Esophagogastroduodenoscopy Findings at Divine Mercy Hospital-Father Bash Foundation, South Western Uganda: A 6 Years Retrospective Analysis

Abstract

Background: Esophagogastroduodenoscopy (EGD) is a procedure in which the health worker (endoscopist) uses a long flexible tube with a camera (endoscope) to pass through the mouth in order to visualize the mucosal surface of the esophagus, stomach and duodenum. It is a key investigation required for screening and diagnosis of several disease conditions involving the gastrointestinal tract such as gastroesophageal reflux disease, esophageal candidiasis, esophageal varices, esophageal cancer, gastritis, duodenitis and gastric cancer, among others. Symptoms attributed to such pathologies include: epigastric pain, heartburn, dysphagia, odynophagia, bloating, early satiety, postprandial vomiting, hematemesis and melena. These conditions are associated with significant morbidity and mortality in various health facilities and the population at large. This study aimed at documenting the various indications and endoscopy findings in patients who underwent upper gastrointestinal endoscopy at Divine Mercy Hospital in south western Uganda. Methods: We conducted a 6-year retrospective review of endoscopy reports for patients who underwent EGD at DMH from October, 2018 to September, 2024. The data extracted included patient’s name, gender, indications for the EGD, findings at endoscopy and histology result where applicable. We used Stata 17 to analyse the data and it was summarized in frequency tables, means and standard deviation. A chi square p-value < 0.05 was considered significant. The study was approved by Mbarara University of Science and Technology Research Ethics committee and administrative clearance was obtained from DMH to access hospital records. Results : Endoscopy reports of 1,854 patients who underwent EGD were retrieved. The mean age of participants was 55.4 (± 18.5) years. Majority were males (56.6%). The most common indications for endoscopy were epigastric pain (n = 1249, 67.4%) and dysphagia (n = 397, 21.4%). Benign findings in the esophagus included GERD (n = 628, 33.9%), candidiasis (n = 172, 9.3%), b enign esophageal stricture (n = 22, 1.2%), hiatus hernia (n = 21, 1.1%) and esophageal varices (n = 13, 0.7%). Esophageal tumors (n = 364, 19.6%) were found mainly in the mid esophagus (55.8%) and distal esopagus (36.8%). Squamous cell carcinoma was the most common histological variant in the esophagus (n = 251, 79.2%). In the stomach, gastritis was the most common finding (n = 1167, 62.9%) followed by gastric ulcers (n = 48, 2.6%) and gastric outlet obstruction without any visible tumor (n = 40, 2.2%). 49 patients had confirmed gastric cancer and these were mainly intestinal type adenocarcinomas located in the antrum/pylorus. The duodenum was grossly normal in majority of patients who did not have any proximal obstructive lesions. Conclusion : In south western Uganda, the most common indication for EGD was epigastric pain followed by dysphagia. Gastritis and GERD were the main benign findings at endoscopy. Esophageal malignancies were more common in the mid esophagus and majority were SCC. Gastric tumors were more common in the distal half of the stomach and they were mainly intestinal type adenocarcinomas.