Clinical characteristics of colonoscopy in 448 patients in the Zanzibar Archipelago: a cross-sectional study

Colonic Diverticulosis at Colonoscopy in Africa: A Systematic Review and Meta-Analysis of Pooled Estimates

INTRODUCTION

There is need to ascertain any epidemiologic shift of diverticulosis among Africans with traditionally high fiber diet consumption patterns and rare diverticulosis prevalence.

METHODS

We systematically searched PubMed, Scopus, Cochrane Library, African Journal Online (AJOL), and Google Scholar. Eligibility criteria included full-text observational and experimental human colonoscopy studies on asymptomatic and symptomatic African population from 1985 to 2022. Case reports, conference abstracts, dissertations, systematic reviews, and studies lacking colonoscopy findings were excluded. NIH quality assessment tool for observational cohort and cross-sectional studies was used to assess risk of bias. Meta-analysis was performed using the random-effect model. Heterogeneity was assessed using inconsistency (I2) statistics.

RESULTS

Thirty studies were included. Pooled prevalence rate of colonic diverticulosis in the last decade (2012-2022) has increased to 9.7% (95% CI 6.5-13.4; I2 = 97.3%) from 3.5% (95% CI 1.4-6.4; I2 = 62.7%). The highest regional prevalence rate was in West African studies at 11.3% (95% CI 7.6-14.9; I2 = 96.2%). Proportion of individuals with diverticulosis ≥50 years and male sex were 86.9% (95% CI 80.5-92.1) and 65.2% (95% CI 55.0-74.8), respectively. The left colon had the highest diverticulosis frequency (37% [148/400]). Bleeding/inflammation complications were sparingly detected (OR 0.2 [95% CI 0.03-0.75; p < 0.0001]).

CONCLUSION

An increasing utilization of colonoscopy revealed approximately a threefold increase in the prevalence rate of colonic diverticulosis in Africa. This pathology was most common in males aged >50. Left colon was predominantly affected. Further studies are needed to demonstrate the effect of westernization of diet.

Challenges in the diagnosis and management of IBD: a sub-Saharan African perspective

With the exception of South Africa, inflammatory bowel disease (IBD) has long been considered uncommon in sub-Saharan Africa (SSA) with a dearth of peer-reviewed publications from the subcontinent. This most likely reflects underreporting as some cases may be missed due to the high burden of infectious diseases which may closely mimic IBD. In addition, many countries in SSA have limited endoscopic capacity, inadequate access to diagnostic imaging and a notable scarcity of histopathologists, radiologists and gastroenterologists. Beyond these obstacles, which significantly impact patient care, there are many other challenges in SSA, particularly the unavailability of key IBD therapies. In this review, we discuss barriers in diagnosing and managing IBD in SSA, as well as some of the initiatives currently in place to address these short comings.

Colorectal cancer in Tanzania: the current status and future directions

Introduction

Globally, colorectal cancer (CRC) is the third most common malignancy and the second most common cause of cancer death. By 2030, the incidence is expected to increase to reach 2.2 million cases and 1.1 million deaths. In Sub-Saharan Africa, accurate cancer incidence data is limited, but anecdotally, clinicians note a significant rise in the incidence of CRC in the past decade. To educate clinicians on the growing burden of CRC, the Tanzanian Surgical Association hosted a 4-day CRC symposium from 3rd to 6th October 2022. Following the meeting, a group of multidisciplinary stakeholders created a working group whose first task was to assess the epidemiology, presentation and available resources for CRC care in Tanzania. The findings of that assessment are described in this article.

Findings

The true incidence of CRC in Tanzania is currently unknown. However, individual high-volume centres have noted a dramatic rise in cases of colon and rectal cancer on their wards. A review of the published data on CRC in Tanzania showed that most patients present with CRC late and the limited availability of endoscopic and diagnostic services poses a challenge for accurately staging these patients prior to treatment. Multidisciplinary care, including surgery, chemotherapy and radiation, is available for the treatment of CRC in Tanzania, although the capacity and quality of these services vary throughout the country.

Conclusion

There is a substantial burden of CRC in Tanzania that appears to be increasing. While there is capacity in the country to provide all aspects of multidisciplinary care, late presentation, limited access to diagnostic and treatment services and poor coordination continue to be significant barriers to providing optimal treatment to these patients.

Clinical Characteristics and Main Findings of Colonoscopy in Tripoli Central Hospital: A Cross-Sectional Study of 1858 Patients

Introduction Colonoscopy is used to detect colorectal abnormalities, including inflammatory bowel disease, polyps, cancers, and other colorectal lesions. We aimed to analyze the demographic and clinical characteristics, main findings, and indications of patients who underwent colonoscopy in the Surgery department of Tripoli Central Hospital in Libya. Methods The study data were retrospectively extracted from the medical in and out-patient records of individuals who underwent colonoscopy procedures between December 2009 and December 2016 in the general surgery department of Tripoli General Hospital. Results A total of 1858 patients underwent colonoscopy during the study period with a mean age of 51.7 ± 18.5 years. Hematochezia was the most common patient complaint (530; 28.5%), followed by constipation (354; 19.1%), and weight loss (178; 9.6%), respectively. Seven-hundred sixty-five (765; 41.2%) participants completed the procedure, 420 (22.6%) did not, and 673 (36.2%) participants failed the colonoscopy. The most common reasons for procedure failure were failed preparation (609; 55.7%), followed by patient intolerance (251; 23.0%), and obstructive lesions (229; 21.0%). The most common finding was colonic masses, followed by polyps (29.0% and 20.8%, respectively). Conclusion This study describes the characteristics of colonoscopy patients in the largest surgical center in Libya over seven years. Hematochezia and chronic constipation were the most common complaints among the participants with reported complaints. Half of the colonoscopy procedures are incomplete or failed due to the lack of patient preparation. Colonic masses and polyps were the most common among the reported colonoscopic findings. Future research to increase the quality of colonoscopy service and patient preparations in Libya is required.