High quality colonoscopy in a low volume unit; is it achievable?

Designing an Effective Colorectal Cancer Screening Program in Egypt: A Qualitative Study of Perceptions of Egyptian Primary Care Physicians and Specialists

BACKGROUND

In Egypt more than one-third of colorectal cancer (CRC) cases occur in individuals aged 40 years and younger, and are diagnosed at advanced stages; currently, CRC screening is not done as a routine part of preventive care. To lay the foundation for the development of a CRC multilevel screening program in Egypt, this qualitative study aimed to explore the perspectives of Egyptian physicians.

MATERIALS AND METHODS

The PRECEDE-PROCEED model, which focuses on predisposing (intrapersonal), reinforcing (interpersonal), and enabling (structural) factors inherent in health behaviors, served as our theoretical framework. Primary health care physicians, oncologists, and gastroenterologists practicing in Alexandria, Egypt, participated in 1 one-hour semistructured interview. Interviews were audio recorded, transcribed, translated into English, and analyzed by thematic analysis.

RESULTS

Seventeen physicians participated (n = 8 specialists and n = 9 primary care physicians). Barriers to CRC screening included socioeconomic status, a lack of emphasis on prevention, fear, and cost (predisposing); a belief that only high risk patients should be screened and a lack of confidence in providers to perform and interpret screening tests appropriately (reinforcing); and cost, lack of availability of the tests, and inadequate training for laboratory technicians and providers (enabling). Potential facilitators included implementing a media campaign emphasizing early detection, curability and prevention (predisposing); educating physicians and eliciting physician engagement (reinforcing); and decreasing costs, making screening tests widely available, and providing well-trained providers (enabling).

CONCLUSION

A CRC screening program is needed in Egypt, and to be successful it would likely need to address barriers at multiple levels.

IMPLICATIONS FOR PRACTICE

In Egypt, colorectal screening is not a routine part of preventive care, and colorectal cancer is often diagnosed at an advanced stage in individuals aged 40 years or younger. Screening can prevent and detect colorectal cancer in its early stages, but before designing any screening program, understanding the context is important as cultural beliefs may impact the acceptability of screening methods. By exploring the perspectives of Egyptian physicians, this study found important insights into how screening program components should be considered in the Egyptian culture and lays the foundation for the development of a multilevel colorectal screening program in Egypt.

Quality assurance in gastrointestinal endoscopy: An Egyptian experience

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.

Indications and outcome of colonoscopy in the middle of Nile delta of Egypt

BACKGROUND

In Egypt, few data are available on the outcome of colonoscopy. Epidemiologic studies have shown that inflammatory bowel disease (IBD) tends to increase. Endoscopists have reported an increasing incidence of IBD and colorectal cancer (CRC). This may be explained by an increasing index of suspicion and the availability of endoscopy. Population-based studies are lacking.

AIM

The aim of our study was to retrospectively evaluate the patient characteristics and final diagnosis in patients subjected to colonoscopy in Tanta University Hospital and affiliated hospitals at the middle of Nile delta of Egypt, which is one of the most densely populated regions in the country.

METHODS

This study was done at the endoscopy units of Tanta University Hospital and affiliated hospitals (all units of colonoscopy at Gharbia governorate) from June 2008 to June 2009. A total of 864 patients presented with different indications for colonoscopy. All findings were recorded, analyzed, and discussed.

RESULTS

Colonoscopy revealed a diagnosis of ulcerative colitis (UC) in 22%, hemorrhoids in 18%, CRC in 15%, benign colorectal polyps in 9%, Crohn's disease (CD) in 3%, diverticulosis in 2%, and anal fissures in 2% of patients. No organic colonic disease was found in 28% of patients. Complications occurred in less than 1% of the cases.

CONCLUSION

In Egyptian patients subjected to colonoscopy, the most frequent diagnoses were UC, followed by hemorrhoids, CRC, benign polyps, and CD. This may represent an increasing incidence of UC and CRC. Colonoscopy was safe and few complications were recorded. Prospective population-based studies are needed in order to measure the incidence, prevalence, and risk factors of various diseases of the colon in Egypt.