A seven-year retrospective review of colonoscopy records from a single centre in Zambia

Abstract

IntroductionColorectal disease is common throughout the world, but the spectrum of diagnoses across Africa remains largely unexplored. There is anecdotal evidence of changing colorectal disease but this has not been systematically investigated. The aim of this study was to enhance our insight into the spectrum of colonoscopic diagnoses in Zambia.MethodsWe retrieved written colonoscopy reports from January 2008 to December 2015. Collected data were coded by experienced endoscopists and analysed by age, sex, referral source, indication and diagnosis.ResultsIncluded in this analysis were 573 colonoscopy reports. The most common diagnosis was haemorrhoids (n=151, 26%), followed by tumours (n=96,17%). Over this time period, the proportion of normal colonoscopies decreased by 32% (P<0.001), presumably due to introduction of screening of all requests, while the rate of polyp detection increased from 5% to 10% (P=0.006). The detection of polyps was highest in patients less than 16 years (OR 8.4; 95% CI 2.4–26.2, P<0.001). Of those with colorectal tumours, 33/96 (35%) were less than 45 years although the occurrence was higher with advancing age (P=0.02). Diverticular disease was more common in older age groups (median (IQR) age 70 (60–75) years, versus 47 (34–62) years for those without the disease; P=0.0001).ConclusionThis audit has shown that more than a third of colorectal tumours seen during colonoscopy are in patients below the age of 45 years, with the occurrence of polyps being highest in those below 16 years. Diverticular disease is most common in older age groups.

The ‘ins and outs’ of colonoscopy at Wits Donald Gordon Medical Centre, South Africa: A practice audit of the outpatient endoscopy unit

“…[17] Studies from Zambia and Nigeria reported overall PDRs of 10% and 7.4%, respectively. [18,19] Unfortunately, none of the studies from our region reported ADRs, as very few of the colonoscopies performed were true screening scopes. For the same reason, these PDRs must be interpreted with caution.…”

“…Although some endoscopists challenge the association between withdrawal times and PDR/ADR (as increasing withdrawal time alone will not improve an ADR/PDR that is already adequate), data suggest that longer withdrawal times are strongly associated with an increase in PDR and ADR, particularly when endoscopists do not achieve accepted benchmarks. [1,13,19,21] Another factor that could have affected our PDR/ADR was the adequacy of our outpatient bowel preparation, which was below the ASGE/ACG Task Force benchmark of ≥85%. Interestingly, our results showed that inadequate bowel preparation yielded similar PDRs and ADRs to adequate bowel preparation, which could indicate that we are 'over-calling' poor bowel preparation as opposed to it actually being inadequate.…”

Colorectal cancer screening with fecal immunochemical testing: a community-based, cross-sectional study in average-risk individuals in Nigeria

“…Haemorrhoids were found at colonoscopy in more than half of participants who tested positive in this study, and are a common finding on colonoscopy in Nigeria and other parts of sub-Saharan Africa in averagerisk populations. 29 There are mixed reports in the literature on the prevalence and contribution of haemorrhoids to false-positive findings in fecal immunochemical testing in high-income countries. [30][31][32] Anal fissure and perianal eczema have been strongly associated with false-positives in other fecal immunochemical testing studies, 30,33 and were reported by just under a third of participants overall, but were not associated with fecal immunochemical testing positivity.…”

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“…Generally, the adenoma detection rates among patients seeking colonoscopy are lower across the African continent. [9][10][11] It is more likely to diagnose CRC in black patients presenting for colonoscopy, despite the paradoxical low polyp detection rates. This is because the black African population are more likely to present for colonoscopy after onset of alarm symptoms.…”