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©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Apr 16, 2022; 14(4): 235-249
Published online Apr 16, 2022. doi: 10.4253/wjge.v14.i4.235
Endoscopic resection of superficial bowel neoplasia: The unmet needs in the Egyptian practice
Mohamed H Emara, Mariam Zaghloul, Haidi Karam-Allah Ramadan, Salem Youssef Mohamed, Mohammed Tag-Adeen, Ahmed Alzamzamy, Mohamed Alboraie, Ahmad Madkour, Ahmed Youssef Altonbary, Tarik I Zaher, Ahmed Abo Elhassan, Nermeen Abdeen, Mohammed Hussien Ahmed
Mohamed H Emara, Mariam Zaghloul, Mohammed Hussien Ahmed, Department of Hepatology, Gastroenterology and Infectious Diseases, Kafrelsheikh University, Kafr Elshiekh 33516, Egypt
Haidi Karam-Allah Ramadan, Department of Tropical Medicine and Gastroenterology, Assiut University, Assiut 71515, Egypt
Salem Youssef Mohamed, Department of Internal Medicine, Faculty of Medicine, Gastroenterology and Hepatology Unit, Zagazig University, Zagazig 44519, Egypt
Mohammed Tag-Adeen, Division of Gastroenterology and Hepatology, Department of Internal Medicine, South Valley University, Qena Faculty of Medicine, Qena 83523, Egypt
Ahmed Alzamzamy, Department of Gastroenterology and Hepatology, Maadi Armed Forces Medical Complex, Military Medical Academy, Cairo 11841, Egypt
Mohamed Alboraie, Department of Internal Medicine, Al-Azhar University, Cairo11884, Egypt
Ahmad Madkour, Department of Endemic Medicine, Helwan University, Cairo 11795, Egypt
Ahmed Youssef Altonbary, Department of Gastroenterology and Hepatology, Mansoura University, Mansoura 35516, Egypt
Tarik I Zaher, Department of Tropical Medicine, Zagazig University, Zagazig 44519, Egypt
Ahmed Abo Elhassan, Department of Tropical Medicine, Suez Canal University, Ismailia 41522, Egypt
Nermeen Abdeen, Department of Tropical Medicine, Alexandria University, Alexandria 21526, Egypt
Author contributions: Emara MH, Ahmed MH, Mohamed SY, Ramadan HKA, Alboraie M, and Zaghloul M proposed the concept; Emara MH, Ahmed MH, Mohamed SY, Ramadan HKA, Alboraie M, Zaghloul M, Altonbary AY, Madkour A, Zaher TI, Abdeen N, Abo Elhassan A, Tag-Adeen M, A Alzamzamy proposed the questionnaire and revised it; Zaghloul M performed statistical analysis; Emara MH, Ahmed MH, Mohamed SY, Ramadan HKA, Alboraie M, Zaghloul M, and Tag-Adeen M wrote the draft; all authors revised the article, read the final manuscript and all approved it; all authors performed web search, aid in questionnaire distribution.
Institutional review board statement: The institutional review board of Kafrelsheikh University approved the questionnaire (approval code MKSU code 36-9-21).
Informed consent statement: In this survey form all participants were informed about the volunteer role to participate.
Conflict-of-interest statement: All authors declare that they did not have any conflict of interest.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at [
emara_20007@yahoo.com].
STROBE statement: All the authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Mohamed H Emara, MD, Professor, Department of Hepatology, Gastroenterology and Infectious Diseases, Kafrelsheikh University, Algeish, Kafr Elshiekh 33516, Egypt.
emara_20007@yahoo.com
Received: November 12, 2021
Peer-review started: November 12, 2021
First decision: December 12, 2021
Revised: December 22, 2021
Accepted: March 26, 2022
Article in press: March 26, 2022
Published online: April 16, 2022
Processing time: 146 Days and 13.8 Hours
BACKGROUND
Management of superficial bowel neoplasia (SBN) in early stages is associated with better outcomes. The last few decades experienced a paradigm shift in the management of SBN with the introduction of advanced endoscopic resection techniques (ERTs). However, there are no clear data about the aspects of ERTs in Egypt despite the growing gastroenterology practice.
AIM
To investigate the knowledge, attitude, and practice of ERTs toward management of SBN among Egyptian practitioners and the suitability of the endoscopy units’ infrastructures toward these techniques.
METHODS
An online 2-pages questionnaire was used. The first page comprised demographic data, and questions for all physicians, about the knowledge (11 questions) of and attitude (5 questions) toward ERTs as a therapeutic option for SBN. The second page investigated the practice of ERTs by endoscopists (6 questions) and the infrastructures of their endoscopy units (14 questions). The survey was disseminated through July 2021 and the data were collected in an excel sheet and later analyzed anonymously.
RESULTS
The complete responses were 833/2300 (36.2%). The majority of the participants were males (n = 560, 67.2%), middle-aged (n = 366, 43.9%), consultants (n = 464, 55.7%), gastroenterologists (n = 678, 81.4%), spending ≥ 15 years in practice (n = 368, 44.2%), and were working in university hospitals (n = 569, 68.3%). The majority correctly identified the definition of SBN (88.4%) and the terms polypectomy, endoscopic mucosal resection (EMR), and endoscopic submucosal dissection (ESD) (92.1%, 90.2%, and 89.1% respectively). However, 26.9%, 43.2% and 49.5% did not recognize the clear indication of polypectomy, EMR, and ESD respectively. Although 68.1% of physicians are convinced about the ERTs for management of SBN; only 8.9% referred all candidate cases for ERTs. About 76.5% of endoscopists had formal training in the basic polypectomy techniques while formal training for EMR and ESD was encountered only in 31.9% and 7.2% respectively. About 71.6% and 88.4% of endoscopists did not perform EMR or ESD in the last one year. Consequently, the complication rate reported by endoscopists was limited to 18.1% (n = 103) of endoscopists. Only 25.8% of endoscopists feel confident in the management of ERTs-related complications and a half (49.9%) were not sure about their competency. Regarding the endoscopy units’ infrastructures, only 4.2% of the centers had their endoscopes 100% armed with optical enhancements and 54.4% considered their institutions ready for managing ERTs-related complications. Only 18.3% (n = 104) of endoscopists treated their complicated cases surgically because the most frequent ERTs-related complications were procedural bleeding (26.7%), and perforations (17%).
CONCLUSION
A significant deficiency was reported in the knowledge and attitude of Egyptian practitioners caring for patients with SBN toward ERTs. The lack of trained endoscopists in both EMR and ESD in part is due to unsuitable infrastructures of many endoscopy units.
Core Tip: A paradigm shift in the management of superficial bowel neoplasia had been observed over the last few decades with the introduction of new endoscopic resection techniques and the advancements reported in the endoscopes and accessories. These advanced endoscopic resection techniques especially endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) necessitates the insertion of knowledge and improvement of the practice attitude of the practitioners before delivering education and training programs to skilled endoscopists. The current study investigated these aspects among Egyptian practitioners and it revealed a significant deficiency in the knowledge and attitude with lack of trained endoscopists in both EMR and ESD in part is due to unsuitable infrastructures of many endoscopy units.
