Indications, outcomes and complications of endoscopies performed at a regional hospital in Kwazulu-Natal, South Africa

Abstract

Background: The primary purpose for performing an endoscopy is to identify the aetiology for patient symptoms and then to initiate appropriate treatment. Having excluded organic upper gastrointestinal (GI) disease using endoscopy, further investigations can then be undertaken to identify other possible causes for the patient’s symptoms, or alternatively to assure both the patient and the clinician that no serious pathology is present.

Aim: To provide a descriptive analysis of the indications, findings, and complications of upper and lower endoscopies performed at the Edendale Hospital gastroenterology unit.

Method: This retrospective quantitative, descriptive cross- sectional study analysed the demographic characteristics, indications, findings and complications of endoscopies performed at Edendale Hospital in Pietermaritzburg between January 2017 to December 2018.

The sample size of 350 patients was statistically deemed appropriate for a retrospective chart review obtained by systemic random selection of every 6th patient.

Results: Results of 342 patients were analysed- of which 300 (87.72%) patients had gastroscopies and 42 (12.28%) had colonoscopies performed. Twenty patients (5.85%) had both gastroscopy and colonoscopy procedures performed. One patient (0.29%) suffered a sedation- related complication. Over half of the patients (199/342, 58.19%) were females. Patient age ranged from 18 years to 90 years with the reported median age being 52 years. Most patients (332/342, 97.08%) were Black South

Africans. Over one-fifth of the patients (74/342, 21.6%) were HIV positive, with more than one-quarter of these patients undergoing colonoscopy (12/42,28.5%) and one- fifth (62/300, 20%) gastroscopy.

Epigastric pain was the commonest indication for upper-GI scope (106/300, 35.3%), followed by dysphagia (59/300, 19.67%) and heartburn (59/300, 19.67%). The commonest indication for colonoscopy was per rectal (PR) bleeding (19/42, 45.2%), followed by constipation (17/42, 40.48%).

The most frequent upper endoscopy finding was that of diffuse gastritis (106/300, 35.3%) while haemorrhoids was the most common diagnosis made on colonoscopy (10/42, 21.7%).

One hundred and forty patients (140/300, 40.94%) were initiated on treatment for Helicobacter pylori with triple therapy while eighty-nine (89/300, 26.02%) patients were treated with proton-pump inhibitors monotherapy. One-fifth of the patients who presented with epigastric pain were taking non-steroidal anti-inflammatory drugs while 23% of patients with heartburn were using calcium channel blockers.

We showed similar results in both the HIV negative and HIV positive patients for both gastroscopy and colonoscopy. Epigastric pain (68,22.6% vs 28, 9.3%) was common in both groups with diffuse gastritis (49, 16.3%, vs 31, 10.3%) being a common gastroscopy finding in both cohorts with PR bleeding being the commonest symptom for colonoscopy (19% vs 16.6%).

Conclusion: The main indication for upper gastroscope in this study was that of epigastric pain and the majority of these patients had a diagnosis of diffuse gastritis made on endoscopy while the main indication for colonoscopy was PR bleeding and the major finding in these colonoscopy patients was haemorrhoids. Similar findings were noted in both HIV-positive and -negative patients.