Gastrointestinal endoscopy experience of surgical trainees throughout rural Africa
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and Other Interventional Techniques
Gastrointestinal endoscopy experience of surgical trainees throughout rural Africa Robert K. Parker1,2 · Michael M. Mwachiro1,3 · Hillary M. Topazian4 · Richard Davis5 · Albert F. Nyanga6 · Zachary O’Connor7 · Stephen L. Burgert3 · Mark D. Topazian8 Received: 4 August 2020 / Accepted: 15 November 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background Gastrointestinal endoscopy (GIE) is not routinely accessible in many parts of rural Africa. As surgical training expands and technology progresses, the capacity to deliver endoscopic care to patients improves. We aimed to describe the current burden of gastrointestinal (GI) disease undergoing GIE by examining the experience of surgical training related to GIE. Methods A retrospective review was conducted on GIE procedures performed by trainees with complete case logs during 5-year general surgery training at Pan-African Academy of Christian Surgeons (PAACS) sites. Cases were classified according to diagnosis and/or indication, anatomic location, intervention, adverse events, and outcomes. Comparisons were performed by institutional location and case volumes. Analysis was performed for trainee self-reported autonomy by postgraduate year and case volume experience. Results Twenty trainees performed a total of 2181 endoscopic procedures. More upper endoscopies (N = 1,853) were performed than lower endoscopies (N = 325). Of all procedures, 546 (26.7%) involved a cancer or mass, 267 (12.2%) involved a report of blood loss, and 452 (20.7%) reported pain as a component of the diagnosis. Interventions beyond biopsy were reported in 555 (25%) procedures. Esophageal indications predominated the upper endoscopies, particularly esophageal cancer. Trainees in high-volume centers and in East Africa performed more interventional endoscopy and procedures focused on esophageal cancer. Procedure logs documented adverse events in 39 cases (1.8% of all procedures), including 16 patients (0.8%) who died within 30 days of the procedure. Self-reported autonomy improved with both increased endoscopy experience and post-graduate year. Conclusions GIE is an appropriate component of general surgery residency training in Africa, and adequate training can be provided, particularly in upper GI endoscopy, and includes a wide variety of endoscopic therapeutic interventions. Keywords Global health · Medical education · Healthcare workforce · Surgical procedures · Operative/statistics and numerical data · Gastrointestinal diseases · Health care delivery · Health services Marked healthcare disparities are present in low- and middle-income countries (LMICs), with a large burden of disease that would be amenable to endoscopic diagnosis and therapy if they were available [1]. Tackling the burden of chronic and non-communicable disease is increasingly a priority for public health interventions in LMICs [2]. A survey of endoscopists throughout sub-Saharan Africa demonstrated a lack of resources, infrastructure, and training,
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