**10. Conclusions and recommendations**

The problems that face the teaching and practice of gastrointestinal endoscopy in developing countries are protean and generally reflect the low level of human and infrastructural development in these countries:


The health care system in the developing countries needs a radical reorganization. The budgetary allocation to health and the implementation of policies related to health need radical improvement.

Challenges of Gastrointestinal Endoscopy in Resource-Poor Countries 13

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The governments should work in liaison with various medical societies to come out with firm guidelines that will take into account the financial capabilities of these obviously poorer countries without unduely compromising the health of their citizens and ensure strict compliance by all stakeholders.

It is no longer realistic to talk about global standards because of the problem of resource allocation. The available resources and technologies differ from country to country. For example, the ability to use narrow-band imaging, ERCP or procedures that are considered standard components of endoscopy in the United States may not be possible in developing countries and the guidelines must reflected these differences. It is essential to be cognizant of the local resources and to identify quality within their constraints.

The funding of health services should tend towards prepayment strategies rather than outof-pocket payment and health insurance is a veritable tool for achieving this.

### **11. References**


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The funding of health services should tend towards prepayment strategies rather than out-

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compliance by all stakeholders.

**11. References** 


**2** 

**(UGIE)** 

*Sri Lanka* 

Arjuna P. De Silva

*Faculty of Medicine University of Kelaniya* 

**Evidence Based Guidelines for Preparation** 

Current endoscopic guidelines advice a 6 hour fast for solids and a 4 hours fast for liquids before UGIE1, while most anaesthesia guidelines advice a 6 hour fast for solids and a 2 hour fast for clear liquids1,2. The purpose for fasting before UGIE is two fold. The first is the same as in anaesthesia prior to surgery, to prevent the aspiration of food contents3. The second, which is specific for endoscopy, is to provide clear vision4. However, prolonged fasting may result in patient discomfort and undue stress5. Due to practical delays the fasting period for endoscopy can become much longer than the stipulated six hours, thus causing even more patient discomfort. This may become especially difficult to tolerate for patients with gastroesophageal reflux disease (GERD). Physiological studies have shown that clear fluids leave the stomach rapidly6, and several anesthetic guidelines now recommend a 2-hour preoperative fast for clear fluids and a 6-h fast for solids before general anesthesia2,7. A pilot study done by us on 20 patients using real-time ultrasonography showed the time taken for

The second issue with the guidelines was that these guidelines focus on a Western type diet1. Rice is the staple diet in many Asian countries which include more than half the worlds population. Rice consumption is also increasing in many western societies8. Normally, the proximal part of the stomach acts as a reservoir for food and the distal end acts as the grinder9. Gastric emptying in normal subjects is complicated process, and is affected by,various meal related factors like the fat content, consistency and the size of the meal10. However, patient dependant factors like age, sex and body mass index (BMI) have been shown to have no significant association with gastric emptying11. In a pilot study using real time ultrasound scanning we found that the time taken for complete gastric emptying after a standard rice meal was 10 hours. To the best of our knowledge there are no published guidelines on endoscopic preparation for a rice based diet. We therefore decided to investigate whether a six hour fast after a rice based meal was sufficient prior to UGIE.

The aim of the first study was to determine whether a 6-hour fast for solids and a one-hour fast for water prior to UGIE gives good endoscopic vision and less patient discomfort. The aim of the second study was to determine whether a six hour fast after a standard rice

a clear liquid (plain tea) or water to empty from the stomach was one hour.

based meal is sufficient to achieve good endoscopic vision during UGIE.

**1. Introduction** 

**2. Aims** 

**Before Upper Gastrointestinal Endoscopy** 

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