title: Esophagogastroduodenoscopy in a public referral hospital in Lilongwe, Malawi: spectrum of disease and associated risk factors.
abstract: BACKGROUND
  Esophagogastroduodenoscopy (EGD) is a valuable tool for diagnosing and treating upper gastrointestinal disease. Prioritizing the use of EGD in resource-limited settings must be customized to local populations to maximize population benefit from the examination.
  
  
  METHODS
  Cross-sectional, retrospective review of EGD reports was conducted at Kamuzu Central Hospital (KCH), Lilongwe, Malawi. Esophageal tumors were defined as obstructive or nonobstructive and esophageal varices were graded on a scale of I to IV. Descriptive statistics were calculated and logistic regression performed for each disease state compared with all other reports.
  
  
  RESULTS
  A total of 1,034 cases were reviewed (56% male; mean age (standard deviation), 44 (17) years). The most common indications were dysphagia (37%), hematemesis (21%), and epigastric pain (16%). The most common diagnoses were normal (36%), esophageal cancer (27%), and esophageal varices (17%). Eighty-six percent of esophageal tumors were obstructive and 45% of esophageal varices were grade III or IV. Normal examinations were more likely to be female, younger, and present with dyspepsia. Esophageal cancers were more likely to be male, older, present with dysphagia, and present from districts outside Lilongwe. Esophageal varices were more likely to present with hematemesis.
  
  
  CONCLUSIONS
  EGD is a limited resource at KCH; patient selection should be guided by patient age and indication. The high burden of esophageal cancer and varices in Malawi suggests that therapeutic endoscopy would be beneficial.
authors.affiliation: University of North Carolina Project, Lilongwe, Malawi. lindsey.wolf@ucsf.edu.
authors.forename: Lindsey L
authors.initials: LL
authors.lastname: Wolf
authors.affiliation: Department of General Surgery, Kamuzu Central Hospital, Lilongwe, Malawi.
authors.forename: Rahim
authors.initials: R
authors.lastname: Ibrahim
authors.affiliation: Department of General Surgery, Kamuzu Central Hospital, Lilongwe, Malawi.
authors.forename: Changchun
authors.initials: C
authors.lastname: Miao
authors.affiliation: Department of General Surgery, Kamuzu Central Hospital, Lilongwe, Malawi.
authors.forename: Arturo
authors.initials: A
authors.lastname: Muyco
authors.affiliation: University of North Carolina Project, Lilongwe, Malawi.|Division of Infectious Diseases, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Mina C
authors.initials: MC
authors.lastname: Hosseinipour
authors.affiliation: University of North Carolina Project, Lilongwe, Malawi.|Department of Otolaryngology/Head and Neck Surgery, Lineberger Comprehensive Cancer Center, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Carol
authors.initials: C
authors.lastname: Shores
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D003430:Cross-Sectional Studies; D016145:Endoscopy, Digestive System; D004938:Esophageal Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D004932:Esophageal and Gastric Varices / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006779:Hospitals, Public; D006801:Humans; D016015:Logistic Models; D008295:Malawi / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015995:Prevalence; D012017:Referral and Consultation; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult