**3.1 Procedure room**

4 Gastrointestinal Endoscopy

Because of the pivotal role of endoscopy in the teaching and practice of gastroenterology, various professional bodies in the developed countries have produced guidelines on what constitutes the minimum necessary facilities, equipment and staffing to deliver safe and effective endoscopy (Digestive Health Foundation, Australia, 2007, American Society of Gastrointestinal Endoscopy (ASGE) 2010). The training and qualification of endoscopists and nursing staff, the endoscopic equipment and accessories, the reprocessing of endoscopes, monitoring and resuscitation equipment must all be of globally accepted standards. Some of these standards will be highlighted in this article and compared with what obtains in

An endoscopy unit may be hospital-based or free standing. For hospital-based endoscopy units, the location shall be in close proximity to acute emergency services. The location within the complex shall permit free access for out-patients and for the transport of inpatients by bed, trolley or wheel chair. Where the endoscopy unit is not located within the main hospital complex, provision for enclosed transfer of patients is advisable. Where the endoscopy service is in a free standing facility, it should be located within a 15 minute ambulance journey of an acute hospital that provides an intensive care or emergency service. There should be an agreed arrangement with this hospital to admit patients in a

The endoscopy services that are available in the developing countries do not meet the standards stated above. Very often there is a lot of improvisation in the siting of endoscopy suites. In some countries they are located in wards without any consideration for access to out-patients and transport of in-patients. The privately owned endoscopy services are even worse because in most cases, once the equipment is procured, it is installed in any existing facility. The absence of effective certification and accreditation of centres makes matters

An ideal endoscopy unit should posses the following areas as minimum requirements.

Each of these areas should have proper supply of consumables and necessary equipment. For instance; a recovery area should be situated adjacent to the procedure room(s) and must be freely accessible by a normal recovery room trolley. The recovery room should also have

developing countries using Nigeria as a typical example.

**2. Location of services** 

medical emergency.

worse.

**3. Facilities** 




(Digestive Health Foundation, Australia, 2007).





The procedure room should be at least 4 meters by 5 meters. Larger rooms are required for video endoscopy and if endoscopic retrograde cholangiopancreatography (ERCP) procedures are performed, a larger room of not less than 35 square meters is required. The procedure room must be equipped with at least the following:


#### **3.2 Power supply**

The problem of power supply is a major one in resource-poor countries. The Nigerian energy industry has been described as one of the most inefficient in the world in terms of meeting the needs of its customers. This has had a devastating effect on business to the extent that most businesses have to rely on generators, which are very expensive to run. Endoscopy procedures are often interrupted or cut short by power outages. Such incessant outages have deleterious effects on the endoscopy equipment with the result that there is frequent breakdown. The generators that serve as alternative may not be big enough to power air conditioners thus it is common to see the endoscopist, other support staff and the patient sweating profusely during endoscopic procedure. The quality of work done in this type of environment is bound to be substandard. The commonest cause of inconclusive endoscopic procedure in Nigeria is power failure.
