Emeka Ray-Offor - Academia.edu (original) (raw)

Papers by Emeka Ray-Offor

Orient Journal of Medicine, 2015

Journal of the West African College of Surgeons, 2022

Oncology Journal of India, 2020

Background: Undocumented observations suggest a rising incidence of gastrointestinal tract cancer... more Background: Undocumented observations suggest a rising incidence of gastrointestinal tract cancers (GITc) among urban dwellers in Nigeria. Aim: The aim is to report on the incidence and clinic-pathological characteristics of GITc in Port Harcourt and its environs. Materials and Methods: Clinical, pathological, and demographic information on cancer patients obtained from various hospitals, radiology centers, and pathology laboratories within Port Harcourt and Obio-Akpor local government areas of Rivers state between 2008 and 2017 were reviewed. The information was coded using the International Classification of Diseases for Oncology, 3rd Edition and stored in Canreg 4 software in the Port Harcourt cancer registry. Results: GITc constituted the third-most common systemic cancers consisting of 12.2% (328 cases) with a male-to-female ratio of 1.05:1. The annual age-standardized rate ranged between 1.1–21.6/100,000 for females and 1.8–15.9/100,000 for males, with the highest rate recorded in 2017. The mean age was 51.2 ± 15.8 years with bimodal peak age groups of 50–54 and 55–59 years. The most common sites for GITc were colorectal followed by the liver and stomach consisting of 44.5%, 16.5%, and 15.2% of cases, respectively. Epithelial malignancies, i.e., carcinomas markedly predominated over malignancies of other cell types such as mesenchymal cell malignancies, lymphoreticular cell malignancies, and germ cell malignancies and constituted 92.4% of total GITc. Conclusion: GITc is posing a public health challenge in Port Harcourt and environs. A government-sponsored health plan on cancer control, including awareness campaigns on the adoption of more healthy lifestyles, hepatitis B vaccination, colonoscopy screening with prompt treatment, is advocated.

Pan African Medical Journal, 2021

Introduction: intrauterine pathologies were traditionally evaluated by blind dilatation and curet... more Introduction: intrauterine pathologies were traditionally evaluated by blind dilatation and curettage along with hysterosalpingography. Hysteroscopy is a veritable tool for evaluation of uterine cavity pathologies with an increasing availability in Nigeria. The study aims to report the diagnostic yield and therapeutic outcome of hysteroscopy in women with infertility from a Nigerian metropolis. Methods: a retrospective cross-sectional study of consecutive cases of infertile women referred for hysteroscopy to an ambulatory care endoscopy facility in Port Harcourt, Nigeria. The variables collated included age, parity, past gynaecological history, indication, hysteroscopy findings and interventions. Statistical analysis was performed using SPSS version 25. Results: included in study were 75 patients undergoing a total of 124 hysteroscopic procedures. The age range of patients was 25 to 56 years (mean 40.7 ± 5.9 years). A positive diagnostic yield of 93.3% with non-visualization of intracavitary uterine pathology in 5 patients was recorded. The most common pathologies were submucous myoma-25(31.3%), endometrial polyps-18(22.5%) and intrauterine adhesions-18(22.5%). There was no statistical difference between the mean age of patients with or without polyp, myoma and intrauterine adhesions (P = 0.185, P = 0.510 and P = 0.619 respectively) but a non-linear relationship between age and polyp detection (Eta2 = 0.024). Operative hysteroscopies were all performed on outpatient basis but staged in 30(40.0%) patients. Conclusion: benign uterine growths and intrauterine adhesions are frequent causes of uterine factor infertility. A high successful completion rate of hysteroscopic interventions was achieved.

Introduction: Colorectal cancer (CRC) is a disease of global importance. The practice and formula... more Introduction: Colorectal cancer (CRC) is a disease of global importance. The practice and formulation of effective health policies in developing countries is marred by lack of appropriate colorectal cancer screening and up-to-date cancer registry. Aims: To study the frequency and presentation pattern of CRC in two metropolitan cities in a region of Nigeria. Materials and Method: An observational study of lower gastrointestinal (GI) endoscopy performed from April 2013 to April 2018 at private/public health facilities with endoscopy service in 2 major cities in the Niger Delta area, Nigeria. A questionnaire was distributed for completion to all practicing endoscopists in the area. The variables collated included demographics, indications, endoscopic findings and histopathology. Analysis was done using IBM SPSS Statistics for Windows, version 20 Armonk, NY. Results: A total of 466 flexible lower GI endoscopies were recorded: 434 colonoscopies; 32 sigmoidoscopies. Histologically confirm...

African Journal for Infertility and Assisted Conception, 2021

Abnormal uterine bleeding (AUB) is change in frequency of menses, duration of flow or amount of b... more Abnormal uterine bleeding (AUB) is change in frequency of menses, duration of flow or amount of blood loss. It is a common gynaecological problem. Up to 33% of women referred to Gynaecological outpatient clinics have this problem and the proportion raises more in pre-and postmenopausal women. 1,2 This condition has enormous consequences with regard to social life, morbidity and clinical workload. 2,3 AUB may be due to various causes,

Cureus, 2021

Introduction Gastric cancer is a leading cause of cancer mortality worldwide. The burden of this ... more Introduction Gastric cancer is a leading cause of cancer mortality worldwide. The burden of this disease is highest in developing countries of East Asia, Eastern Europe, and parts of Central and Southern America. Africa, despite having a similar high profile of Helicobacter pylori infection with East Asia, has a reported low prevalence of gastric cancer. There is a paucity of data on the natural history and endoscopic presentation of gastric cancer in West Africa. Aim To study the topography and morphology of gastric cancer from two institutions in Southern Nigeria. Methods A cross-sectional retrospective study of 622 consecutive cases of upper gastrointestinal (GI) endoscopy performed in two referral endoscopy facilities in Port Harcourt, Rivers State, Nigeria from February 2012 to January 2021. Variables collated from centre records included age, sex, ethnicity, symptoms, site, endoscopic classification, and histology of gastric cancers. Statistical analysis was performed using IBM SPSS version 20 (IBM Corp., Armonk, NY). Results There were 17 (2.7%) cases of histologically confirmed gastric cancer. The age range of patients was from 34 years to 99 years (mean 60.7 ± 14.6 years). There were nine males and eight females (M:F ratio of 1.1:1). Antrum and cardia were predominantly affected in 10 (60.0%) and seven (6.7%) cases, respectively. Borrmann type 1 advanced gastric tumor was seen in seven (53.8%) and adenocarcinoma, the predominant histology, in 14 (82.4%) cases. Helicobacter pylori was detected in a sole case of gastric cancer. Conclusion Gastric cancer is uncommon in our environment and with a delayed presentation. A predominance of gastric antrum topography and exophytic growth morphology is the pattern.

Background : Biopsies occasioned by diseases affecting the lymphoreticular system are commonly en... more Background : Biopsies occasioned by diseases affecting the lymphoreticular system are commonly encountered in histopathology laboratory. Methods/ materials: A five-year retrospective study of lympho-reticular tissue biopsies seen in four different centers in the Niger Delta region of Nigeria was undertaken. Age, gender, site of lesion, clinical diagnoses were considered and tissue slides were reviewed. Results: Two hundred and forty six tissues comprising of 239 lymph nodes, 4 bone marrows and 3 splenic tissues were reviewed. One hundred and fourteen cases (46.3%) were males while 132 (53.6%) were females, giving male: female ratio of 1:1.2. The mean age was 29.6 years ± 24.1, and range was 11 months to 80 years. Adults of age range 20-39 years accounted for the highest number of biopsies. While neoplastic lesions consisting mainly of Non-Hodgkin lymphoma (NHL) and Hodgkin lymphoma (HL) dominated in adults, non-neoplastic lesions consisting mainly of reactive hyperplasia and Tubercu...

Nigerian Journal of Surgery : Official Publication of the Nigerian Surgical Research Society, 2021

Background: COVID-19 pandemic has affected surgical practice worldwide. Laparoscopic procedures u... more Background: COVID-19 pandemic has affected surgical practice worldwide. Laparoscopic procedures utilizing gas for pneumoperitoneum require specific consideration. Method: A panel of experts of the Laparoscopic Surgery Society of Nigeria (LASSON) was constituted to draft recommendations on the conduct of minimal access surgical (MAS) procedures during and after the pandemic in Nigeria. Results: The Society strongly believes that laparoscopy and other (MAS) procedures can be safely performed during and after the current COVID-19 pandemic if appropriate safety measures are adhered to. The Society therefore makes the following recommendations for all units performing MAS in Nigeria: (1) Design clear cut measures to navigate the pandemic in each hospital. (2) Triage surgical services and procedures. (3) Encourage screening and testing of all patients (4) Provide adequate patient communication and consenting (5) Ensure compulsory use of Personal Protective Equipments (PPEs) (6) Minimize p...

The Nigerian Health Journal, 2015

BACKGROUND Accurate diagnosis of disease conditions using laboratory, imaging or endoscopic inves... more BACKGROUND Accurate diagnosis of disease conditions using laboratory, imaging or endoscopic investigation is essential for appropriate treatment. There is paucity of data on upper GI endoscopy in Port-Harcourt. This audit of our early experience is intended to provide data on the pattern of endoscopy findings which is needed to improve the quality of patient care. The study aims to report the pattern of presentation as well as the endoscopic and pathologic findings of symptomatic upper gastro-intestinal disease conditions. METHOD All consecutive patients presenting to the endoscopy unit of a private hospital from February 2012to October 2013 were prospectively studied. The sociodemographic, indications, endoscopic findings and histopathologic report for biopsies were collated. Data was statistical analyzed using SPSS version 20. RESULTS There were 44 OGDs in 37 patients performed during the study period. Twenty-one were males and 16 females. A male: female ratio of 1.3:1 and age ran...

Background: Rubber band ligation is widely practiced for treatment of haemorrhoidal disease. Aims... more Background: Rubber band ligation is widely practiced for treatment of haemorrhoidal disease. Aims: To study the early and long-term outcome of rubber band ligation for grades I-III haemorrhoids. Study Design: A prospective cohort study. Place and Duration of Study: Oak Endoscopy Centre (Digestive Disease Unit) Port Harcourt, Rivers State Nigeria between June 2017, and October 2020.l Methodology: We included one hundred and thirteen cases of rubber band ligations in 41 patients (32 males and 9 female; 24-75 years), with haemorrhoids of varying grades. The variables studied were sociodemographic, presenting complaints, anti-platelet/ anti-clotting drug history, sites of haemorrhoids, sessions of haemorrhoidal rubber band ligation, early and long-term outcome. Statistical analysis was done using IBM SPSS version 20. Results: The mean age of study patients was 51.3 ± 13.0 years and there were 9(22.0%) patients with grade I haemorrhoids, 17 (41.4%) grade II, and 15 (36.6%) gade III. The ...

Pan African Medical Journal, 2021

Introduction an adequate bowel preparation is essential for good mucosal inspection during colono... more Introduction an adequate bowel preparation is essential for good mucosal inspection during colonoscopy. This study aims to compare the efficacy of two validated oral lavage solutions for colonoscopy preparation in African patients. Methods a prospective observational study of patients undergoing colonoscopy in a referral endoscopy facility in Port Harcourt, Nigeria, using sodium picosulfate magnesium citrate (SPMC) and 4L split-dose polyethylene glycol (PEG). Variables collated were sociodemographic, primary indication, comorbidities, Aronchick bowel preparation scale, polyp/adenoma detection, caecal intubation and outcome. Statistical analysis was performed using IBM SPSS version 20. Results one hundred and twenty-four patients received PEG prior to colonoscopy and SPMC in 175 patients. The age range was from 22 to 92 years; mean age of 53.8 ± 14.2 years for PEG group and 55.3 ± 13.2 years for SPMC group (p=0.361). There were 215 males and 84 females. An excellent/good bowel preparation scale was recorded in 77 (62%) PEG group and 130 (74.3%) for SPMC group (p=0.592). PEG was predominantly used in the early years of endoscopists practice with the odds ratio (OR) of no polyp detection in the PEG vs SPMC groups as 1.64 (confidence interval CI 1.06-2.55) versus 0.76 (CI 0.62-0.92), respectively (p=0.016). For no adenoma detection, OR was 4.18 (CI 1.12-15.60) versus OR 0.63 (CI 0.52-0.75), respectively (p=0.012). Conclusion there is similar efficacy profile using either split volume PEG or SPMC prior to colonoscopy in these African patients. Polyp and adenoma detection rates are highly dependent on the expertise of the endoscopist.

European Journal of Medical and Health Sciences, 2021

Background: Hernia repair is one of the most common procedures performed by general surgeons, mos... more Background: Hernia repair is one of the most common procedures performed by general surgeons, mostly in an elective setting. The true incidence/prevalence of hernias in Nigeria is unknown, however, suture (tissue) repair is predominantly reported. Aims: To study the distribution of adult abdominal wall hernia and the surgical and anaesthetic techniques for elective repair in a Nigerian tertiary hospital. Methods: A retrospective cross-sectional study of surgical patients undergoing elective abdominal wall hernia repair in University of Port Harcourt Teaching Hospital Nigeria from January 2009 to December 2014. Data extracted from the theatre records were patients’ demographic, type of hernia, repair technique, anaesthesia, operating time, and cadre of performing surgeon. Statistical analysis was performed using SPSS version 20. Results: A total of 400 adult patients had elective repair of abdominal wall hernias during study period. The age range was from 17- 85 years (mean 39.3 ± 6....

African Health Sciences, 2020

Background: Epidemiological studies on peptic ulcer disease (PUD) have shown a recent decrease in... more Background: Epidemiological studies on peptic ulcer disease (PUD) have shown a recent decrease in hospital admissions in Western countries. Objective: This paper aimed to study the current status and risk factors of PUD in a Nigerian metropolis. Methods: A cross-sectional study of symptomatic patients at upper gastrointestinal (GI) endoscopy diagnosed with PUD from February 2014 to September 2019 at a referral endoscopy facility in Port Harcourt, Niger delta region of Nigeria. The variables studied included demographics, symptoms and duration, blood group, chronic non-steroidal anti-inflammatory (NSAID) use, smoking, endoscopic and histology findings. Statistical analysis was performed using SPSS version 20. Results: A total of 434 upper GI endoscopies were performed during the study period with thirty-one diagnosis of PUD made. The mean age of gastric ulcer (GU) and duodenal ulcer (DU) cases were 54.4 ± 20.2yrs and 48.1 ± 14.5yrs respectively (p = 0.367). GU to DU ratio was 1.4:1. ...

Cureus, 2021

Background and aim Clinical and endoscopic parameters are predictive of patient outcome following... more Background and aim Clinical and endoscopic parameters are predictive of patient outcome following acute upper gastrointestinal bleeding. The study aimed to investigate factors related to re-bleed and mortality following initial endoscopy among Nigerian patients with recent upper gastrointestinal bleeding (UGIB). Methods This is a cohort study of patients undergoing endoscopy for recent-onset UGIB at a referral endoscopy facility in Port Harcourt, Rivers State, Nigeria, from April 2014 to November 2020. Patients' demographic and clinical data, American Society of Anesthesiologists (ASA) physical status, amount of blood transfusion, endoscopy results, and Rockall scores were retrieved from patients' charts. The re-bleed and mortality rates were noted on follow-up by telephone. Statistical analysis was performed using SPSS version 20 (IMB Inc., Armonk, USA). Results A total of 560 patients had flexible video oesophagogastroduodenoscopy during the study period, and 46 (8.2%) of these were included in the study. Their age ranged from 28 years to 84 years (mean 58.6 ± 15.8 years) with 32 (69.6%) males and 14 (30.4%) females. Peptic ulcer disease (PUD) and gastritis/gastric erosions were the leading endoscopic diagnoses in 24 (52.2%) and 12 (26.1%) patients, respectively. Multiple comorbidities (p=0.021) and higher ASA score (mean 3.0; 95% confidence interval CI: 2.47-3.53; p=0.021) are associated with re-bleed, which was recorded in seven (15.2%) patients. Four (8.7%) cases of mortality were recorded in patients with a mean full Rockall score of 4.25 (95% CI: 1.52-6.97; p=0.021). Conclusion Re-bleed is more common in patients with multiple comorbidities, ASA score of three or more, and bleeding gastro-oesophageal varices at initial endoscopy. Mortality was significantly higher in patients with a full Rockall score of more than three.

Gastroenterology, Hepatology and Endoscopy, 2019

Journal of Clinical Gastroenterology and Hepatology, 2018

Background: Colonoscopy is the gold standard for diagnosis and screening of colorectal cancer. Th... more Background: Colonoscopy is the gold standard for diagnosis and screening of colorectal cancer. There is an increasing utilization of this gastroenterology service in recent years. Aim: To study the diagnostic yield of colonoscopy in a metropolitan city of Nigeria. Patients and method: A prospective study of all consecutive patients undergoing colonoscopy in a referral endoscopy facility in Port Harcourt metropolis of Nigeria between March 2014 and September 2017. Data collated included: age, sex, location/type of lesion found by colonoscopy and pathologic diagnosis. Statistical analysis was done using SPSS for Windows and Version 20.0 (Armonk, NY: IBM Corp). Results: A total of 212 colonoscopies were performed in 210 patients. The age range was from 4 to 86 years; mean age of 53.5 ± 13.9 years. There were 148 males and 64 females; M: F ratio of 2.3:1. A total of 176 (83.0%) procedures had a positive diagnostic yield and the site distribution of pathologies included: anus/anal canal 128 (41.3%); recto-sigmoid 76 (24.6%); transverse colon 44 (14.4%). Haemorrhoids 112 (54.4%); diverticular disease 27 (13.1%) and polyps were frequent findings with multiple pathologies seen in 74 (34.7%) cases. Conclusion: Colonoscopy has a high diagnostic yield in middle-aged population with a high rate of multiple pathologies seen. Diverticular disease is not uncommon among the studied population as traditionally reported.

Gastroenterology Insights, 2019

Colonoscopy is a screening tool for colorectal cancer. The cost of this service, ready availabili... more Colonoscopy is a screening tool for colorectal cancer. The cost of this service, ready availability and expertise are factors limiting its routine use in low-/middle-income countries. The aim was to study premalignant colonic polyps in asymptomatic middle-aged Nigerians and highlight the usefulness of screening colonoscopy in a sub-Saharan African population. We carried out an observational study on asymptomatic patients undergoing screening colonoscopy in a referral endoscopy facility in Port Harcourt, Rivers State, Nigeria from January to December 2018. The variables collated were demographics, endoscopic and histologic findings. Statistical analysis was done using IBM SPSS Statistics for Windows, version 20 Armonk, NY. A total of 144 colonoscopy procedures were performed during the study period with 70 asymptomatic cases for screening indication. Sixty-five were males and 5 females. The age range was from 48 years to 60 years; mean 54.8 ± 3.6 years. A polyp-detection rate of 53.7...

Annals of African Medicine, 2019

Background: An engorgement and prolapse of the anal cushion lead to haemorrhoidal disease. There ... more Background: An engorgement and prolapse of the anal cushion lead to haemorrhoidal disease. There are different anatomical sites and presentation of this common pathology which affects the quality of life. Aims: To study the predilection sites, presentation and treatment of haemorrhoidal disease. Patients and Method: A cohort study of patients diagnosed with haemorrhoids at an Endoscopy centre in Port Harcourt, Rivers State Nigeria from February 2014- July 2017.The patients were divided into 2 groups: A - asymptomatic and B- symptomatic. Variables studied included: demographics, anatomic variations, grade of haemorrhoids, clinical presentation and treatment. Statistical analysis was performed using IBM SPSS Statistics for Windows, version 20.0. Armonk, NY. Results: One hundred and twenty- one cases were included in study. There were 76 males and 45 males with age range from 15 -80 years (mean 51.9±13.1yrs). Bleeding per rectum was the most common presentation. The position frequency of haemorrhoids in decreasing order were: right posterior (34.1%); right anterior (28.2%); left lateral (17.1%); left posterior (7.6%). Multiple quadrants were affected in 58(72.5%) cases of external haemorrhoids. Grade I, II and III haemorrhoids were seen in 38 (31%), 31(26%) and 21(17%) cases respectively. Conclusion: The most common anatomical site of external haemorrhoids is the right posterior quadrant position; frequently, multiple sites are simultaneously affected. Goligher classification Grade 1 hemorrhoids are effectively treated by injection sclerotherapy using 50% dextrose solution; a cheap and physiologic sclerotherapy agent.

Endoscopy, 2017

Background and study aim Inadequate bowel cleansing negatively affects the efficiency of colonosc... more Background and study aim Inadequate bowel cleansing negatively affects the efficiency of colonoscopy in routine clinical practice. The aim of this study was to design and validate a predictive model for inadequate bowel cleanliness. Patients and methods The model was built from 667 consecutive outpatients (development cohort) who were prospectively scheduled for colonoscopy between June and September 2014. The validation cohort included 409 outpatients who underwent colonoscopy between October and December 2014. Cleansing was evaluated using the Boston Bowel Preparation Scale (BBPS). Bowel preparation was administered on the same day as the examination. Results In the development cohort, BBPS was adequate in 541 patients (81.1 %). At multivariate analysis, antidepressants (odds ratio [OR] 4.25, 95 % confidence interval [CI] 1.91 – 9.47), co-morbidity (OR 3.35, 95 %CI 2.16 – 5.18), constipation (OR 2.09, 95 %CI 1.29 – 3.40), and abdominal/pelvic surgery (OR 1.60, 95 %CI 1.03 – 2.47) ...

Orient Journal of Medicine, 2015

Journal of the West African College of Surgeons, 2022

Oncology Journal of India, 2020

Background: Undocumented observations suggest a rising incidence of gastrointestinal tract cancer... more Background: Undocumented observations suggest a rising incidence of gastrointestinal tract cancers (GITc) among urban dwellers in Nigeria. Aim: The aim is to report on the incidence and clinic-pathological characteristics of GITc in Port Harcourt and its environs. Materials and Methods: Clinical, pathological, and demographic information on cancer patients obtained from various hospitals, radiology centers, and pathology laboratories within Port Harcourt and Obio-Akpor local government areas of Rivers state between 2008 and 2017 were reviewed. The information was coded using the International Classification of Diseases for Oncology, 3rd Edition and stored in Canreg 4 software in the Port Harcourt cancer registry. Results: GITc constituted the third-most common systemic cancers consisting of 12.2% (328 cases) with a male-to-female ratio of 1.05:1. The annual age-standardized rate ranged between 1.1–21.6/100,000 for females and 1.8–15.9/100,000 for males, with the highest rate recorded in 2017. The mean age was 51.2 ± 15.8 years with bimodal peak age groups of 50–54 and 55–59 years. The most common sites for GITc were colorectal followed by the liver and stomach consisting of 44.5%, 16.5%, and 15.2% of cases, respectively. Epithelial malignancies, i.e., carcinomas markedly predominated over malignancies of other cell types such as mesenchymal cell malignancies, lymphoreticular cell malignancies, and germ cell malignancies and constituted 92.4% of total GITc. Conclusion: GITc is posing a public health challenge in Port Harcourt and environs. A government-sponsored health plan on cancer control, including awareness campaigns on the adoption of more healthy lifestyles, hepatitis B vaccination, colonoscopy screening with prompt treatment, is advocated.

Pan African Medical Journal, 2021

Introduction: intrauterine pathologies were traditionally evaluated by blind dilatation and curet... more Introduction: intrauterine pathologies were traditionally evaluated by blind dilatation and curettage along with hysterosalpingography. Hysteroscopy is a veritable tool for evaluation of uterine cavity pathologies with an increasing availability in Nigeria. The study aims to report the diagnostic yield and therapeutic outcome of hysteroscopy in women with infertility from a Nigerian metropolis. Methods: a retrospective cross-sectional study of consecutive cases of infertile women referred for hysteroscopy to an ambulatory care endoscopy facility in Port Harcourt, Nigeria. The variables collated included age, parity, past gynaecological history, indication, hysteroscopy findings and interventions. Statistical analysis was performed using SPSS version 25. Results: included in study were 75 patients undergoing a total of 124 hysteroscopic procedures. The age range of patients was 25 to 56 years (mean 40.7 ± 5.9 years). A positive diagnostic yield of 93.3% with non-visualization of intracavitary uterine pathology in 5 patients was recorded. The most common pathologies were submucous myoma-25(31.3%), endometrial polyps-18(22.5%) and intrauterine adhesions-18(22.5%). There was no statistical difference between the mean age of patients with or without polyp, myoma and intrauterine adhesions (P = 0.185, P = 0.510 and P = 0.619 respectively) but a non-linear relationship between age and polyp detection (Eta2 = 0.024). Operative hysteroscopies were all performed on outpatient basis but staged in 30(40.0%) patients. Conclusion: benign uterine growths and intrauterine adhesions are frequent causes of uterine factor infertility. A high successful completion rate of hysteroscopic interventions was achieved.

Introduction: Colorectal cancer (CRC) is a disease of global importance. The practice and formula... more Introduction: Colorectal cancer (CRC) is a disease of global importance. The practice and formulation of effective health policies in developing countries is marred by lack of appropriate colorectal cancer screening and up-to-date cancer registry. Aims: To study the frequency and presentation pattern of CRC in two metropolitan cities in a region of Nigeria. Materials and Method: An observational study of lower gastrointestinal (GI) endoscopy performed from April 2013 to April 2018 at private/public health facilities with endoscopy service in 2 major cities in the Niger Delta area, Nigeria. A questionnaire was distributed for completion to all practicing endoscopists in the area. The variables collated included demographics, indications, endoscopic findings and histopathology. Analysis was done using IBM SPSS Statistics for Windows, version 20 Armonk, NY. Results: A total of 466 flexible lower GI endoscopies were recorded: 434 colonoscopies; 32 sigmoidoscopies. Histologically confirm...

African Journal for Infertility and Assisted Conception, 2021

Abnormal uterine bleeding (AUB) is change in frequency of menses, duration of flow or amount of b... more Abnormal uterine bleeding (AUB) is change in frequency of menses, duration of flow or amount of blood loss. It is a common gynaecological problem. Up to 33% of women referred to Gynaecological outpatient clinics have this problem and the proportion raises more in pre-and postmenopausal women. 1,2 This condition has enormous consequences with regard to social life, morbidity and clinical workload. 2,3 AUB may be due to various causes,

Cureus, 2021

Introduction Gastric cancer is a leading cause of cancer mortality worldwide. The burden of this ... more Introduction Gastric cancer is a leading cause of cancer mortality worldwide. The burden of this disease is highest in developing countries of East Asia, Eastern Europe, and parts of Central and Southern America. Africa, despite having a similar high profile of Helicobacter pylori infection with East Asia, has a reported low prevalence of gastric cancer. There is a paucity of data on the natural history and endoscopic presentation of gastric cancer in West Africa. Aim To study the topography and morphology of gastric cancer from two institutions in Southern Nigeria. Methods A cross-sectional retrospective study of 622 consecutive cases of upper gastrointestinal (GI) endoscopy performed in two referral endoscopy facilities in Port Harcourt, Rivers State, Nigeria from February 2012 to January 2021. Variables collated from centre records included age, sex, ethnicity, symptoms, site, endoscopic classification, and histology of gastric cancers. Statistical analysis was performed using IBM SPSS version 20 (IBM Corp., Armonk, NY). Results There were 17 (2.7%) cases of histologically confirmed gastric cancer. The age range of patients was from 34 years to 99 years (mean 60.7 ± 14.6 years). There were nine males and eight females (M:F ratio of 1.1:1). Antrum and cardia were predominantly affected in 10 (60.0%) and seven (6.7%) cases, respectively. Borrmann type 1 advanced gastric tumor was seen in seven (53.8%) and adenocarcinoma, the predominant histology, in 14 (82.4%) cases. Helicobacter pylori was detected in a sole case of gastric cancer. Conclusion Gastric cancer is uncommon in our environment and with a delayed presentation. A predominance of gastric antrum topography and exophytic growth morphology is the pattern.

Background : Biopsies occasioned by diseases affecting the lymphoreticular system are commonly en... more Background : Biopsies occasioned by diseases affecting the lymphoreticular system are commonly encountered in histopathology laboratory. Methods/ materials: A five-year retrospective study of lympho-reticular tissue biopsies seen in four different centers in the Niger Delta region of Nigeria was undertaken. Age, gender, site of lesion, clinical diagnoses were considered and tissue slides were reviewed. Results: Two hundred and forty six tissues comprising of 239 lymph nodes, 4 bone marrows and 3 splenic tissues were reviewed. One hundred and fourteen cases (46.3%) were males while 132 (53.6%) were females, giving male: female ratio of 1:1.2. The mean age was 29.6 years ± 24.1, and range was 11 months to 80 years. Adults of age range 20-39 years accounted for the highest number of biopsies. While neoplastic lesions consisting mainly of Non-Hodgkin lymphoma (NHL) and Hodgkin lymphoma (HL) dominated in adults, non-neoplastic lesions consisting mainly of reactive hyperplasia and Tubercu...

Nigerian Journal of Surgery : Official Publication of the Nigerian Surgical Research Society, 2021

Background: COVID-19 pandemic has affected surgical practice worldwide. Laparoscopic procedures u... more Background: COVID-19 pandemic has affected surgical practice worldwide. Laparoscopic procedures utilizing gas for pneumoperitoneum require specific consideration. Method: A panel of experts of the Laparoscopic Surgery Society of Nigeria (LASSON) was constituted to draft recommendations on the conduct of minimal access surgical (MAS) procedures during and after the pandemic in Nigeria. Results: The Society strongly believes that laparoscopy and other (MAS) procedures can be safely performed during and after the current COVID-19 pandemic if appropriate safety measures are adhered to. The Society therefore makes the following recommendations for all units performing MAS in Nigeria: (1) Design clear cut measures to navigate the pandemic in each hospital. (2) Triage surgical services and procedures. (3) Encourage screening and testing of all patients (4) Provide adequate patient communication and consenting (5) Ensure compulsory use of Personal Protective Equipments (PPEs) (6) Minimize p...

The Nigerian Health Journal, 2015

BACKGROUND Accurate diagnosis of disease conditions using laboratory, imaging or endoscopic inves... more BACKGROUND Accurate diagnosis of disease conditions using laboratory, imaging or endoscopic investigation is essential for appropriate treatment. There is paucity of data on upper GI endoscopy in Port-Harcourt. This audit of our early experience is intended to provide data on the pattern of endoscopy findings which is needed to improve the quality of patient care. The study aims to report the pattern of presentation as well as the endoscopic and pathologic findings of symptomatic upper gastro-intestinal disease conditions. METHOD All consecutive patients presenting to the endoscopy unit of a private hospital from February 2012to October 2013 were prospectively studied. The sociodemographic, indications, endoscopic findings and histopathologic report for biopsies were collated. Data was statistical analyzed using SPSS version 20. RESULTS There were 44 OGDs in 37 patients performed during the study period. Twenty-one were males and 16 females. A male: female ratio of 1.3:1 and age ran...

Background: Rubber band ligation is widely practiced for treatment of haemorrhoidal disease. Aims... more Background: Rubber band ligation is widely practiced for treatment of haemorrhoidal disease. Aims: To study the early and long-term outcome of rubber band ligation for grades I-III haemorrhoids. Study Design: A prospective cohort study. Place and Duration of Study: Oak Endoscopy Centre (Digestive Disease Unit) Port Harcourt, Rivers State Nigeria between June 2017, and October 2020.l Methodology: We included one hundred and thirteen cases of rubber band ligations in 41 patients (32 males and 9 female; 24-75 years), with haemorrhoids of varying grades. The variables studied were sociodemographic, presenting complaints, anti-platelet/ anti-clotting drug history, sites of haemorrhoids, sessions of haemorrhoidal rubber band ligation, early and long-term outcome. Statistical analysis was done using IBM SPSS version 20. Results: The mean age of study patients was 51.3 ± 13.0 years and there were 9(22.0%) patients with grade I haemorrhoids, 17 (41.4%) grade II, and 15 (36.6%) gade III. The ...

Pan African Medical Journal, 2021

Introduction an adequate bowel preparation is essential for good mucosal inspection during colono... more Introduction an adequate bowel preparation is essential for good mucosal inspection during colonoscopy. This study aims to compare the efficacy of two validated oral lavage solutions for colonoscopy preparation in African patients. Methods a prospective observational study of patients undergoing colonoscopy in a referral endoscopy facility in Port Harcourt, Nigeria, using sodium picosulfate magnesium citrate (SPMC) and 4L split-dose polyethylene glycol (PEG). Variables collated were sociodemographic, primary indication, comorbidities, Aronchick bowel preparation scale, polyp/adenoma detection, caecal intubation and outcome. Statistical analysis was performed using IBM SPSS version 20. Results one hundred and twenty-four patients received PEG prior to colonoscopy and SPMC in 175 patients. The age range was from 22 to 92 years; mean age of 53.8 ± 14.2 years for PEG group and 55.3 ± 13.2 years for SPMC group (p=0.361). There were 215 males and 84 females. An excellent/good bowel preparation scale was recorded in 77 (62%) PEG group and 130 (74.3%) for SPMC group (p=0.592). PEG was predominantly used in the early years of endoscopists practice with the odds ratio (OR) of no polyp detection in the PEG vs SPMC groups as 1.64 (confidence interval CI 1.06-2.55) versus 0.76 (CI 0.62-0.92), respectively (p=0.016). For no adenoma detection, OR was 4.18 (CI 1.12-15.60) versus OR 0.63 (CI 0.52-0.75), respectively (p=0.012). Conclusion there is similar efficacy profile using either split volume PEG or SPMC prior to colonoscopy in these African patients. Polyp and adenoma detection rates are highly dependent on the expertise of the endoscopist.

European Journal of Medical and Health Sciences, 2021

Background: Hernia repair is one of the most common procedures performed by general surgeons, mos... more Background: Hernia repair is one of the most common procedures performed by general surgeons, mostly in an elective setting. The true incidence/prevalence of hernias in Nigeria is unknown, however, suture (tissue) repair is predominantly reported. Aims: To study the distribution of adult abdominal wall hernia and the surgical and anaesthetic techniques for elective repair in a Nigerian tertiary hospital. Methods: A retrospective cross-sectional study of surgical patients undergoing elective abdominal wall hernia repair in University of Port Harcourt Teaching Hospital Nigeria from January 2009 to December 2014. Data extracted from the theatre records were patients’ demographic, type of hernia, repair technique, anaesthesia, operating time, and cadre of performing surgeon. Statistical analysis was performed using SPSS version 20. Results: A total of 400 adult patients had elective repair of abdominal wall hernias during study period. The age range was from 17- 85 years (mean 39.3 ± 6....

African Health Sciences, 2020

Background: Epidemiological studies on peptic ulcer disease (PUD) have shown a recent decrease in... more Background: Epidemiological studies on peptic ulcer disease (PUD) have shown a recent decrease in hospital admissions in Western countries. Objective: This paper aimed to study the current status and risk factors of PUD in a Nigerian metropolis. Methods: A cross-sectional study of symptomatic patients at upper gastrointestinal (GI) endoscopy diagnosed with PUD from February 2014 to September 2019 at a referral endoscopy facility in Port Harcourt, Niger delta region of Nigeria. The variables studied included demographics, symptoms and duration, blood group, chronic non-steroidal anti-inflammatory (NSAID) use, smoking, endoscopic and histology findings. Statistical analysis was performed using SPSS version 20. Results: A total of 434 upper GI endoscopies were performed during the study period with thirty-one diagnosis of PUD made. The mean age of gastric ulcer (GU) and duodenal ulcer (DU) cases were 54.4 ± 20.2yrs and 48.1 ± 14.5yrs respectively (p = 0.367). GU to DU ratio was 1.4:1. ...

Cureus, 2021

Background and aim Clinical and endoscopic parameters are predictive of patient outcome following... more Background and aim Clinical and endoscopic parameters are predictive of patient outcome following acute upper gastrointestinal bleeding. The study aimed to investigate factors related to re-bleed and mortality following initial endoscopy among Nigerian patients with recent upper gastrointestinal bleeding (UGIB). Methods This is a cohort study of patients undergoing endoscopy for recent-onset UGIB at a referral endoscopy facility in Port Harcourt, Rivers State, Nigeria, from April 2014 to November 2020. Patients' demographic and clinical data, American Society of Anesthesiologists (ASA) physical status, amount of blood transfusion, endoscopy results, and Rockall scores were retrieved from patients' charts. The re-bleed and mortality rates were noted on follow-up by telephone. Statistical analysis was performed using SPSS version 20 (IMB Inc., Armonk, USA). Results A total of 560 patients had flexible video oesophagogastroduodenoscopy during the study period, and 46 (8.2%) of these were included in the study. Their age ranged from 28 years to 84 years (mean 58.6 ± 15.8 years) with 32 (69.6%) males and 14 (30.4%) females. Peptic ulcer disease (PUD) and gastritis/gastric erosions were the leading endoscopic diagnoses in 24 (52.2%) and 12 (26.1%) patients, respectively. Multiple comorbidities (p=0.021) and higher ASA score (mean 3.0; 95% confidence interval CI: 2.47-3.53; p=0.021) are associated with re-bleed, which was recorded in seven (15.2%) patients. Four (8.7%) cases of mortality were recorded in patients with a mean full Rockall score of 4.25 (95% CI: 1.52-6.97; p=0.021). Conclusion Re-bleed is more common in patients with multiple comorbidities, ASA score of three or more, and bleeding gastro-oesophageal varices at initial endoscopy. Mortality was significantly higher in patients with a full Rockall score of more than three.

Gastroenterology, Hepatology and Endoscopy, 2019

Journal of Clinical Gastroenterology and Hepatology, 2018

Background: Colonoscopy is the gold standard for diagnosis and screening of colorectal cancer. Th... more Background: Colonoscopy is the gold standard for diagnosis and screening of colorectal cancer. There is an increasing utilization of this gastroenterology service in recent years. Aim: To study the diagnostic yield of colonoscopy in a metropolitan city of Nigeria. Patients and method: A prospective study of all consecutive patients undergoing colonoscopy in a referral endoscopy facility in Port Harcourt metropolis of Nigeria between March 2014 and September 2017. Data collated included: age, sex, location/type of lesion found by colonoscopy and pathologic diagnosis. Statistical analysis was done using SPSS for Windows and Version 20.0 (Armonk, NY: IBM Corp). Results: A total of 212 colonoscopies were performed in 210 patients. The age range was from 4 to 86 years; mean age of 53.5 ± 13.9 years. There were 148 males and 64 females; M: F ratio of 2.3:1. A total of 176 (83.0%) procedures had a positive diagnostic yield and the site distribution of pathologies included: anus/anal canal 128 (41.3%); recto-sigmoid 76 (24.6%); transverse colon 44 (14.4%). Haemorrhoids 112 (54.4%); diverticular disease 27 (13.1%) and polyps were frequent findings with multiple pathologies seen in 74 (34.7%) cases. Conclusion: Colonoscopy has a high diagnostic yield in middle-aged population with a high rate of multiple pathologies seen. Diverticular disease is not uncommon among the studied population as traditionally reported.

Gastroenterology Insights, 2019

Colonoscopy is a screening tool for colorectal cancer. The cost of this service, ready availabili... more Colonoscopy is a screening tool for colorectal cancer. The cost of this service, ready availability and expertise are factors limiting its routine use in low-/middle-income countries. The aim was to study premalignant colonic polyps in asymptomatic middle-aged Nigerians and highlight the usefulness of screening colonoscopy in a sub-Saharan African population. We carried out an observational study on asymptomatic patients undergoing screening colonoscopy in a referral endoscopy facility in Port Harcourt, Rivers State, Nigeria from January to December 2018. The variables collated were demographics, endoscopic and histologic findings. Statistical analysis was done using IBM SPSS Statistics for Windows, version 20 Armonk, NY. A total of 144 colonoscopy procedures were performed during the study period with 70 asymptomatic cases for screening indication. Sixty-five were males and 5 females. The age range was from 48 years to 60 years; mean 54.8 ± 3.6 years. A polyp-detection rate of 53.7...

Annals of African Medicine, 2019

Background: An engorgement and prolapse of the anal cushion lead to haemorrhoidal disease. There ... more Background: An engorgement and prolapse of the anal cushion lead to haemorrhoidal disease. There are different anatomical sites and presentation of this common pathology which affects the quality of life. Aims: To study the predilection sites, presentation and treatment of haemorrhoidal disease. Patients and Method: A cohort study of patients diagnosed with haemorrhoids at an Endoscopy centre in Port Harcourt, Rivers State Nigeria from February 2014- July 2017.The patients were divided into 2 groups: A - asymptomatic and B- symptomatic. Variables studied included: demographics, anatomic variations, grade of haemorrhoids, clinical presentation and treatment. Statistical analysis was performed using IBM SPSS Statistics for Windows, version 20.0. Armonk, NY. Results: One hundred and twenty- one cases were included in study. There were 76 males and 45 males with age range from 15 -80 years (mean 51.9±13.1yrs). Bleeding per rectum was the most common presentation. The position frequency of haemorrhoids in decreasing order were: right posterior (34.1%); right anterior (28.2%); left lateral (17.1%); left posterior (7.6%). Multiple quadrants were affected in 58(72.5%) cases of external haemorrhoids. Grade I, II and III haemorrhoids were seen in 38 (31%), 31(26%) and 21(17%) cases respectively. Conclusion: The most common anatomical site of external haemorrhoids is the right posterior quadrant position; frequently, multiple sites are simultaneously affected. Goligher classification Grade 1 hemorrhoids are effectively treated by injection sclerotherapy using 50% dextrose solution; a cheap and physiologic sclerotherapy agent.

Endoscopy, 2017

Background and study aim Inadequate bowel cleansing negatively affects the efficiency of colonosc... more Background and study aim Inadequate bowel cleansing negatively affects the efficiency of colonoscopy in routine clinical practice. The aim of this study was to design and validate a predictive model for inadequate bowel cleanliness. Patients and methods The model was built from 667 consecutive outpatients (development cohort) who were prospectively scheduled for colonoscopy between June and September 2014. The validation cohort included 409 outpatients who underwent colonoscopy between October and December 2014. Cleansing was evaluated using the Boston Bowel Preparation Scale (BBPS). Bowel preparation was administered on the same day as the examination. Results In the development cohort, BBPS was adequate in 541 patients (81.1 %). At multivariate analysis, antidepressants (odds ratio [OR] 4.25, 95 % confidence interval [CI] 1.91 – 9.47), co-morbidity (OR 3.35, 95 %CI 2.16 – 5.18), constipation (OR 2.09, 95 %CI 1.29 – 3.40), and abdominal/pelvic surgery (OR 1.60, 95 %CI 1.03 – 2.47) ...