ENDOSCOPY AND THEIR PREDICATING VALUE OF UPPER GASTROINTESTINAL MALIGNANCY IN ACSH, NORTHERN ETHIOPIA.

Abstract

Background: In a resource-limited setup like Ethiopia, Alarm symptoms are generally accepted as an indication for prompt endoscopy, and these are effective and inexpensive tools to optimize diagnostic yield and identify malignant lesions in patients with upper GI complaints. However, previous studies noted that the sensitivity of alarm features for predicting cases with upper GI malignancies is unsatisfactory (29). Some studies on other part of Ethiopia have yielded mixed results. So far, there has been no study done in Ayder that assessed to what extent the indications of upper GI endoscopy could help identify patients with significant UGI pathologies or malignancies. Methods: Facility based cross-sectional study was conducted in patients who underwent upper GI endoscopy at GI clinic in ACSH from Jan 2019 and Jun 2024 was included in the study. Descriptive statistics were used as appropriate.Data analysis was done using SPSS 27.0 statistical software. Bivariate and multivariate analysis was done to identify significant indications of upper GI malignancy, finally, statistical significance was declared at p-value <0.05. Results: A total of 1,484 patients underwent complete upper gastrointestinal tract endoscopic evaluation during the study period. The median age of the patients was 38 years. Males accounted for 70.4% of the patients. Dyspepsia (21.6%) was the most common indication for endoscopic evaluation. Esophagitis (15.2%) were the most common pathology. The prevalence of upper GI malignancy recorded in our endoscopy cases 11.2%, and of those, 71.1 % had confirmed cancer of the stomach, the esophagus and the duodenum. It was statistically significant giving our study subjects a 7.9% (p<0.001) prevalence of cancer. Gastric cancer was accounting 62.7%, esophageal cancer 27.1%, duodenal cancer 5.08 % and gastro esophageal junction cancer 5.08%. The majority 77.1% of them had one or more alarm symptoms. The sensitivity, specificity, PPV and NPV of having any alarm features for predicting malignancy were 77.1%, 62.1%, 16.4% and 96.6%, respectively. The individual alarm symptoms such as an unexplained loss of weight, persistent vomiting and dysphagia were statistically significant correlation with a UGI malignancy (P: - 0.001) .Based on receiver operating characteristic curve, the optimal age for screening of malignancy was 39.5 years in this population. Conclusion: Dyspepsia was the most common indication for EGD followed by screening varices of CLD patients. Clinically significant endoscopic findings were common. Esophagitis, pan gastropathy and esophageal varices were the common endoscopic finding. Of those, malignancies gastric CA followed by esophageal CA were common. Alarm symptoms were highly prevalent which was significantly higher among patients in the abnormal endoscopic group, particularly in upper GI malignancy group than in theix normal endoscopic group. There were inconsistent in finding between endoscopy and biopsy result. Being age above 39.5 and female, and certain alarm features (persistent vomiting, dysphagia, and unexplained weight loss) were independent predictor of UGI malignancy.