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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
ARTICLE HIGHLIGHTS
Research background
Stakeholders of gastroenterology practice in Egypt are asked to improve all aspects of practice. They should focus on giving basic knowledge, improve the attitude of practitioners before giving the advanced training and supply the required infrastructures. The barriers to the deficiency in all aspects of primary and secondary outcomes can be focused on in future surveys.
Research motivation
Our study concluded that lack of knowledge towards endoscopic resection techniques (ERTs), reluctant attitude, lack of well-trained endoscopists, and shortage of infrastructures are the main obstacles that hamper performing endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) on wider scale and on a routine basis in Egypt.
Research objectives
Complete responses were 833/2300. The majority correctly identified the definition of superficial bowel neoplasia (SBN), the terms polypectomy, EMR, and ESD (88.4%, 92.1%, 90.2%, and 89.1% respectively). However, 26.9%, 43.2%, and 49.5% did not recognize the clear indications of polypectomy, EMR, and ESD respectively. Although 68.1% are convinced about the ERTs; 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 year. Only 25.8% of endoscopists feel confident in the management of ERTs-related complications. Only 4.2% of the centers had their endoscopes 100% armed with optical enhancements.
Research methods
This observational study began with the development of a questionnaire during May and June 2021, after agreement upon it an online 2-page questionnaire was developed and distributed through July 2021. The questionnaire was distributed through social media including WhatsApp and Facebook as well as emails from the national relevant scientific groups. The study focused on Egyptian physicians caring for patients with gastrointestinal health problems
Research results
The primary aim of our study was to assess the knowledge and attitude of Egyptian physicians caring patients with SBN toward the ERTs as potential curative methods. Furthermore, the practice of Egyptian endoscopists practicing ERTs was also investigated. The secondary endpoint was to assess the infrastructure of the endoscopy units regarding the manpower, scopes, and accessories, as well as policies within.
Research conclusions
In Egypt we have a growing endoscopy practice, however little is known about physician knowledge, attitude, and practice toward ERTs. Furthermore, the nationwide spread of endoscopy units needs to be explored as regards the suitability to run these advanced techniques.
Research perspectives
There is a global era in the management of SBN due to the introduction of advanced ERTs mainly EMR and ESD.
