Lower gastrointestinal endoscopy in a tertiary healthcare facility in south-west Nigeria-a five year review of the spectrum of indications and endoscopic abnormalities
Oguntoye Oluwatosin Oluwagbenga
Background: Complaints of lower gastrointestinal symptoms are common in everyday clinical practice; the underlying aetiology varies widely. Lower gastrointestinal endoscopy (Colonoscopy) is the gold standard investigation for evaluating lower gastrointestinal symptoms. It is very useful in the proper diagnosis and determination of the appropriate treatment, including endotherapy, of the underlying pathology.Aim/Objective:To determine the spectrum of indications and endoscopic abnormalities in the patients undergoing lower gastrointestinal endoscopy at a tertiary healthcare facility located in a rural community in south-west Nigeria.Methods: This was a retrospective cohort study of all patients who had lower gastrointestinal endoscopy between February 2016 and February 2021 (a period of 5 years). The Age, Gender, Indication and the Endoscopy findings were obtained from the endoscopy register. A total of 48 lower gastrointestinal endoscopies had been performed over the period. The data obtained was analyzed using the Statistical Package for the Social Sciences (SPSS) version 21.0. Descriptive statistics used included frequency tables, means and standard deviations.Results: A total number of 48 lower gastrointestinal endoscopies were performed during the period under review, out of which 34 (70.8%) were males and 14 (29.2%) were females with a male to female ratio of 2.4 to 1. The age range of the patients was 35 to 86 years with a mean (±SD) of 61.7(±14.03) and median of 62.5 years. The highest number of lower gastrointestinal endoscopies were performed on male individuals above 60 years of age. Symptoms of lower gastrointestinal bleeding (haematochezia/melaena) constitute the most common indication for lower gastrointestinal endoscopy (27.1%), followed by a clinical suspicion of a rectal tumour 12.5%, documented abnormality on an imaging study 10.4% and tenesmus 10.4%. The caecal intubation rate from this study was 87.5%. The commonest endoscopic abnormality detected from this study was Large bowel tumour (45.8%) with the following distribution: Rectum 14.6%, Rectosigmoid 10.4%, Sigmoid colon 10.4%, Ascending colon 6.2%, Descending colon 2.1% and Caecal pole tumour 2.1%. The other abnormalities detected include Colon polyps 12.5%, Haemorrhoids 6.2%, Diverticulosis 6.2%. Ulcerative colitis 4.2% and Rectal polyp 4.2%. Normal endoscopy findings were found in 27.1% of the patients. Large bowel tumours were the commonest cause of lower gastrointestinal bleeding in this study followed by haemorrhoids and diverticulosis.Conclusion: The commonest indication for lower gastrointestinal endoscopy in this study was lower gastrointestinal bleeding while the commonest endoscopic abnormality was large bowel tumour. Large bowel tumours were the most common cause of lower gastrointestinal bleeding and left-sided bowel tumours were the more commonly found tumours in this study. It may therefore be concluded that, large bowel tumours are the commonest underlying gastrointestinal pathology of patients’ symptomatology necessitating lower gastrointestinal endoscopic evaluation. Certainly, the importance of lower gastrointestinal endoscopy in the evaluation of patients with lower gastrointestinal symptoms cannot be overemphasized.