Preface

Endoscopy has had a major impact in developing modern gastroenterology. By using different data it provided a better understanding of pathogenic mechanisms, described new entities and changed diagnostic and therapeutic strategies. Some examples such as the relationship esophagitis-Barrett, esophagus-esophageal adenocarcinoma, the description of early gastric cancer, the relationship helicobacteria-pylori-duodenal ulcer-gastric cancer and the affiliation colon adenoma-colon cancer remind us of the influence of endoscopy in gastroenterology. Moreover, endoscopy has surpassed its function as an examination tool and it became a rapid and efficient therapeutic tool of low invasiveness. We cannot imagine gastroenterology today without endoscopic hemostasis in variceal or non-variceal upper bleeding, gastric or colonic polypectomy, biliary sphincterotomy and endoscopic biliary stone removal, biliary or pancreatic endoscopic stenting or endoscopic drainage of abdominal fluid collection.

Meanwhile, taking benefit of many technical advances, endoscopy has had a spectacular development. New video-endoscopes, endoscopes with working channel, magnification endoscopes, confocal of narrow band imaging endoscopes emerged. Sophisticated devices for endoscopic ultrasound with the possibility of fine-needle aspiration or elastography, endoscopic capsules for exploring the small intestine as well as enteroscopes with single or double balloon and spiral enteroscopy are several examples of the evolution of the endoscopy field. At the same time many diagnostic techniques (vital staining, fluorescence) or treatment techniques (e.g. banding, metallic clips, laser use, plasma-argon coagulation, stenting, mucosectomies) recognized real improvement. .

The contributions in this book are diverse and very valuable. InTech Open Access Publisher selected several known names from all continents and countries with different levels of development. Multiple specific points of view, with respect to different origins of the authors were presented together with various topics regarding diagnostic or therapeutic endoscopy. As a result, the reader can take into consideration not only theoretical or practical knowledge in the field, but also the experience, point of view and local situation in a specific center of gastroenterology or in a specific country. This actually represents a valuable tool for formation and continuous medical education in endoscopy considering the performances or technical possibilities in different parts of the world.

#### X Preface

My activity as editor was aided by the contribution of two exceptional endoscopists who accepted the statute of co-editors: associate professor Marcel Tantau MD, PhD and lecturer Andrada Seicean MD, PhD. I thank them sincerely for accepting to contribute to this publication, for the quality of their activity and their promptitude in editing chapters. Many thanks to InTech Open Access Publisher which offered me the possibility of editing this very attractive book. It was a real pleasure to read such interesting works by so many experts from all over the world. My sincere thanks to all my co-workers for the quality of the chapter editing. Not in the last turn, I thank Ms. Masa Vidovic and Ms. Mia Devic for their perfect, prompt and efficient co-operation.

#### **Prof. Oliviu Pascu MD PhD Dr h.c. FRCP/Edin**

3rd Medical Department University of Medicine and Pharmacy 'luliu Hatieganu' Cluj-Napoca Romania

X Preface

My activity as editor was aided by the contribution of two exceptional endoscopists who accepted the statute of co-editors: associate professor Marcel Tantau MD, PhD and lecturer Andrada Seicean MD, PhD. I thank them sincerely for accepting to contribute to this publication, for the quality of their activity and their promptitude in editing chapters. Many thanks to InTech Open Access Publisher which offered me the possibility of editing this very attractive book. It was a real pleasure to read such interesting works by so many experts from all over the world. My sincere thanks to all my co-workers for the quality of the chapter editing. Not in the last turn, I thank Ms. Masa Vidovic and Ms. Mia Devic for their perfect, prompt and efficient co-operation.

**Prof. Oliviu Pascu MD PhD Dr h.c. FRCP/Edin**

University of Medicine and Pharmacy 'luliu Hatieganu'

3rd Medical Department

Cluj-Napoca Romania

**Part 1** 

**General Aspects** 

**Part 1** 

**General Aspects** 

**1** 

**Challenges of Gastrointestinal** 

*Gastroenterology Unit, Department of Medicine, University of Nigeria Teaching Hospital Ituku/Ozalla,* 

Nwokediuko Sylvester Chuks

*P.M.B. 01129 Enugu,* 

*Nigeria* 

**Endoscopy in Resource-Poor Countries** 

Over the past 100 years, there has been a dramatic and explosive growth of information about and technology related to the science and practice of gastroenterology. Endoscopy services are the mainstay of diagnosis and treatment in gastroenterology. Endoscopies have undergone significant changes enabled by advances in information technology (IT). The ability to take video pictures onto the computer screen and to print them has enabled more

The developed countries of the world have taken great advantage of these innovations and developments but the story is totally different for the developing or resource – poor countries. The developing countries are characterized by low measures of development such as income per capita, rate of literacy, life expectancy and other health indices. These countries have not achieved a significant degree of industrialization relative to their populations, and which have in most cases a low standard of living. Strictly speaking, the term developing implies mobility and does not acknowledge that development may be in decline or static in some countries, particularly African countries. It is for this reason that the World Bank classifies countries on the basis of Gross National Income (GNI) per capita

Digestive diseases impose a substantial burden on global health. In the United States, over 40 billion US Dollars was used for gastrointestinal disease in one year (Sandler et al 2002).Comparable information on the digestive health of people living in developing countries may not be available but it is known that diarrheal diseases account for 17.9% of deaths in low-income countries compared to 1.6% in high-income countries (World Health Organization, WHO 2008). Helicobacter pylori is a leading cause of gastrointestinal disease globally. Whereas the prevalence of this infection has declined considerably in the developed world, it is still very high in the developing countries (Torres et al 2000), with the majority of the global burden of infection found here (World Gastroenterology Organization, WGO 2006) because most of the risk factors for its transmission are rife in the developing countries. These include low socio-economic status, crowded living conditions, several children sleeping on one bed, large numbers of siblings and unclean water (Webb et al 1994, Malaty et al 1996, Lindkvist et al 1998, Dominici et al 1999, Nabwera et al 2000).

effective image capture, image storage and retrieval as well as quality assessment.

**1. Introduction** 

(World Bank, 2010).
