Appropriateness and diagnostic yield of open access gastroscopy in two tertiary centers in South-western Nigeria.

Background: There is need for the appropriate use of gastroscopy. Objective: To determine the appropriateness of upper gastrointestinal endoscopy, and its association with significant endoscopy findings in our environment. Methods: This was a prospective study of subjects who underwent gastroscopy at two centers in south-western Nigeria between August 2020 and August 2021. Indications were classified as either appropriate or inappropriate according to the ASGE guidelines, gastroscopic findings as either significant or not significant, patients as either elderly (≥ 60 years) or not, inpatients or outpatients, and referrals as either gastroenterologist referral, or not. Results: There were 227 subjects, 131 (57.7%) females, mean age 45 ± 13.7 years. Fifteen percent were elderly, 65.6% were gastroenterologist referrals, 14.1% were inpatients, while 45.8% had co-morbidities. Endoscopy was appropriately indicated in 81.9%, and significant endoscopy findings were detected in 95.6%. Appropriateness was not associated with significant endoscopy findings. The sensitivity, specificity and AUROC of the ASGE guidelines were 10%, 82%, and 0.46 respectively. Conclusion: According to our study, most procedures are appropriately indicated. However, appropriateness did not determine endoscopy yield. Larger studies are needed to determine the utility of the ASGE guidelines in our environment.

Solitary peutz-jeghers type hamartoma in a Nigerian: A case report of a rare finding and review of literature.

Background: We report a case of solitary Peutz-Jeghers (P-J) type hamartomatous polyp in the sigmoid colon of an asymptomatic Nigerian without other diagnostic criteria for full-blown P-J syndrome. Case Report: During colonoscopy for a 58-year-old man, a solitary, pedunculated polyp was seen in the sigmoid colon. Histopathological examination of the endoscopically resected mass revealed the classical features of P-J type hamartoma. A search for lentigines on the skin or mucous buccal membranes was negative. There is no family history of such findings. Conclusion: The case here presented is truly rare as a review of the scientific literature appears, to the best of our knowledge, not to contain such a unique presentation from our locality nor indeed from among Black Africans. We conducted a review of the literature and wished to highlight the evolving concept that solitary P-J polyps be considered a distinct disease entity when it appears in the absence of other features of the syndrome complex.

RésuméContexte: Nous rapportons un cas de polype hamartomateux solitaire de type Peutz ­ Jeghers (P J) dans le côlon sigmoïde d'un Nigérian asymptomatique sans autres critères diagnostiques du syndrome P J complet. Rapport de cas: Au cours de la coloscopie d'un homme de 58 ans, un polype solitaire pédonculé a été observé dans le côlon sigmoïde. L'examen histopathologique de la masse réséquée par voie endoscopique a révélé les caractéristiques classiques de l'hamartome de type PJ. Une recherche de lentigines sur la peau ou les muqueuses buccales a été négative. Il n'y a pas d'antécédents familiaux de telles découvertes. Conclusion: Le cas présenté ici est vraiment rare car une revue de la littérature scientifique semble, à notre connaissance, ne pas contenir une présentation aussi unique de notre localité ni même des Noirs africains. Nous avons effectué une revue de la littérature et avons souhaité mettre en évidence le concept évolutif selon lequel les polypes P J solitaires doivent être considérés comme une entité pathologique distincte lorsqu'ils apparaissent en l'absence d'autres caractéristiques du complexe du syndrome. Mots clés: Coloscopie, pigmentation mucocutanée, Nigéria, syndrome de Peutz ­ Jeghers, hamartome de Peutz ­ Jeghers solitaire.

Diverticular disease at colonoscopy in Lagos State, Nigeria.

BACKGROUND: The upsurge in the reported cases of diverticular disease (DD) has led to a re-appraisal of the earlier held views that it was a rare entity in Nigeria. The advent of colonoscopy has contributed in no small way to this change. We sought to determine the clinical characteristics, indications for colonoscopy, and intra-procedural findings among these patients. MATERIALS AND METHODS: A retrospective cross-sectional study was carried out on the colonoscopy records from four private endoscopy units based in Lagos State, Nigeria. The records were drawn from a 5-year period (August 2010 to July 2015). The endoscopy logs and reports were reviewed, and the bio data, indications, and colonoscopy findings were gleaned. RESULTS: A total of 265 colonoscopies were carried out in the stated period. Of these, 28 (10.6%) had DD. Of the patients with DD, 5 (17.9%) were females while 23 (82.1%) were males. Their ages ranged from 46 to 94 years (mean = 68.2 ± 11 years). Fifteen patients had been referred for the procedure on account of hematochezia alone (15 = 53.6%). Other reasons for referral included abdominal pain alone (2 = 7%), hematochezia plus abdominal pain (5 = 17.9%), and change in bowel habits (3 = 10.8%). Ten (35%) patients had pan-colonic involvement. Regional disease involved the right side alone in only one case (3.5%) while the other combinations of sites are as follows; 6 (21.4%) in the sigmoid colon alone, 2 (7%) in the descending colon alone, 5 (17.9%) in the sigmoid-descending colon, 4 (14.3%) in the sigmoid-descending-transverse colon, thus the sigmoid colon was involved in 25 (89.3%) cases. Five cases (17.9%) had endoscopic features suggestive of diverticulitis. CONCLUSIONS: DD should no longer be regarded as a rare problem in the Nigerian patient. The study findings support the notion of higher prevalence among the elderly, in males, and of sigmoid colon involvement.

Clinicopathologic review of polyps biopsied at colonoscopy in Lagos, Nigeria.

INTRODUCTION: Colorectal polyps are known precursors of colorectal cancers. The increase in utilization of colonoscopy in Nigeria has meant a rise in the recently reported incidence of these lesions. The aim of this study is to evaluate the clinicopathological profile of colorectal polyps biopsied during the inaugural 12 month period of colonoscopy from a private endoscopy suite in Nigeria. METHODS: This is a retrospective review of all the clients who had polyps diagnosed at colonoscopy over a 12 month period (August 2014 -July 2015) at a private endoscopy suite in Lagos, Nigeria. This analysis of prospectively collected data was performed using clinical information from the endoscopy logs and pathology database system of a private endoscopy suite based in Lagos, Nigeria. RESULTS: A total of 125 colonoscopies were carried out over the stated period. Of these, 14 individuals had a total of 18 polyps- 4 clients (28.6% of the persons with polyps) had two polyps each. The polyp detection rate was 11.2% while the polyp per colonoscopy rate was 14.4%. Of these clients, males were 10 in number; giving a male to female ratio of 2.5:1. Their ages ranged from 37 to 77 years (mean= 57.3 years). The presenting complaint at colonoscopy was hematochezia in 11 (78.6%), new onset constipation in 2 (14.2%) and peri-anal pain in 1 patient (7.1%). The polyps were distributed as follows; 2 (11.1%) in the ascending colon, 1 (5.6%) each in the transverse and descending colons, 8 (44.4%) in the sigmoid colon, 6(33.3%) located in the rectum. Hence, there was left sided (15 of 18= 83.3%) preponderance. Pathologically, tubular (adenomatous) polyp with or without low grade dysplastic changes was diagnosed in 6 of the 18 polyps (giving an adenoma detection rate of 4.8%), 4 (22.2%) were inflammatory polyps, 1 (5.6%) was malignant and another had the rare inflammatory fibroid polyp. Five (27.8%) of the specimens were reported as non-specific colitis. CONCLUSION: The study supports the present wisdom that polyps are clearly less prevalent in our environment when compared to the Western world. The increased prevalence with advancing age, in male subjects and of left sided lesions, is also in keeping with previous results from our environment. A case is also advanced for the increased deployment of endoscopy as a tool for the detection of these polyps and ultimately, the reduction of colorectal cancer in our population.

Gastrointestinal stromal tumor of the anal wall in a Nigerian.

Documented reports of gastrointestinal stromal tumors (GIST) are relatively few in the sub-Saharan continent. The body of evidence points towards anal wall involvement being a rarity indeed. In this article we document a 61 year old Nigerian man who presented with bleeding per rectum and in whom the histological features (including immunohistochemistry) of the biopsied anal lesion was GIST.

Portal hypertensive duodenopathy manifesting as "kissing" duodenal ulcers in a nigerian with alcoholic cirrhosis: a case report and brief review of the literature.

Multiple duodenal ulcers are an uncommon finding in portal hypertensive duodenopathy (PHD). They represent a potential source of clinically significant bleeding from the upper gastrointestinal system in patients with cirrhosis. As this particular ulcer entity in relation to PHD has no distinguishing symptoms aside from those relating to the consequent bleeding, most of them are found either on routine endoscopic screening for cirrhotics or on endoscopic examination for cause(s) of bleeding in this patient population. The case documented below highlights many of the aspects of pathogenesis, associations, and consequences of this unique endoscopic finding in cirrhotic patients.

Prevalence of a marker of active helicobacter pylori infection among patients with type 2 diabetes mellitus in Lagos, Nigeria.

BACKGROUND: There appears to exist a potentially important interplay between diabetes mellitus (DM) and Helicobacter pylori (H. pylori) infection. Findings from previous studies have been conflicting. Only a few studies have examined the topic in a sub-Saharan African population. This study sought to determine the prevalence of H. pylori infection among Type 2 diabetes mellitus (T2DM) patients in Lagos, Nigeria. FINDINGS: H. pylori infection was detected in 18% of T2DM patients and 13% of controls but there was no statistical significance in this difference (p = 0.52). The prevalence of H. pylori was neither associated with the known duration of T2DM nor was it associated with age, gender, body mass index (BMI), smoking status. T2DM was not shown to be a risk factor independently associated with risk for H. pylori infection (OR = 0.87, 95% CI = 0.58-1.31, p = 0.57). CONCLUSIONS: The lack of a statistical significant difference between the H. pylori infection rates in T2DM patients and controls suggests that the infection is not increased in T2DM. Larger studies need to be conducted to confirm the study findings.