ArticleJournal of the West African College of Surgeons
Aetiology and Feasibility of Endoscopic Interventions for Massive Upper Gastrointestinal Bleeding in Makurdi, North-Central Nigeria.
Article in Journal of the West African College of Surgeons. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Introduction: Massive upper gastrointestinal bleeding (UGIB) is a life-threatening emergency with high mortality. Emergency upper gastrointestinal (GI) endoscopy, endotherapy, interventional radiology, and surgery are necessary to control the bleeding source and restore normal physiology. However, these interventions are suboptimal in most centres in Nigeria, contributing to the dismal mortality observed in this condition. Objectives & Methodology: We aimed to determine the aetiology, feasibility of endoscopic intervention, and outcome of management of massive UGIB in Madonna Hospital, Makurdi, over a 30-month-period by retrospectively reviewing the medical and procedural records of patients presenting with hypotension from an endoscopically diagnosed upper GI bleeding source. Result: A total of 39 patients were identified, with a mean age of 49.3 ± 17.7 years. Among them, 27 were males (69.2%) and 12 were females (30.8%). Bleeding peptic ulcers were the cause of massive UGIB in 21 cases (53.8%), followed by variceal bleeding, observed in 10 (25.6%) cases. Most of these cases were amenable to endoscopic treatment using adrenaline injection, endoclips, endoscopic variceal band ligation, and diathermy fulguration. Thirty-three (84.6%) patients survived, while the in-hospital mortality following initial endoscopic intervention was 6 out of 39 patients (15.4%), which is comparable to figures from more advanced climes. Conclusion & Recommendation: Endoscopic management of massive UGIB is feasible in a low-resource setting. However, timely access to emergency endoscopy is vital to reduce mortality. Strategies to reduce risk factors for peptic ulcers and oesophageal varices are necessary to reduce the incidence of massive UGIB in Makurdi, Nigeria.
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