The role of gastrointestinal endoscopy in a developing country

Eight-thousand-six-hundred-and-eighty patients were examined endoscopically over a period of six years. Significant pathological lesions were detected in 79.6% of the cases. While duodenal ulcers were seen at the same frequency as in the West, the number of gastric ulcers were considerably fewer, the ratio of gastric to duodenal ulcer being 1:8.4. Gastric cancer was also observed less commonly than in the West, but gastric lymphoma constituted 21% of all gastric malignancies. By endoscoping all bleeders within 24 hours we were able to identify the source of bleeding in 90.9% of the cases, and a lesion was detected in 96.8%. Direct visualisation of the duodenal and jejunal mucosa supported by histological examination was of paramount importance in the early detection of Immunoproliferative Small Intestinal Disease (IPSID) and its differentiation from other diseases such as tuberculosis, bilharzial jejunitis and Crohn's disease which are seen in our population.