Browsing by Author "Naaeder, S.B."
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Item Acute appendicitis(Current Challenges with their Evolving Solutions in Surgical Practice in West Africa: A Reader, 2013) Naaeder, S.B.; Clegg-Lamptey, J.N.; Dakubo, J.C.B.In lieu of an abstract, here is a brief excerpt of the content: •51• Chapter 5 Acute Appendicitis S.B. Naaeder, J.N. Clegg-Lamptey and J.C.B. Dakubo Introduction In 1886 Reginald H. Fitz first described appendicitis in his presentation titled “Perforating inflammation of the vermiform appendix with special reference to its early diagnosis and treatment” to the first meeting of the Association of American Physicians in Washington DC1 . He coined the term appendicitis to distinguish it from other inflammatory conditions in the region of the caecum such as typhilitis and perityphilitis. This was followed by Charles McBurney’s description of his classical sign in the diagnosis of acute appendicitis in 18892 . Appendicitis is now the most common intra-abdominal emergency surgical condition worldwide. It has been postulated that acute appendicitis is the first serious disease to emerge following dietary modification with the adoption of fibre-depleted diets. In 1920 Rendle Short propounded the hypothesis that the rise in the incidence of acute appendicitis in western populations was primarily due to the substitution of high-residue diets with refined low-fibre diets.3 This concept was popularized by Dennis Burkitt4 who reviewed all the available epidemiological and experimental evidence and concluded that undue refining of dietary carbohydrate was the most important causative factor of acute appendicitis, diverticular disease and large bowel cancer. He noted the rarity of these large bowel diseases in African populations who consumed diets high in fibre and the high incidence of these diseases in populations living on low fibre diets.4 The incidence of acute appendicitis is rising in Africa and this has been attributed to socio-economic advancement with its accompanying life-style changes and adoption of low-residue diets. However, current evidence suggests that low-residue diet may not be the important aetiological factor in acute appendicitis as has been postulated. This is •52• Chapter 5 because, in Africa, patients with acute appendicitis consume traditional high -residue diets and urbanization has been shown to have no effect on the dietary fibre intake and bowel function of Africans5 . Incidence There is considerable variation in the incidence of appendicitis all over the world. The disease is common in western nations but much less so in developing countries, however, this is changing. Recent reports suggest that the incidence of acute appendicitis is declining in the developed world. The reason for this decline is not clear but it has been suggested that this may be related to an increase in dietary fibre intake in these populations6 . Between 1989 and 2000 the age-standardized hospital admission rates for acute appendicitis in England was noted to have decreased by 12.5 per cent in males and 18.8 percent in females7 . In the USA the incidence of appendicitis decreased by 14.6 per cent between 1970 and 1984.6 All reports on acute appendicitis were unanimous that acute appendicitis was rare in Africa six to seven decades ago.8,9 This is no longer the situation as the incidence of the disease has been increasing progressively ever since. Adekunle O.O et al. reported a progressive increase in the annual incidence of acute appendicitis in Nigeria between 1973 and 198310 . Similar trends have been reported in both rural and urban communities in Ghana11-15 and other parts of Africa.16-17 Acute appendicitis was uncommon in Ghana in the 1940s; by 1966 the annual incidence was 2.2 per 10,000 population.12 This rose to 2.63 per 10,000 population by 197113 and currently the reported annual incidence of acute appendicitis is 3.18 per 10,000 population.14 This is still lower than the annual incidence rate of 11 per 10,000 population reported in the USA with an even higher rate (25 per 10,000 population) in the young (10-19 years).6 Acute appendicitis is now the leading cause of the acute abdomen in Africa including the West African sub-region18-21 . Aetiology of acute appendicitis The cause of appendicitis has been attributed to a number of factors. Diets low in residue have been blamed4 but studies in Ghana have disputed this notion.5,22 These studies noted that urbanization had •53• Acute Appendicitis no effect on the dietary habits of Ghanaians and that dietary fibre intake was high in patients with acute appendicitis. Gelfand found that patients admitted with acute appendicitis in Africa followed a traditional diet.23 Appendicular luminal obstruction is thought to initiate the inflammatory changes associated with acute appendicitis. The obstruction is by a faecolith in...Item Appendicitis in Accra: A contemporary appraisal(Ghana Medical Journal, 2003-06) Clegg-Lamptey, J.N.A.; Naaeder, S.B.Appendicitis used to be a rare disease in Accra and other parts of West Africa over five decades ago. By 1971 the incidence in Accra had increased to 2.63/10,000. From 1st June 1998 to 31st May 2000 patients presenting with appendicitis in all the major hospitals and clinics in Accra were analysed to determine the incidence of appendicitis. A prospective study of all patients admitted with acute appendicitis at the Korle Bu Teaching Hospital (KBTH) during the same period was done to determine the use of preoperative prophylactic antibiotics, complication rate and duration of hospital stay (bed occupancy) following appendicectomy. The frequency of appendicectomy for acute appendicitis relative to other general surgical emergency operations and to total operations in KBTH was also determined. There were 1409 cases of appendicitis, 72% male and 28% female, an overall male to female ratio of 2.6:1. The yearly incidence of appendicitis in Accra was 3.18/10,000, only slightly more than three decades ago. The peak incidence was in the 20 to 24 age group. In almost all age groups it was twice as common in males as in females. In KBTH, appendicitis constituted 31% of emergencies and 14% of general surgical operations. Ninety one percent received prophylactic antibiotics. The appendix was retrocaecal at operation in 55% of cases. The wound infection rate following appendicectomy in KBTH was 8.75% with a total complication rate of 17%. The mean duration of stay in hospital was 6 days. The 30-day mortality was 1.3%. Acute appendicitis is the commonest general surgical emergency in Accra, being twice as common in males as in females below 60 years. Its incidence has remained relatively stable over the past 30 years.Item Breast cancer in Ghanaian women: What has changed?(American Journal of Clinical Pathology, 2013-07) Edmund, D.M.; Naaeder, S.B.; Tettey, Y.; Gyasi, R.K.Objectives: To evaluate breast cancer in Ghanaian women and to compare these findings with those of previous studies by using histopathologic data. Methods: A review of all breast cancer specimens from January 2005 through December 2009 in our institution was conducted. Results: Of 4,109 female breast specimens reviewed, 1,342 (32.7%) were malignant. Mean (SD) patient age was 50.3 (13.3) years, and mean size of the primary tumors was 4.5 cm. Eighteen (1.3%) specimens were malignant phyllodes tumors. Significant positive associations were found between size of the primary tumor and histologic type (P = .01), histologic grade (P = .001), nodal involvement (P < .001), and TNM stage (P < .001). Conclusions: More than 3 decades after the first publication of breast cancer in Ghanaian women, patients are still presenting with large clinically and histologically advanced invasive cancers. © 2013 American Society for Clinical Pathology.Item The burden and characteristics of peripheral arterial disease in patients undergoing amputation in Korle Bu Teaching Hospital, Accra, Ghana(Ghana Medical Journal, 2017-09) Bediako-Bowan, A.A.A.; Adjei, G.O.; Clegg-Lamptey, J.N.; Naaeder, S.B.Background: To determine the prevalence of Peripheral Arterial Disease (PAD) and associated risk factors in patients undergoing amputation at the Korle Bu Teaching Hospital (KBTH), Accra, Ghana. Objectives: A cross- sectional study of all patients undergoing lower extremity amputation at the Department of Surgery, KBTH. Materials: A coded questionnaire was used to ascertain risk factors for PAD. The Edinburgh Claudication Questionnaire was used to determine symptomatic PAD and a 5 mmHz hand held Summit® Doppler together with an Accoson ® sphygmomanometer was used to determine PAD and its severity. Method: Clinical diagnosis of symptomatic PAD was made using a symptom-based questionnaire and signs of PAD determined by measuring the ankle brachial pressure index (ABPI) by means of a handheld Doppler and sphygmomanometer. Risk factors were determined using the coded questionnaire and related to the occurrence and severity of PAD. Results: The prevalence of PAD among recruited participants was 71%. Twenty-eight per cent of participants with PAD in the index limb also showed signs of PAD in the other limb. The diagnosis of PAD was made in 71%, using ABPI, and 13%, using ECQ. Twenty-seven per cent of patient with hypertension, seventeen per cent with diabetes and all patients with hypercholesterolemia were not on any form of medication. Conclusion: There is a high prevalence of PAD among patients undergoing lower extremity amputation at the KBTH. The majority of PAD patients presented with moderate to severe PAD. Instituting measures to identify and control risk factors of PAD may reduce this high burden.Item Cancer of the colon and rectum(Current Challenges with their Evolving Solutions in Surgical Practice in West Africa: A Reader, 2013) Naaeder, S.B.; Dakubo, J.C.B.In lieu of an abstract, here is a brief excerpt of the content: •104• Chapter 10 Cancer of the Colon and Rectum S.B. Naaeder and J.C.B. Dakubo Introduction Population and epidemiological studies have established a marked variation in the incidence of colorectal cancer in different parts of the world. The disease is common in Western societies when compared with its incidence in developing countries in Africa, Asia and South America. The apparently low incidence of colon and rectal cancer in Africa, may be due to the enormous scourge from communicable diseases and malnutrition that had kept down life expectancy in the African as well as the lack of accurate cancer records. Colorectal cancer is a disease of older persons and therefore as a population grows older the incidence of the disease will increase on demographic grounds alone. Such increase in the average life expectancy and the incidence of colorectal cancer in some populations in Africa has been reported1 . However, major demography- linked increases in the colorectal cancer burden in developing countries may not take place for some time because young persons will continue to form the majority of the population. Incidence The worldwide incidence of colorectal cancer now exceeds 1.2 million index cases per year, half of whom will die of their disease2 . Globally, colorectal cancer is the third commonest malignant neoplasm after cancer of the lung and breast (women only). It retains its third position after lung and prostate cancer in men and rises to become the second most common cancer after breast cancer in women. It accounts for 10.0 percent of all malignant neoplasms in males and 9.4 percent of all malignant tumours in females worldwide.2 It is slightly more common in men than in women (ratio 1.4:1).2 The incidence •105• Cancer of the Colon and Rectum is highest in Australia/New Zealand, Western Europe and North America and lowest in South America, South-Central Asia, the Middle East and Africa. Intermediate rates are noted in Eastern Europe, Latin America and parts of Asia as well as Southern Africa. Currently the incidence rates are stabilizing in Northern and Western Europe. In the USA colorectal cancer incidence has been declining in the past two decades, largely due to screening of asymptomatic individuals and removal of colorectal polyps before they progress to cancer3 . However, the incidence of colorectal cancer is increasing in developing countries which now contribute a little over a third of new cases of colorectal cancers to the annual worldwide incidence2 . In West Africa the incidence of colorectal is increasing, albeit, slowly. Generally, incidence rates change with time. In Ghana there has been an 8-fold increase in the number of new cases of colorectal cancer seen per year from an average of 4.1 new cases in the 1960s to an average of 32.6 new cases currently4,5 . It is now the third most common malignant disease after cancer of the breast and liver in Ghana6 . In Nigeria it is the fourth most common malignant neoplasm7 . Hospital-based data in Ghana and Nigeria show the crude incidence rates of colorectal cancer to be 11.18 per 100 000 population and 3.4 per 100 000 population respectively.5,7 These rates are far lower than the incidence rates of over 40 per 100 000 population reported in Western nations.8 Cancer of the colon and rectum is one of the leading causes of death from malignant disease. It is the fourth most frequent cause of cancer death worldwide accounting for 8.0 percent of cancer deaths.2 In the USA colorectal cancer ranks third as a cause of cancer death after lung and prostate cancer in men and after lung and breast cancer in women3 . Whereas the mortality rate from colon cancer is decreasing in the United States and Western Europe the opposite is occurring in Central and Eastern Europe and lowest in Africa.2,8 In Ghana it is the 10th cause of cancer death overall and the 8th and 9th cause of cancer deaths in males and females respectively.9 Risk Factors A number of risk factors are associated with colorectal cancer, some modifiable and others non-modifiable. The non-modifiable risk •106• Chapter 10 factors include age, sex and genetic factors. Cancer of the colon and rectum affects all age groups but the risk increases with age with a little over 90 percent of cases aged 50 years or older in western countries.3 In 1960 6.7 percent of Ghanaians were 50...Item Changing pattern of intestinal obstruction in Accra, Ghana.(Hepato-Gastroenterology, 2000) Archampong, E.Q.; Naaeder, S.B.; Darko, R.BACKGROUND/AIMS: Over the past 50 years acute intestinal obstruction has remained among the commonest causes of the acute abdomen, along with peritonitis, appendicitis and gastrointestinal perforations. However several observers have noticed over the past 2 decades a shift in the etiological spectrum. The study aims at ascertaining the precise nature of the change. METHODOLOGY: Published data on intestinal obstruction from the Korle Bu Teaching Hospital over the past 50 years were reviewed, as the consistent report format permitted ready comparison of the series. Emphasis was placed on clinical features, established cause and resulting complications. RESULTS: The case load of intestinal obstruction has dwindled over the past 3 decades, accounting for 0.7% of all hospital admissions compared with 1.4% 30 years earlier. External hernias together with adhesive bands still constitute the bulk of presenting cases, but the proportions have changed with strangulated hernias accounting for 59.8% instead of 77.6%. The change has paralleled a rise in elective hernia day case surgery. The incidence of intussusception has almost doubled (7.4% from 4.0%) and it still afflicts the very young. Colonic neoplasms have been commoner over the past 2 decades although the incidence (3.3%) falls short of Western figures. Overall mortality has remained unchanged at 9.4% and this has been associated with a rise in resection rates to 18.3%. CONCLUSIONS: The patterns of intestinal obstruction have been much influenced by changing attitudes regarding elective hernia surgery and evolving financial policies.Item Colorectal carcinoma: An update of current trends in Accra. [Carcinome colorectal: Une mise à jour des tendances actuelles de Accra](2010) Dakubo, J.C.B.; Naaeder, S.B.; Tettey, Y.; Gyasi, R.K.BACKGROUND: Clinical experience and earlier studies indicate that the number of colorectal cancer cases seen annually in the Accra metropolis is increasing. OBJECTIVE: This study was aimed at providing a current update on colorectal cancer in Accra, Ghana. METHODS: A prospective study of confirmed cases of colorectal cancer diagnosed from January 1997 - December 2007. RESULTS: Three hundred and fifty-nine colorectal cancer cases were studied. Males were 192(53.5%) and females 167(46.5%) with an annual incidence of 32.6 new cases. The crude incidence rates were 12.53, 9.87 and 11.18 per 100,000 population for males, females and overall respectively. Rectal bleeding 185(51.1%), abdominal mass 76(21.1%), intestinal obstruction 62(17.3%), intestinal perforation nine (2.5%) and iron deficiency anaemia nine (2.5%) cases were the main presentations. There were 168 (46.8%) rectal and 191(53.2%) colon tumours. Two hundred and thirty-one patients had laparotomy with 225 resections, and 128 patients for various reasons did not undergo surgery. The Astler Coller stages of the tumours at diagnosis were C 2 84(36.7%), C 1 53(22.1%), B 2 49(21.4%), D 17(7.4%), B 1 14(6.1%) and A 12(5.1%) cases. Adenocarcinoma was the commonest histological type 321(89.4%), with the majority either well-differentiated (62.5%) or moderately well-differentiated (25.6) carcinomas. Poorly differentiated carcinomas accounted for 28 cases (7.8%). Post-operative mortality was 6.1%. Long term survival could not be assessed as the majority of patients were lost to follow up. CONCLUSION: The incidence of colorectal cancer has increased over the last four decades in tandem with an aging population of Accra with adenocarcinoma as the predominant histological type.Item Gastro-duodenal peptic ulcer perforation.(East African Medical Journal, 2009) Dakubo, J.C.B.; Naaeder, S.B.; Clegg-Lamptey, J.N.OBJECTIVES: To determine the epidemiology of, and define the morbidity and mortality factors following emergency surgery for patients with perforated peptic ulcer disease in Accra, Ghana. DESIGN: A retrospective and prospective hospital-based study. SETTING: The general and paediatric surgical wards of the Korle-Bu Teaching Hospital. MAIN OUTCOME MEASURES: Demography, the systolic BP, pulse rate and haemoglobin on admission at ER, co-morbid conditions, site of perforation, surgical method and treatment outcome. SUBJECTS: A total of 326 cases treated for peptic ulcer perforation, 267 males and 59 females; ratio 4.5:1, with mean age of 40.9, SD 16.4 and range 4-87 years, were studied. RESULTS: The incidence of peptic ulcer perforation rose from 1.6% in 1998 to 5.3% in 2002 and stabilised at 5%, and overall accounted for 4.6% of acute abdomen. Co-morbid conditions were present in 48 (18.2%) of cases. Ulcerogenic substance intake was in 177 (67%) patients. One hundred and twenty two (46.2%) patients reported to hospital within 24 hours of perforation. There were 287 (88%) duodenal, 22 (7.1%) prepyloric, and 19(4.9%) type 1 gastric ulcer perforations. Simple closure with omental patch was performed in 299 (94.3%), truncal vagotomy and drainage in 10 (3.2%), and Billroth II partial gastrectomy in seven (2.2%). Post-operative complications occurred in 62 (19%); overall mortality was 36 (11%). Logistic regression analysis of the patients clinical variables showed that age less that 60 years (p-value, OR and 95% CI; 0.002, 3.964 and 1.668-9.420), duration of perforation of more than 24 hours before admission (p-value, OR and 95% CI; 0.011, 2.471 and 1.228-4.971), alcohol intake (p-value, OR and 95% CI; 0.009, 2.543 and 1.259-5.135) and resectional surgery (p-value, OR and 95% CI; 0.000, 8.25E and 74204908.138-9162648048.1) were statistically significant in determining postoperative complications. Age 60 years and above (p-value, OR and 95% CI; 0.018,4.359 and 1.284-14.802), alcohol intake (p-value, OR and 95% CI; 0.042, 3.238 and 1.046-10.021) and resectional surgery (p-value, OR and 95% CI; 0.000, 1.20E and 938112920.94-1.54E+ 11) were the factors that showed statistical significance in determining post-operative mortality. CONCLUSION: Perforated peptic ulcer disease is emerging as a frequent cause of acute abdomen in our centre and affects the youth commonly. Age 60 years and above, duration of perforation for more than 24 hours before admission, alcohol intake and resectional surgery were the variables that showed statistical significance in predicting post-operative morbidity and/or mortality.Item Human pentastomiasis: A case report(West African Journal of Medicine, 2006) Dakubo, J.C.B.; Etwire, V.K.; Kumoji, R.; Naaeder, S.B.We report a case of human pentastomiasis in a 55-year-old farmer whose diagnosis was made incidentally during laparotomy on account of a mechanical small intestinal obstruction caused by adhesions. Encysted parasites and degenerative granulomas were found in the omentum and in the subserosal layer of the small intestine. These parasites were diagnosed as Armillifer armillatus larvae. The patient made an uneventful recovery after the operation and was discharged. He is being followed up.Item Pathology and the surgical management of goitre in an endemic area initiating supplementary iodine nutrition [Histopathologie et prise en charge du goitre dans une zone endémique initiant une supplémentation alimentaire en iode](West African Journal of Medicine, 2013-03) Dakubo, J.C.B.; Naaeder, S.B.; Tettey, Y.; Gyasi, R.K.Goitre in the West African sub-region is caused by iodine deficiency and goitrogens in the diet. Supplementary iodine nutrition on a mass scale was started in Ghana in 1996. In areas where iodine deficiency have been corrected the histological pattern of goitre changes and this influences surgical decision making. Data on the histological types of goitre in our institution is lacking. OBJECTIVE: To define the histopathological types of goitre in this initial period of iodine supplementation and relate this to the types of thyroid surgeries that were performed. METHODS: It was a prospective study of consecutive patients who underwent thyroidectomy from January 2003-December 2007. Descriptive statistics was employed in analyzing the data RESULTS: Five hundred and twenty eight cases were studied made up of 470 (89%) females and 58 (11%) males with mean age of 41.98yrs, SD ±12.90yrs. The excised mean thyroid tissue weight was 161.4g, SD ±116.3yrs. Hyperplastic goitres were 373 (70.7%), toxic goitre 70 (13.3%), adenoma 37 (7.0%), carcinoma 25 (4.7%) and thyroiditis 23 (4.4%). Papillary carcinoma accounted for 56% (14) cancers. Subtotal thyroidectomy was performed in 278 (52.7%) of patients, near total thyroidectomy 107 (20.3%), lobectomy 98 (18.6%), total thyroidectomy 24 (4.5%), excision or completion thyroidectomy 20 (3.8%) and de-bulking 1 patient. Overall, complications occurred in 32 patients (6.1%) and were made up mostly of haemorrhage in 10 (1.9%), Hypocalcaemia 10 (1.9%), unilateralRecurrent Laryngeal Nerve(RLN) injury 3 (0.57%), Tracheal collapse 3 (.57%) and Bilateral RLN injury 2 (0.4%). CONCLUSION: The introduction of iodine supplementationon a mass scale in Ghana is yet to have its fullest impact on thyroid diseases. Goitres are still large and cause pressure effects. Toxic, inflammatory and malignant goitres are gaining prominence, and surgery for malignant goitre was oncologically inadequate.Near total thyroidectomy is recommended as the minimum surgery to avert the need for completion thyroidectomies in view of the lack of preoperative pathological diagnosis of thyroid lesions. © 2013, West African Journal of Medicine. All rights reserved.Item Pattern of Abdominal injuries in Korle Bu Teaching Hospital, Accra(Ghana Medical Journal, 1990-09) Naaeder, S.B.Two Hundred and thirty-four cases of abdominal trauma over the past 6 years were reviewed. There were four times as many male as female patients. The peak age incidence was in the second and third decades. Road traffic accidents were the commonest causes of blunt injures whereas stab wounds predominated penetrating injuries. The spleen and the small bowel were the most common Viscera injured. Although accidental injury ill our environments is a common cause of morbidity fatalities are few in those with abdominal traumaItem Pattern of breast disease in Ghana(Ghana Medical Journal, 2000-12) Asumanu, E.; Vowotor, R.; Naaeder, S.B.A study of breast diseases as seen at a surgical clinic in the Korle Bu Teaching Hospital (KBTH) over a period of 12 months is presented. There were 300 patients, 295 women and 5 men with a mean age of 33.6 years. Benign breast disorders were present in all groups but were commoner in the younger age groups. Lumps were more common in the upper lateral quadrants. Fibroadenosis, 100(33.3%), was found to be the commonest breast disorder among Ghanaian women. Mastitis/breast abscess, 56( 18.7%), was the second most common breast disease affecting mainly nursing mothers. Fibroadenoma constituted 16.3% (52/300) of cases and was the third most common lesion. Nearly 47% of 47 patients with breast carcinoma presented with stages III and IV disease. Male breast disorders were relatively uncommon and constituted 1.7%(5/300) of breast diseases. Thus, the pattern of breast diseases in Ghana contrasts those of other places where fibroadenoma is reported to be the commonest breast diseases. The incidence of breast carcinoma is increasing in Ghana but many patients present late. Efforts must therefore be directed at public education as well as research into the epidemiology and outcome of breast carcinoma in Ghana.Item Position and susceptibility to inflammation of vermiform appendix in Accra, Ghana(East African Medical Journal, 2006) Clegg-Lamptey, J.N.; Armah, H.; Naaeder, S.B.; Adu-Aryee, N.A.OBJECTIVES: To determine the normal (non-inflamed) position of the vermiform appendix in Ghana and carry out a pilot study to test the hypothesis "The retrocaecal appendix is less prone to inflammation". DESIGN: Retrospective autopsy study. SETTING: The pathology department and the department of surgery theatres of the Korle Bu Teaching hospital in Accra, Ghana SUBJECTS: Consecutive autopsies and inflamed appendices at appendicectomy. Deaths occurring from untreated appendicitis were excluded from the autopsy study. Conversely non-inflamed appendices and appendices from interval appendicectomy were excluded from the appendicitis study. RESULTS: There were 1358 autopsies and 323 inflamed appendices. In the autopsy study the retrocaecal position was the most common (914 [67.3%]). Other positions were pelvic (294 [21.6%]), preileal (66 [4.9%]), postileal (51 [3.8%]) and paracaecal (33 [2.4%]). These positions were similar in males and females. The positions of 323 inflamed appendices were: retrocaecal (183 [56.7%]), pelvic (66 [20.4%]), preileal (20 [6.2%]), postileal (15 [4.6%]) and paracaecal (39 [12.1%]). Comparing the nonretrocaecal to the retrocaecal position by chi square, the non-retrocaecal position was more prone to inflammation (p<0.001). CONCLUSION: The position of the normal appendix in Ghana differs from Western literature. The retrocaecal position appears less prone to inflammation in Ghanaians.Item Small intestinal mucormycosis(Ghana Medical Journal, 2004-12) Dakubo, J.C.J.; Akoto, H.; Aboah, M.; Kumodji, R.; Naaeder, S.B.Item Upper Gastrointestinal Endoscopy at the Korle Bu Teaching Hospital, Accra, Ghana(2007-03) Aduful, H.K.; Naaeder, S.B.; Darko, R.; Baako, B.N.; Clegg-Lamptey, J.N.A.; Nkrumah, K.N.; Adu-Aryee, N.A.; Kyere, M.Objectives To study the indications for endoscopy, the endoscopic diagnosis and other lessons learnt. Methods A retrospective and prospective audit of all upper gastrointestinal endoscopies performed in the Endoscopy Unit of the Korle-Bu Teaching Hospital from January 1995 to December 2002 was performed. Results A total of 6977 patients, 3777 males and 3200 females with age range 1 year 8 months to 93 years were endoscoped. The mean age of males was 43.5 ± 0.5 and females 43.7 ± 0.6 years. Epigastric pain (42.5%), dyspepsia (32.8%) and haematemesis and melaena (14.2%) were the commonest reasons for endoscopy. Chronic duodenal ulcer (19.6%), acute gastritis (12.7%), duodenitis (10.2%), oesophagitis (7.5%) were the commonest diagnoses. Normal endoscopy was reported in 41.1% patients, and was higher in the younger age group compared to the older (R = 0.973, P<0.001). Nine hundred and ninety (14.2%) patients were endoscoped for haematemesis and melaena of which chronic duodenal ulcer (32.1%), gastritis/gastric erosions (12.8%), oesophageal varices (9.8%), carcinoma of the stomach (6.4%), and duodenitis (4.2%), were the commonest causes. No lesion was found in 20.6% of these patients. Urease test was positive in 75% of all biopsy specimen and 85% in chronic duodenal ulcer, gastritis and duodenitis. Conclusion The normal endoscopy rate is high and needs to be reduced in order to help prolong the lives of the endoscopes. Chronic duodenal ulcer is usually associated with H. pylori infection and is the commonest cause of upper gastrointestinal bleeding.