The role of endoscopy after upper gastrointestinal bleeding in sub-Saharan Africa: A prospective observational cohort study

• Published in: Malawi medical journal Vol. 32; no. 3; pp. 139 - 145
• Main Authors: Gallaher, Jared R, Mulima, Gift, Qureshi, Javeria, Shores, Carol G, Charles, Anthony G
• Format: Journal Article
• Language: English
• Published: Malawi University of Malawi 01.09.2020; The Medical Association Of Malawi
• Subjects: Adult; Cohort analysis; Cohort Studies; Endoscopy; Endoscopy, Digestive System - adverse effects; Endoscopy, Digestive System - methods; Female; Gastrointestinal Hemorrhage - diagnostic imaging; Gastrointestinal Hemorrhage - mortality; Gastrointestinal Hemorrhage - surgery; Humans; Liver cirrhosis; Male; Middle Aged; Observational studies; Original Research; Prospective Studies; Survival Analysis; Africa; endoscopy; sub-Saharan Africa; upper gastrointestinal bleeding
• ISSN: 1995-7262; 1995-7270; 1995-7262
• DOI: 10.4314/mmj.v32i3.6

Upper gastrointestinal (UGI) bleed is a common surgical disease in sub-Saharan Africa where there is often a lack of diagnostic and interventional adjuncts such as endoscopy. This study sought to characterize the role of endoscopy in management of acute UGI bleeding. This is a prospective observational analysis of adults presenting with an UGI bleed to a tertiary center in Lilongwe, Malawi, over two years. Patients were classified as having no endoscopy, diagnostic endoscopy, or endoscopy with variceal banding. Bivariate, survival analysis, and logistic regression analyses were used to compare intervention cohorts. 293 patients were included with 49 patients (16.7%) receiving endoscopy with banding, 65 (22.2%) patients receiving diagnostic endoscopy only, and 179 (61.1%) receiving no endoscopy. Upon survival analysis comparing to the no endoscopy group, cox hazard modelling showed an adjusted hazard ratio over 30 days of 0.12 (95% CI 0.02, 0.88, p=0.038) for the endoscopic banding group and a hazard ratio of 0.39 (95% CI 0.13, 1.16, p=0.090) for the diagnostic endoscopy only group. Physical exam findings consistent with cirrhosis and decreasing age were independent predictors of an endoscopic diagnosis of variceal bleeding. Esophagogastric varices are a common cause of UGI bleeding in sub-Saharan Africa and can be predicted with age and physical exam findings. Endoscopy with variceal banding has a survival benefit for patients presenting with acute UGI bleed even with relatively low utilization. Appropriately triaging patients with likely variceal bleeding and improving endoscopy capacity would likely have a significant impact on mortality.