Endoscopic Management of Gastrointestinal Bleeding: A Retrospective Analysis of Cases in Nairobi
Abstract
Background: Gastrointestinal bleeding (GIB) is a common medical emergency with substantial morbidity and mortality. Data on endoscopic management in sub-Saharan Africa are limited. This study evaluates etiology, endoscopic strategies, and outcomes of GIB in Nairobi, Kenya.
Objective: Analyze etiology, treatment outcomes, and predictors of rebleeding among patients managed endoscopically at three tertiary hospitals in Nairobi.
Methods: Retrospective analysis of 450 patients who underwent endoscopy for acute GIB (Jan 2018–Dec 2021). Demographics, presentation, endoscopic findings, therapies, and outcomes were abstracted. Logistic regression identified predictors of rebleeding and mortality.
Results: Of 450 patients, 62% had upper GIB and 38% lower GIB. Mean age 52.3 ± 16.7 years; 58.2% male. Upper GIB etiologies: peptic ulcer disease (42.5%), esophageal varices (24.6%), gastric erosions (15.7%). Lower GIB: diverticular disease (28.1%), colorectal tumors (22.8%), hemorrhoids (18.7%). Endoscopic therapy performed in 68.2% (injection, thermal coagulation, band ligation); technical success 92.3%. Rebleeding in 11.8%. Predictors of rebleeding: liver disease (OR 2.84), hemodynamic instability (OR 3.21), Rockall ≥ 6 (OR 2.97). Thirty-day mortality 7.3%, associated with age, comorbidity, and instability at presentation.
Conclusion: Endoscopic therapy shows high technical success in the Kenyan context. Early risk stratification and prompt endoscopy are essential. Prospective work should inform locally adapted GIB protocols in resource-limited settings.
Keywords
Publication Details
Citation
Omondi L, Njoroge P, Kamau W, Otieno G, Mwangi J, Waihenya R, et al. (2022). Endoscopic Management of Gastrointestinal Bleeding: A Retrospective Analysis of Cases in Nairobi. World Journal of Gastroenterology, 28(15), 1578–1589.
Funding
Gastroenterology Society of Kenya; research grant from Kenyatta National Hospital.
Key Tables and Figures
Etiology of Upper and Lower GI Bleeding
| Diagnosis | Number | Percentage (%) |
|---|---|---|
| Upper GI Bleeding (n=279) | ||
| Peptic ulcer disease | 119 | 42.5% |
| Esophageal varices | 69 | 24.6% |
| Gastric erosions | 44 | 15.7% |
| Esophagitis | 21 | 7.5% |
| Mallory–Weiss tear | 14 | 5.0% |
| Gastric/esophageal tumors | 12 | 4.3% |
| Lower GI Bleeding (n=171) | ||
| Diverticular disease | 48 | 28.1% |
| Colorectal tumors | 39 | 22.8% |
| Hemorrhoids | 32 | 18.7% |
| Colitis | 27 | 15.8% |
| Angiodysplasia | 16 | 9.4% |
| Other | 9 | 5.3% |
Table 1: Etiology of GI bleeding in 450 patients who underwent endoscopic evaluation.
Success Rates of Endoscopic Interventions
Figure 1: Technical success rates of different interventions.