original article

Vol. 10 No. 1

Awareness and Compliance With the Updated Sydney System Recommendations Among Nigerian Gastrointestinal Endoscopists

June 2018

— Jemilohun AC and Adeoti ML


Background: It has been reported that gastric biopsy sets that comply with the Updated Sydney System (USS) biopsy sampling protocol have significantly better histological yield than those that do not for the most common gastric inflammatory conditions: Helicobacter pylori and intestinal metaplasia. We determined the level of awareness and compliance with the USS guidelines among Nigerian gastrointestinal endoscopists.

Methods: In a descriptive cross-sectional survey, we interviewed all consenting gastrointestinal endoscopists practicing in Nigeria from March to July 2016. A 13-item self administered questionnaire consisting of sociodemographic data (6-items), knowledge of the USS guidelines (4-items) and compliance with the biopsy sampling protocol (3-items) was used.

Results: A total of 45 respondents in all were included in the final analysis. Of the 45 respondents, 29 (64.4%) were males while 16 (35.6%) were females. The mean age of the participants was 43.70 (±6.91) while the age range was 32-60 years. The mean year of endoscopy practice was 6.82 (±5.55) while the range was 1 to 25 years. Twenty-nine (64.4%) participants were generally aware of the USS, 25 (55.6%) knew the recommended
number of biopsies, while 26 (57.8%) knew the 3 recommended gastric regions. Only 13 (28.9%) of the participants regularly took the recommended number of biopsies, 14 (31.1%) regularly sampled all the recommended stomach regions while 25 (55.6%) respondents regularly separated biopsies from different regions of the stomach into different containers, according to the USS protocol. However, the knowledge of the recommended number of biopsies and the recommended regions both had significant associations (p=0.020 and p =0.021 respectively) with correspondent endoscopy practices.

Conclusion: While the level of awareness and knowledge of the USS guidelines could be considered fair among Nigerian gastrointestinal endoscopists, the level of compliance with the prescribed biopsy sampling protocol is poor. There is a need for relevant professional bodies like SOGHIN to create the awareness of the practice guidelines among their members with proper emphasis on the positive relationship between compliance and gastric histologic yield.

Keywords: Updated Sydney System, Gastrointestinal Endoscopists, Gastric biopsy, Gastritis, Nigeria


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The Nigerian Journal of Gastroenterology and Hepatology, is a quarterly publication of the Society for Gastroenterology and Hepatology in Nigeria (SOGHIN), which publishes original research on the biology and diseases of the Gut, Liver, Pancreas, Peritoneum and Spleen both in humans and experimental animal models.

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