Roro GM, Roro EM, Abebe DM. Addressing gastrointestinal disorders in rural Ethiopia: Success of a weekend outreach colonoscopy service. World J Gastrointest Endosc 2025; 17(9): 110476 [DOI: 10.4253/wjge.v17.i9.110476]
Corresponding Author of This Article
Guda M Roro, Assistant Professor, Consultant, Department of Internal Medicine, Division of Gastroenterology and Hepatology, Addis Ababa University, College of Health Sciences, Zambia Street, Addis Ababa 55215, Lideta Sub city, Ethiopia. gudamerda2@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Endosc. Sep 16, 2025; 17(9): 110476 Published online Sep 16, 2025. doi: 10.4253/wjge.v17.i9.110476
Addressing gastrointestinal disorders in rural Ethiopia: Success of a weekend outreach colonoscopy service
Guda M Roro, Elias M Roro, Dabessa M Abebe
Guda M Roro, Department of Internal Medicine, Division of Gastroenterology and Hepatology, Addis Ababa University, College of Health Sciences, Addis Ababa 55215, Lideta Sub city, Ethiopia
Elias M Roro, Department of Public Health, Wollega University, Nekemte 55215, Oromiya, Ethiopia
Dabessa M Abebe, Department of Surgery, Jimma University, Jima 378, Oromiya, Ethiopia
Author contributions: Roro GM led the conception of the study, acquisition of data, design of the study, and drafting of the article; Roro GM, Roro EM, and Abebe DM participated in data cleaning and analysis and interpretation of data; All authors participated in drafting the article, contributed in critical revisions of intellectual content of the manuscript, and provided final approval of the version of the article to be published.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of Jimma University Institute of Health (No. JUIH/IRB/359/23).
Informed consent statement: All patients, or their legal guardians, provided informed written consent prior to the colonoscopy procedure.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest to disclose.
Data sharing statement: Microsoft Excel data on the basic information used for the study is available upon request.
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: Guda M Roro, Assistant Professor, Consultant, Department of Internal Medicine, Division of Gastroenterology and Hepatology, Addis Ababa University, College of Health Sciences, Zambia Street, Addis Ababa 55215, Lideta Sub city, Ethiopia. gudamerda2@gmail.com
Received: June 10, 2025 Revised: July 7, 2025 Accepted: August 4, 2025 Published online: September 16, 2025 Processing time: 97 Days and 15 Hours
Abstract
BACKGROUND
Colonoscopy is essential for screening, diagnosing, and treating lower gastrointestinal diseases; however, access is limited in resource-constrained areas. Barriers to endoscopy services include a shortage of trained specialists and inadequate equipment and infrastructure. Most gastroenterologists in Ethiopia work in major cities, leaving the 80% rural population with limited access to endoscopy due to economic and logistical challenges. Such inequitable access negatively impacts optimal patient care and outcomes and potentially skews data on disease prevalence. To address these issues we implemented weekend outreach endoscopy program in Southwest Ethiopia where such services were previously unavailable. Findings were documented electronically and stored safely.
AIM
To evaluate the findings, success, and impact of weekend outreach colonoscopy services in predominantly rural Southwest Ethiopia.
METHODS
In partnership with Jimma Awetu Hospital, a senior gastroenterologist from Addis Ababa University established an outreach endoscopy service in 2019, training local nursing staff as coordinators. Physicians selected and referred patients for colonoscopy, and informed consent was obtained before the procedure. A total of 1612 procedures were performed using a portable Fujinon EPX-2500-HD system, and findings were documented electronically. Data were analyzed using descriptive statistics on Statistical Package for the Social Sciences 29.
RESULTS
From 2019 to 2024 1612 colonoscopy procedures were performed, achieving an 83.0% diagnostic yield. The cohort was predominantly male (70.6%) with a mean age of 44 years; 61% were under 50. Ninety-one percent of patients were referred by 21 hospitals across three regions. Primary indications included abdominal pain (26.8%) and lower gastrointestinal bleeding (25.3%). Abnormal findings included inflammation (39.5%), colorectal masses (13.2%), and hemorrhoid (11.8%). Histology confirmed inflammatory bowel disease in 11.5%, cancers in 11.0%, and polyps in 10.0%. In this study half of colorectal cancer cases occurred in patients under 50 with prevalence rates of 18.8% in females and 10.8% in males, challenging the global trend that shows this disease predominantly affects older individuals and males.
CONCLUSION
This weekend outreach colonoscopy service implemented standard diagnostics, improved the existing service, and generated vital evidence on local disease patterns with the potential to positively impact clinical practice and policy-making.
Core Tip: Over the past 6 years, we have performed over 6000 endoscopy procedures at an outreach site in southwest Ethiopia, a region lacking a functional endoscopy unit. Among the 1612 colonoscopy findings, the most common were nonspecific inflammation, colorectal masses, inflammatory bowel disease, and polyps. Notably, half of the colorectal cancer cases in this study occurred in patients under 50 with a prevalence of 18.8% in females and 10.8% in males. This contradicts the global trend in which the disease predominantly affects males and older individuals. Less than 5.0% of all patients underwent colonoscopy for screening or suspected colorectal cancer.
