Digestive endoscopy: towards a reference center in West Africa

Since its creation in 1994, La Chaîne de l’Espoir has used its international network of medical experts to train local teams with the aim ofempowering them. Today, the focus is naturally on building sub-regional centres of excellence, as illustrated by the program to support digestive endoscopy in Senegal (or “SENENDO program”). Launched in Dakar, Senegal, in 2021, it aims to create a national center of excellence for diagnostic and interventional digestive endoscopy, which will spread throughout West Africa and particularly benefit children suffering from caustic esophageal strictures.

Digestive endoscopy: real needs identified in Africa

What is digestive endoscopy?

Also known as ” fibroscopy “, digestive endoscopy is a minimally invasive technique performed via the natural tract. More precisely, it consists of a medical examination that allows us to visualize the inside of the digestive tract by inserting a flexible cable equipped with a camera and a light through the nose, mouth or anus.

In recent years, this medical procedure has undergone significant developments, both in diagnostic and therapeutic terms. These include very high image definition for optimal detection of suspicious raised areas at all levels of the digestive tract.

In addition, a number of endoscopic devices have been developed to offer minimally invasive treatments in combination with or in place of surgery. These include :

• a significant reduction in the rate of complications,
• mostly outpatient care,
• preservation of the integrity and function of digestive organs.

What about diagnostic and interventional digestive endoscopy in Africa?

Prior to 2005, interventional digestive endoscopy did not exist in sub-Saharan Africa, while the use of diagnostic digestive endoscopy was very limited in this part of the world. Between 2005 and 2009, a project was launched to improve access to this type of examination in Senegal. It led to the development of a training program in therapeutic endoscopy and the creation of a specific diploma. However, this program did not include interventional endoscopy – biliopancreatic procedures, for example – and is no longer relevant.

In other words, there is a real need in sub-Saharan Africa for the care, training, equipment and infrastructure required for this medical examination. This need is all the more pressing in that there are few well-equipped endoscopy centers that can benefit from the expertise of endoscopists and endoscopy nurses. Finally, the main reason for developing endoscopy and creating centres of excellence in West Africa is the high incidence of certain pathologies, such as caustic stenosis of the oesophagus.

Consolidate and deepen knowledge during missions

After a review of the 2nd mission and the specific procedures for cleaning complex endoscopes that had been assimilated at the time, this deepening of knowledge was initially achieved through the visualization of numerous endoscopic gestures in the OR, such as endoscopic dilatation, submucosal dissection and preparation of the operating room. During this mission, knowledge transfer also took the form of workshops on various topics (mucosectomy, diathermic loop injection, bleeding and clip fitting). These workshops were made possible thanks to the financial support of Fujifillm, a partner in the SENENDO program.

This program benefits from the invaluable support of the following partners:

• Fujifilm, equipment manufacturer and main sponsor,
• Boston Scientific, supply of medical devices,
• Erbe, equipment manufacturer,
• Life Partners Europe, supply of medical devices and training equipment,
• Assistance Publique – Hôpitaux de Paris (AP-HP),
• University of Paris,
• the French Society of Digestive Endoscopy.

Led by Prof. Gabriel Rahmi, a 4th mission will take place from November 20 to 25, 2022 at Dakar’s main hospital to continue building the skills of Senegalese medical teams in diagnostic and interventional digestive endoscopy.

Digestive endoscopy: what is the SENENDO program?

Digestive endoscopy training: La Chaîne de l’Espoir’s missions

The development of digestive endoscopy should focus on the following three main areas:

• Care,
• Teaching,
• Research.

Dakar’s main hospital is home to the digestive endoscopy center of expertise and to La Chaîne de l’Espoir’s missions. It was chosen because its basic infrastructure is adapted to the characteristics of the SENENDO program. The missions carried out there have the following characteristics:

• A volunteer team from La Chaîne de l’Espoir consisting of 2 doctors and a nurse takes part,
• Simulation workshops (ex vivo mechanical or organic models) and theoretical courses are organized for training purposes,
• Between each mission, video-conferences are held between France and Senegal, as well as between centers in the region and sub-region, to present clinical cases and make any necessary adjustments,
• As part of the companionship program, a 4-month internship for a Senegalese student is planned in an endoscopy unit in France.