Endoscopic Management of Surgical Jaundice in Nigeria

Introduction: Endoscopy management of obstructive jaundice has been limited in Nigeria because of unavailability of ERCP, despite growing demand. This study presents our experience establishing an ERCP program at Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, Nigeria. Methods: ERCP was introduced into a well-established advanced endoscopy unit at OAUTHC. We employed an apprenticeship-style model of training with graded responsibility, multidisciplinary group feedback and short-interval repetition. We collate the sociodemographic and clinicopathologic information on consecutive patients who underwent ERCP from March 2018- December 2019. Result: From 155 referrals, 130 patients underwent ERCP, with a median age of 55 (range 8-83). 50.8% (66/130) were male. In total, 143 procedures were performed on this cohort. Sixteen percent of referrals were inappropriate, secondary to misdiagnosis or poor functional status. Ten patients required a repeat procedure due to technical failure, while three patients had a planned second-stage procedure. The most common indications were cancer of the head of pancreas (52/130), choledocholithiasis (33/130), cholangiocarcinoma (18/130) and gallbladder cancer (9/130). Almost all patients (99%) had sphincterotomies and (57/130) had a stent inserted. Twenty-four of these individuals (42%) had self-expanding metallic stents inserted. In total, seven patients had post ERCP pancreatitis and five periprocedural mortalities were recorded. Conclusion: Using an apprenticeship-style educational model - an experienced endoscopist with a well-established endoscopy unit, it is possible to develop an ERCP program in Nigeria without travelling abroad. The multidisciplinary nature of ERCP service delivery places an incentive on training within the home institution environment.