RESUMEN
Over the last four decades, gastrointestinal endoscopy has become of paramount importance to diagnose, treat and prevent diseases of the digestive tract. Practice variation, however, is likely to have an important effect on the effectiveness of endoscopy and can impair the delivery of high-quality endoscopic procedures. There have been increasing demands to assess the quality of service and track and improve patient outcomes. Quality assurance has paved its way into professional guidelines for physicians. Developing a modern endoscopy unit demands the institution of a quality assurance programme, continuous training and monitoring of service delivery. This article describes our experience in implementing a quality assurance programme in endoscopy in a secondary care government hospital in Egypt. The implementation of quality assurance and improvement programme can lead to dramatic improvements in the quality of endoscopic care and patient outcomes. Quality assurance and continual improvement can be applied in developing countries
RESUMEN
Acute upper gastrointestinal hemorrhage [AUGIH] is a life-threatening emergency that results in high morbidity and mortality. The mortality rate varies between 4% and 14%. The aim of the study was to determine the clinical outcome of AUGIH among patients admitted to a government hospital in Egypt. This was a cross-sectional hospital-based study performed in 1000 patients presenting with AUGIH over a 7-year period between January 2004 and January 2011. One thousand patients were analyzed. Fifty-four percent were male. Mean age was 52 +/- 17 years. Eighty-eight percent were emergency admissions and 12% were inpatients at the time of bleeding. At presentation 68% had major comorbidity and 50% had liver disease. Seven hundred and twenty-four patients [72%] underwent endoscopy. Bleeding varices accounted for 31% of AUGIH and peptic ulcer 28%. Two hundred and thirty-two patients had endoscopically diagnosed bleeding varices or peptic ulcer with a visible vessel or active bleeding. These received endoscopic therapy. Initial hemostasis was achieved in 207 [89%]. Thirteen patients [6%] had therapy at a subsequent endoscopy for further bleeding. Surgery was performed on 9 patients [0.9%] with AUGIH. Complications were reported in 70 patients [7%] mainly liver failure [4%]. Six hundred and eighty-four patients [68%] were discharged improved, 162 [16%] left hospital without a diagnosis and 4 [0.4%] were referred to another facility. The overall mortality was 15%. Mortality was 24% in patients>/=60 years, 37% among inpatients, and 21% in those who had a major comorbidity. Mortality was 22% in patients who had liver disease and 9% in variceal bleeding. The most common cause of AUGIH was variceal in origin. Endoscopic therapy was successful in most cases. Mortality after AUGIH was particularly high among elderly patients, inpatients, and patients who had a major comorbidity, liver disease, and variceal bleeding
RESUMEN
Microscopic colitis [MC] is diagnosed when a patient with chronic watery non-bloody diarrhea [CWND] has an endoscopically normal colon, but colonic biopsies show unique inflammatory changes characteristic of lymphocytic or collagenous colitis. MC is a disorder of unknown etiology. Studies comparing the prevalence of the disease in developing countries as compared to developed countries may shed more light on the possibility of a post-infectious etiology. Most data on the incidence and prevalence of MC are from developed countries where it accounts for 4-13% of cases of CWND. There are only a few reports from developing countries. Two studies from Peru and Tunis, with high prevalence of infectious gastroenteritis, revealed MC in 40% and 29.3% of cases of CWND, respectively. The aim of this study was to investigate the prevalence of MC in patients presenting with CWND in Egypt. A total of 44 patients with CWND of unexplained etiology who had undergone full colonoscopy with no macroscopic abnormalities between January 2000 and January 2010 were assessed retrospectively. The histological appearance of MC was identified in 22 [50%] patients. Twelve [55%] patients were male and 10 [45%] female. Mean age was 40 years [range: 20-65 years]. Twenty [91%] of MC cases had lymphocytic colitis and 2 [9%] had collagenous colitis. The prevalence of MC in Egyptian patients with CWND is high when compared to that in developed countries. MC mainly affects young and middle-aged patients and it is more commonly of the lymphocytic type