Robert K Parker1,2, Michael M Mwachiro3,4, Hillary M Topazian5, Richard Davis6, Albert F Nyanga7, Zachary O'Connor8, Stephen L Burgert4, Mark D Topazian9. 1. Department of Surgery, Tenwek Hospital, PO Box 39, Bomet, 20400, Kenya. robert_k_parker@brown.edu. 2. Department of Surgery, Alpert Medical School of Brown University, Providence, RI, USA. robert_k_parker@brown.edu. 3. Department of Surgery, Tenwek Hospital, PO Box 39, Bomet, 20400, Kenya. 4. Department of Endoscopy, Tenwek Hospital, Bomet, Kenya. 5. Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA. 6. Department of Surgery, AIC Kijabe Hospital, Kijabe, Kenya. 7. Department of Internal Medicine, Mbingo Baptist Hospital, Bamenda, Cameroon. 8. Department of Surgery, Bongolo Hospital, Lebamba, Gabon. 9. Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.
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 post-graduate 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.
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 post-graduate 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:
Gastrointestinal diseases; Global health; Health care delivery; Health services; Healthcare workforce; Medical education; Operative/statistics and numerical data; Surgical procedures
Authors: Michael Mwachiro; Elizabeth Mwachiro; MaryAnne Wachu; Wilter Koske; Linda Thure; Robert K Parker; Russell E White Journal: World J Surg Date: 2020-07-13 Impact factor: 3.352
Authors: Leah K Winer; Matthew P Vivero; Brendan F Scully; Alexander R Cortez; Al-Faraaz Kassam; Roman Nowygrod; Adam D Griesemer; Jean C Emond; Ralph C Quillin Journal: J Surg Educ Date: 2019-11-18 Impact factor: 2.891
Authors: Michael Mwachiro; Robert Parker; Justus Lando; Ian Simel; Nyail Chol; Sinkeet Ranketi; Robert Chepkwony; Linus Pyego; Caren Chepkirui; Winnie Chepkemoi; David Fleischer; Sanford Dawsey; Mark Topazian; Steve Burgert; Russell White Journal: Endosc Int Open Date: 2022-04-14