Gastrointestinal endoscopy experience of surgical trainees throughout rural Africa

Parker, Robert K.; Mwachiro, Michael; Topazian, Hillary M.; Davis, R. Eric; Nyanga, Albert F.; O’Connor, Zachary; Burgert, Stephen L.; Topazian, Mark D.

doi:10.1007/s00464-020-08174-3

Cited by 8 publications

(5 citation statements)

References 40 publications

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“…Lower middle-income countries recorded more cases with orthopedics, endoscopy, central venous access, and amputations. This is a similar finding from a study focusing on endoscopy conducted at multiple training institutions throughout Africa [ 31 ]. While there may be distinctive disease patterns to describe these findings, the changing dynamics of surgical education, specialization, or resource availability should also be considered.…”

Section: Discussionsupporting

confidence: 87%

Operative Case Volumes and Variation for General Surgery Training in East, Central, and Southern Africa

Mwachiro,

Yankunze,

Bachheta

et al. 2023

World j. surg.

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Background Operative experience is a necessary part of surgical training. The College of Surgeons of East, Central, and Southern Africa (COSECSA), which oversees general surgery training programs in the region, has implemented guidelines for the minimum necessary case volumes upon completion of two (Membership) and five (Fellowship) years of surgical training. We aimed to review trainee experience to determine whether guidelines are being met and examine the variation of cases between countries. Methods Operative procedures were categorized from a cohort of COSECSA general surgery trainees and compared to the guideline minimum case volumes for Membership and Fellowship levels. The primary and secondary outcomes were total observed case volumes and cases within defined categories. Variations by country and development indices were explored. Results One hundred ninety-four trainees performed 69,283 unique procedures related to general surgery training. The review included 70 accredited hospitals and sixteen countries within Africa. Eighty percent of MCS trainees met the guideline minimum of 200 overall cases; however, numerous trainees did not meet the guideline minimum for each procedure. All FCS trainees met the volume target for total cases and orthopedics; however, many did not meet the guideline minimums for other categories, especially breast, head and neck, urology, and vascular surgery. The operative experience of trainees varied significantly by location and national income level. Conclusions Surgical trainees in East, Central, and Southern Africa have diverse operative training experience. Most trainees fulfill the overall case volume requirements; however, further exploration of how to meet the demands of specific categories and procedures is necessary.

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Section: Discussionsupporting

confidence: 87%

Operative Case Volumes and Variation for General Surgery Training in East, Central, and Southern Africa

Mwachiro,

Yankunze,

Bachheta

et al. 2023

World j. surg.

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“…In an audit of upper gastrointestinal endoscopy, Quine et al observed that perforation rates decreased if the endoscopist had performed over 500 endoscopies. Given the high and increasing volume of upper gastrointestinal endoscopy at our institution 25 , this probably contributed to the decrease in AEs and improved outcomes over time 26 . Our technical success remained high as the deployment procedure, without fluoroscopy throughout the study period, changed to be based upon measurements alone instead of endoscopic visualization during stent deployment.…”

Section: Discussionmentioning

confidence: 97%

Predictors of adverse events and early mortality after esophageal stent placement in a low resource setting: a series of 3823 patients in Kenya

et al. 2022

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Background and study aims Dysphagia from esophageal cancer may be palliated with self-expanding metallic stents (SEMS). Controversy exists about the use of dilation before SEMS deployment. Patients and methods We performed a retrospective cohort study of patients who had SEMS placement without fluoroscopy for palliation at Tenwek Hospital in Bomet, Kenya between January 1999 and April 2019. The primary outcome was any serious adverse event (AE) (chest pain, stent migration, perforation, bleeding, or all-cause mortality) within 30 days of the procedure. Various demographic and clinical characteristics, and procedural details, were examined as risk factors. Technical success, defined as correct SEMS placement, and clinical success, defined as dysphagia score improvement without 30-day mortality, were examined. Results A total of 3823 patients underwent SEMS placement, with 2844 (74.4 %) placed in the second decade of the study. Technical and clinical success were achieved in 97.2 % and 95.5 %, respectively, with mean dysphagia scores improving from 3.4 (SD 0.6) to 0.9 (SD 1.3) post-stent placement. AEs occurred in 169 patients (4.4 %). AEs, specifically perforations, were associated with dilation to greater than 36F in the first decade. Perforation rates decreased from the first (4.1 %) to the second decade (0.2 %). Only 30% had complete 30-day follow-up data. Conclusions SEMS placement is a safe, effective method of palliating malignant dysphagia, with low rates of AEs and 30-day mortality and high rates of clinical and technical success. Dilation can facilitate placement of SEMS without fluoroscopy but should not be performed above 36F due to the risk of perforation.

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“…Our analysis of functioning endoscopy services throughout the surveyed countries suggests that endoscopy is feasible and sustainable in eastern Africa. We know that training is flourishing in some of the locations we studied, through ongoing efforts to incorporate endoscopy in residency and fellowship curricula 19 , nevertheless, large increases in capacity are still needed. National surgical and gastroenterology societies can champion training of endoscopists and engage with governments to chart pathways to sustainable provision of endoscopy services.…”

Section: Discussionmentioning

confidence: 99%

Gastrointestinal endoscopy capacity in Eastern Africa

et al. 2021

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Background and study aims Limited evidence suggests that endoscopy capacity in sub-Saharan Africa is insufficient to meet the levels of gastrointestinal disease. We aimed to quantify the human and material resources for endoscopy services in eastern African countries, and to identify barriers to expanding endoscopy capacity. Patients and methods In partnership with national professional societies, digestive healthcare professionals in participating countries were invited to complete an online survey between August 2018 and August 2020. Results Of 344 digestive healthcare professionals in Ethiopia, Kenya, Malawi, and Zambia, 87 (25.3 %) completed the survey, reporting data for 91 healthcare facilities and identifying 20 additional facilities. Most respondents (73.6 %) perform endoscopy and 59.8 % perform at least one therapeutic modality. Facilities have a median of two functioning gastroscopes and one functioning colonoscope each. Overall endoscopy capacity, adjusted for non-response and additional facilities, includes 0.12 endoscopists, 0.12 gastroscopes, and 0.09 colonoscopes per 100,000 population in the participating countries. Adjusted maximum upper gastrointestinal and lower gastrointestinal endoscopic capacity were 106 and 45 procedures per 100,000 persons per year, respectively. These values are 1 % to 10 % of those reported from resource-rich countries. Most respondents identified a lack of endoscopic equipment, lack of trained endoscopists and costs as barriers to provision of endoscopy services. Conclusions Endoscopy capacity is severely limited in eastern sub-Saharan Africa, despite a high burden of gastrointestinal disease. Expanding capacity requires investment in additional human and material resources, and technological innovations that improve the cost and sustainability of endoscopic services.

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Gastrointestinal endoscopy experience of surgical trainees throughout rural Africa

Cited by 8 publications

References 40 publications

Operative Case Volumes and Variation for General Surgery Training in East, Central, and Southern Africa

Operative Case Volumes and Variation for General Surgery Training in East, Central, and Southern Africa

Predictors of adverse events and early mortality after esophageal stent placement in a low resource setting: a series of 3823 patients in Kenya

Gastrointestinal endoscopy capacity in Eastern Africa

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