# Bridging the gap in gastrointestinal healthcare in a resource-limited setup: Feasibility study of weekend endoscopy services in Southwest Ethiopia

## TL;DR

A weekend endoscopy service in rural Ethiopia proved feasible and revealed high rates of gastrointestinal disorders, including cancers, highlighting the need for expanded access.

## Contribution

Demonstrates the feasibility of a weekend outreach endoscopy service in a resource-limited setting with high diagnostic yield.

## Key findings

- 2165 endoscopies performed with 93.3% diagnostic yield, showing effectiveness in a rural setting.
- High prevalence of upper gastrointestinal cancers and chronic inflammation was observed.
- Alarm symptoms strongly predicted major endoscopic findings, emphasizing their clinical significance.

## Abstract

Endoscopy is essential for diagnosis and management of gastrointestinal disorders. However, its accessibility in Africa is limited by the need for extensive training and costly equipment. This study aimed to assess the feasibility of a weekend outreach endoscopy service led by a trained gastroenterologist in southwest Ethiopia, where endoscopy services were previously unavailable.

A weekend outreach endoscopy service was launched in 2019 at a primary hospital in Jimma City, located 360 km from Addis Ababa. Procedures were performed using the Fujinon EPX-2500-HD system. Demographic data, endoscopy findings, and histology results were documented electronically. Findings were compared with those from four Ethiopian referral hospitals offering full-time endoscopy services.

A total of 2165 esophagogastroduodenoscopies (EGDs) were performed with a diagnostic yield of 93.3%. The most common indications for EGD were dyspepsia (53.7%) and dysphagia (17.0%). Patients who underwent endoscopy for alarm symptoms as an indication had a 77% to 83% chance of having a major finding compared with those with dyspepsia without an alarm symptom (24%). Squamous cell carcinoma (40.2%), adenocarcinoma (29.6%), and chronic nonspecific inflammation (16.2%) were the predominant histologic findings among those who had a biopsy (n = 425).

The study demonstrates the feasibility and effectiveness of a weekend outreach endoscopy service led by a trained gastroenterologist in a rural Ethiopian setting. The unexpectedly high prevalence of upper gastrointestinal disorders, including cancers, and the long duration of symptoms before endoscopy likely reflect delayed diagnoses due to limited access to endoscopy. Moreover, presence of alarm symptoms predicted major endoscopic findings. Expanding endoscopy services, increasing public awareness, and further research into risk factors and preventive strategies for these diseases are recommended.