Introduction
Upper gastrointestinal (GI) endoscopy is one of the most commonly performed endoscopic procedures in Kenya. These guidelines provide a framework for performing high-quality, safe, and effective upper GI endoscopy procedures adapted to the Kenyan healthcare context while aligning with international standards.
Preprocedural Considerations
Indications
Upper GI endoscopy is indicated for evaluation and management of:
- Persistent upper abdominal symptoms despite appropriate therapy
- Upper abdominal symptoms associated with alarm features (e.g., weight loss, anemia, dysphagia)
- Dysphagia or odynophagia
- Persistent reflux symptoms despite appropriate therapy
- Persistent vomiting of unknown cause
- Other diseases in which the presence of upper GI pathology might modify treatment (e.g., in patients with history of ulcer or GI bleeding)
- Confirmation and specific histological diagnosis of radiologically demonstrated lesions
- Management of acute upper GI bleeding
- Selected cases of suspected portal hypertension for assessment of varices
- Assessment of signs or symptoms suggesting malabsorption or celiac disease
- For tissue sampling from duodenum or jejunum
- Suspected malignancy
- For surveillance procedures (e.g., Barrett's esophagus, polyposis syndromes)
Contraindications
Absolute contraindications include:
- Unstable cardiorespiratory status
- Suspected perforation
- Uncooperative patient in absence of adequate sedation
Relative contraindications include:
- Recent myocardial infarction or pulmonary embolism
- Severe thrombocytopenia
- Coagulopathy
- Large aortic aneurysm
- Severe obstructive pulmonary disease
Quality Indicators
Preprocedure Quality Indicators
- Appropriate documentation of indication
- Informed consent obtained and documented
- Risk assessment for anticoagulation/antiplatelet therapy management
- Prophylactic antibiotics given when indicated
- History of adverse reactions to sedation or anesthesia documented
Intraprocedure Quality Indicators
- Complete examination of esophagus, stomach, and duodenum to the second portion
- Photo documentation of normal landmarks and abnormal findings
- Biopsy specimens obtained in appropriate clinical scenarios
- Adequate tissue sampling (≥4 biopsies) in cases of suspected Barrett's esophagus
- At least 7 minutes examination time for normal upper endoscopy
Postprocedure Quality Indicators
- Procedure report completed within 1 day
- Documentation of adverse events
- Follow-up recommendations documented
- Pathology results communicated to patients within 2 weeks
- Patient satisfaction assessment performed
Adaptations for Resource-Limited Settings
These guidelines recognize the variability in resource availability across different Kenyan healthcare settings. Where standard resources are limited, the following adaptations are recommended:
- Prioritize essential equipment maintenance over acquisition of advanced technologies
- Implement a reprocessing protocol that aligns with available resources while maintaining minimum standards
- Develop regional referral networks for complex cases
- Utilize telemedicine for specialist consultation when local expertise is limited
- Implement risk stratification to prioritize urgent cases in settings with limited endoscopy capacity
Training and Competency
Minimum recommended training for performing upper GI endoscopy in Kenya includes:
- Completion of at least 130 supervised upper GI endoscopy procedures
- Ongoing assessment of competency by direct observation
- Regular participation in quality improvement activities
- Maintenance of a logbook documenting procedures and complications
- Ongoing continuing medical education in endoscopy
Citation
Gastroenterology Society of Kenya. (2023). Clinical Practice Guideline for Upper Gastrointestinal Endoscopy. GSK Guidelines 2023. Nairobi, Kenya.
