Patients’ Lived Experience and Injuries Observed during Upper Digestive Endoscopy at KARA Teaching Hospital (Togo)

Background: Endoscopy remains the most performant medical exam exploring the upper digestive tract; but depending on patients, its tolerance is variable. Objective: This study aimed at describing the experience and evaluating the tolerance, acceptability and injuries observed during upper gastrointestinal endoscopy. Methods: This is a prospective and descriptive study carried out from April to July 2017 in the digestive endoscopy unit of the Kara teaching hospital (Togo). The gastroscopy was performed by the same operator (Hepatogastroenteroloogist). The premedication was done with direct intravenous injection of 10 mg of Metoclopramide hydrochloride and viscous Lidocaine oral gel. Previously, essential information about the examination course was given to patients after obtaining their verbal consent. Patients’ impressions of the experience, tolerance and acceptability were collected on a survey sheet, before and after the examination. Results: One hundred and eleven patients were included, 62 women and 49 men. The average age was 45.9 years (15 88 years), and the sex ratio (F/M) was 1.2. Most of the patients (89.2%) were experiencing the gastroscopy for the first time, and the main reason was epigastralgia in 55%. The examination duration was good at 88.3% and tolerance was good at 72.1%. Tingling, irritation, pain or sore throat feelings were noted in 13.5%. Patients agreeing to make an ulterior UDE if necessary were up to 92.8%. Observed injuries were dominated by antral erythematous gastropathy (28.8%). Conclusion: UDE is well tolerated among our patients and its acceptability is high. Injuries are dominated by inflammatory pathologies of the stomach in our population.


Introduction
Upper digestive endoscopy (UDE) remains the most efficient examination, to explore the upper digestive tract, for both diagnostic and therapeutic [1]. But its unpleasantness is sometimes reported by patients. Its tolerance, experience and acceptability may be poor and, in some cases, make it laborious or impossible to complete. However, the tolerance of UDE remains variable among patients, and previous studies have shown that several factors may be associated with better acceptability of UDE [2] [3]. UDE is performed most of the time without anesthesia, especially in sub-Saharan Africa, due to the lack of anesthesia specialists.
In Togo, there is no precedent study describing the tolerance and acceptability of this examination in patients. Our study aims at describing the experience, tolerance and acceptability of UDE among our patients, and then highlighting the pathologies observed.

Methods
It was a prospective and descriptive study, in the digestive endoscopy unit of the Kara teaching hospital (Togo). It was based on an anonymous questionnaire, and took place from April to July 2017. Patients aged 15 years and over (hospitalized or outpatients), come for UDE during the study period were included, after obtaining their oral consent (which was mentioned on the survey sheet). The material used for endoscopy performance was an Olympus brand video endoscope with axial vision, equipped with a cold light source, a screen making it possible to visualize the different stages of the endoscopic examination and the pathological aspects observed in real time. Examination was performed by the same doctor (specialist in hepatology and gastroenterology). The material disinfection after use was carried out, according to the manual disinfection protocol, recommended by the French Society of Digestive Endoscopy (SFED); placing the endoscope and its accessories in a Hexanios solution, and brushing accessories.

Results
Our study has included 111 patients. Open Journal of Gastroenterology no effect on patients in 49.5% and 36% of them rated the exam room clean, well equipped, well-appointed and comfortable. The room also had no effect on exam processing in 87.4% of cases. A minority of patients (5.4%) said the exam room was too cold. The exam duration was considered good in 88.3% (n = 98) and long in 10.8%. After examination, 46.8% of patients reported feeling nothing, and similarly, 46.8% reported relief. Tingling, irritation or sore throat feelings were reported in 13.5% (n = 15). No complications were observed. The acceptability of a subsequent UDE under the same conditions was noted in 92.8% (n = 103). At the end of the examination, 39.6% of patients expressed their thanks to the medical team and 9.9% had encouraged them to continue working the same way. The patient cooperation's degree was rated acceptable in 76.6% (n = 85) and good in 23.4% (n = 26). The endoscopy performance was normal in 87.38% (97 patients), then a bit laborious in 12.61% (14 patients). The most found pathology was antral erythematous gastropathy (28.8%) ( Table 4).

Discussion
This study, focusing on the experience, tolerance and acceptability of UDE among patients, is the first one in Togo. Responding to the post-endoscopic questionnaire immediately, while some patients were still feeling emotional, could constitute a bias. Likewise, the question relating to the acceptability of UDE could vary if the investigation was carried out a few days later. On another side, the fact that the questionnaire was not self-administered (but administered by someone) could influence the patients' answers as they don't want to compromise the medical team. The female predominance in our study population is also reported by other African authors [ sheet which should be commented on and given to patients during consultation [8]. This information should be given to patients during a pre-examination consultation, preferably the day before as this could improve safety and acceptability Most of our patients (89.2%) were at their first realization of the UDE and this fact had no influence on the tolerance or not of the exam. The key element of good safety was the exam duration, and 88.3% (n = 98) found the duration good (less than 5 minutes) as was the case in the literature [5] [12]. Likewise, the examination room had no effect on the UDE performing, thus explaining, on the one hand, the good tolerance of the examination by the patients. Tingling, irritation, or sore throat sensation was reported in 13.5%. These different feelings described in the throat were noted in 40% according to Sombié et al. [4] and in 44% according to Sehonou et al. [5].  [14].

Conclusion
The

Conflicts of Interest
The authors declare that they have no competing interests. Open Journal of Gastroenterology