Enhancing Colonoscopy Services in Ghana: A Comprehensive Assessment of Referral Indications and Endoscopic Findings in a Leading Tertiary Care Hospital

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Abstract Background: Endoscopy has significantly advanced the investigation of colorectal diseases. In developed countries, screening via colonoscopy plays a crucial role in the early detection and management of colorectal malignancies. In Africa, diagnostic indications constitute the major indication for colonoscopy. The appropriateness of colonoscopy indications in Ghana has not been described. This study seeks to characterise the appropriateness of colonoscopy indications and the range of endoscopic findings at Komfo Anokye Teaching Hospital. Materials and Methods: A cross-sectional study reviewed complete records of patients who underwent lower gastrointestinal endoscopy (LGIE) between January 2017 and December 2021. A structured checklist was used to screen records for completeness. Data were analysed using STATA software version 17. The chi-square test was used to compare variables, with statistical significance set at P < 0.05. Results: A total of 1215 patients underwent LGIE during the period. The mean age of the patients was 51.1 ± 17.6 years, with 757 (62.3%) of them being males. Internal referrals accounted for 70% of cases. Colonoscopies comprised 66% of all LGIE procedures performed. Among the indications, 78.6% were deemed appropriate, with hematochezia being the most common (57.45%). Screening colonoscopy accounted for only 0.5% of the indications. There was an eight-fold increase in the likelihood of detecting an abnormal finding when the indication was appropriate compared to when it was not (adjusted OR 8.6, P value 0.002). Conclusion: Colonoscopy referrals were appropriately indicated in most patients, with hematochezia being the most common indication, similar to trends observed in other African countries. Screening colonoscopy is not common in Ghana, unlike in developed nations.

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