ABSTRACT
Background: Carcinoma of the oesophagus is amongst the top ten cancers worldwide. It shows marked variation in incidence, types and outcome in the various regions of the world. Adenocarcinoma is the main variant worldwide whereas squamous cell carcinoma appears more common in developing countries. Aim of our Study: We mean to ascertain the hospital incidence and epidemiology of patients presenting with histologically confirmed oesophageal cancer. Patients and Methods: This is a retrospective study spanning from January 2008 to December 2014. It is an evaluation and audit of our management of patients with histologically confirmed cases of oesophageal cancer. Results: A total of 42 cases were enrolled in the study. The male: female ratio was 2.2:1. The mean age was 60.1 years, with the mean male age being 62.3 yrs and female 55.1 yrs. All patients presented with dysphagia and 92.9% had some weight loss, with 31% presenting with cachexia. A greater percentage of patients (83.3%) were from the Niger Delta area, residing at the riverine areas. 54.8% were documented to use local gin. The greater percentage (85.7) of patients presented with stage 4 disease. The histological type were squamous cell carcinoma occurring in 85.7% of patients and 14.3% being adenocarcinoma. The tumour was mainly located in the mid portion of the oesophagus 59.5% and 35.7% were located at the lower oesophagus and gastro-oesophageal junction with only 4.8% at the upper thoracic and cervical oesophagus. All had oesophagoscopy and biopsy done either in the endoscopy suite (awake or conscious sedation) or in the theater. Oesophageal intubation was only feasible in 7patients (16.7%) with only 3(7%) patients having oesophagectomy with gastric pull-up. Conclusion: Oesophageal carcinoma is usually squamous and in the middle third of the thoracic oesophagus. Most patients present late with palliation being the only feasible treatment.
ABSTRACT
Background and Objectives: For optimum use of resources in an open access system, official guidelines for the appropriate use of colonoscopy have been proposed by the American Society for Gastrointestinal Endoscopy (ASGE). The objectives of this study were to determine the appropriateness of referrals and to assess the diagnostic yield of colonoscopy based on the 2000 ASGE guidelines. Methods: This was a retrospective study of patients that had colonoscopy in the University of Benin Teaching Hospital from January 2010 to December 2014. The biodata, indications for the procedure, and findings at colonoscopy were retrieved from the colonoscopy register of the endoscopy unit. The year 2000 ASGE guidelines were used to determine the appropriateness of indications for the procedure. Diagnostic yield was defined as the ratio between significant findings detected on colonoscopy and the total number of procedures performed for the indication. Results: Of the 283 patients (158 males; 125 females; mean age 55.2±15.0 years) studied, 66% had colonoscopy for an indication that was considered ‘generally indicated’. It was ‘generally not indicated’ for 2.5%, while 31.4% underwent colonoscopy for reasons ‘not listed’ in the guidelines. The diagnostic yield of the procedure was significantly higher in the ‘generally indicated’ group (41.7%) than in the ‘not listed’ (29.2%) and the generally not indicated (0%) groups. In the multivariate analysis, diagnostic yield was associated with appropriateness of indications that was’ generally indicated’ (odds ratio=1.263, confidence interval=1.072-1.488). Conclusion: About one third of patients had colonoscopy performed for reasons considered inappropriate by the ASGE 2000 guidelines. The diagnostic yield of colonoscopy is predicted by the appropriateness of the indication. Positive diagnostic yield also occurs in the unlisted category. Further studies are required to evaluate the indications for colonoscopy and the possibility of adding some of the unlisted indications to the ASGE guidelines in future revisions. There is need to develop a local guideline well adapted to our environment.