And Middle-Income Countries: Challenges and Solutions

Abstract

Dear editor,Acute gastrointestinal bleeding (AGIB) is a hospital emergency with a 5-10% mortality rate. The incidence rates for upper gastrointestinal bleed (UGIB) and lower gastrointestinal bleeding (LGIB) are 67 and 36 per 100,000, respectively. The patient present with hematemesis, melena, hematochezia, or syncope (1,2) . The leading causes of UGIB are peptic ulcer disease (55%), esophageal varices (16.7%), inflammation (9.75%), Mallory Weiss tears (7.6%), angiodysplasia (6%), and neoplasm (3.45%) (3) . Common causes for the LGIB are diverticular disease (28.5%), angiodysplasia (15%), colitis (16%), polypectomy (12.5%), anorectal diseases (7%) and small bowel bleeding (5.5%) (3) .With advances in medical science, treatment protocols for AGIB have advanced from pharmacological treatment to endoscopic intervention. Endoscopic intervention includes epinephrine injection, thermal coagulation, sclerotherapy, or clip application. Endoscopic management and band ligation are the gold standards for treating AGIB, having 90% effectiveness in stopping the bleeding (4) . Endoscopy has replaced several open medical and surgical procedures.Early emergency endoscopy is defined as the intervention carried out within 24 hours of patient presentation with GIB. This timely intervention ultimately reduces morbidity and mortality by securing early hemostasis and shortening hospital stays (5) . In peptic ulcer disease, the risk of rebleeding with medical therapy alone is 80-90% which can be reduced to 10% with modern combination endoscopic therapy (6) . Endoscopy may also help with the early diagnosis of the malignancies.The inequitable distribution of resources on a global scale extends to medical services. High-income countries have welldeveloped endoscopic facilities, even at the primary health care level (7) . The global consensus for the minimum requirement for an endoscopy unit is the availability of endoscopic light sources, standard monitors, flexible endoscopes, electrosurgical equipment, and at least two gastroscopes and two colonoscopies (8) . Low-and