**1. Introduction**

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

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 (World Bank, 2010).

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).

Challenges of Gastrointestinal Endoscopy in Resource-Poor Countries 5

an oxygen supply dedicated to this area. Oxygen outlets will need to be provided so that each recovery bay is supplied. Wall mounted suction is desirable, however where

The endoscopy units in the developing countries are not in any way near the specifications listed above. It is common to have reception and administration, waiting area, consulting/interview room and staff room all housed in one room. In some instances, doctors and nurses share rooms. Some facilities may have only one toilet for male and female staff and patients. Suction machines and oxygen delivery are often in short supply. What you find in an average endoscopy unit in a developing country is a reflection of what

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

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

unavailable, at least one dedicated mobile suction unit shall be provided.

procedure room must be equipped with at least the following:

is available in an average hospital.



endoscopic procedure in Nigeria is power failure.



*Minimum equipment required for gastrointestinal endoscopy includes:* 



**3.1 Procedure room** 


**3.2 Power supply** 

**4. Equipment** 


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 developing countries using Nigeria as a typical example.
