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Original Article

A 10-Year Review of Colonoscopy at Aminu Kano Teaching Hospital,

Kano Nigeria
Y Musa, YM Abdulkadir1, M Manko2, YS Umar3, AN Mohammed1, I Yusuf4, MM Borodo1 , AA Samaila1

Department of Internal Background: Colonoscopy is an investigation modality used for colorectal

Abstract
Medicine, Federal Medical
Centre Katsina, Katsina
examination; it is the most accurate technique for the diagnosis and surveillance
State Nigeria, 1Department of important colorectal diseases such as cancers  (colorectal cancer) and polyps.
of Internal Medicine, Bayero Aims: Most studies on colonoscopy in Nigeria were conducted in southwest such
University/Aminu Kano as Ilorin, Ife, Ibadan, and Lagos. We therefore feel the need to get information
Teaching Hospital, Kano from other regions such as northwest, the area of this study. The aim of this
Nigeria, 2Department of study was to identify the common indications as well as colonoscopic findings
Medicine, Ahmadu Bello
University/Ahmadu Bello
among patients who had colonoscopy in Aminu Kano Teaching Hospital, Kano.
University Teaching Hospital Methodology: It was a 10‑year retrospective descriptive study of patients
Zaria, Kaduna State Nigeria, who had colonoscopy between January 2008 and December 2017 at the study
3
Department of Medicine, center. Colonoscopy register was used to extract information concerning the
Murtala Muhammad patient’s age, gender, symptoms that necessitated the request for the procedure,
Specialist Hospital, Kano and the endoscopic findings. Results: A  total of 839  patient records were
Nigeria, 4Department of
Histopathology, Bayero
reviewed, males constituted 62.2% of the patients. The mean age  ±  standard
University/Aminu Kano deviation was 43.86  ±  18.36  years, with a range of 8–96  years. The 30–39  years
Teaching Hospital, Kano constituted the modal age group, followed by 40–49  years and 50–59  years.
Nigeria The commonest indications for the procedure were rectal bleeding  (52.4%),
chronic abdominal pain  (51.3%), and diarrhea  (48.8%). The cecal intubation rate
was 98.2% with hemorrhoids as the commonest finding  (42.3%) followed by
suspected inflammatory bowel disease lesions  (18.1%) and suspected colorectal
tumors  (16.2%). Conclusion: The commonest reason for colonoscopy was rectal
Received: bleeding while the commonest colonoscopic finding was hemorrhoids.
09-Aug-2020;
Revision:
17-Feb-2021;
Accepted:
23-Mar-2021; Keywords: Abdominal pain, bleeding per‑rectum, bowel preparation, cecal
Published: intubation rate, colonic cancer, colonic diverticuli, colonic inflammation, colonic
20-Jul-2021 polyp, colonoscopy, constipation, diarrhea, hemorrhoids

Introduction available.[1] Indications could be as a screening tool for

C olonoscopy is an important means of diagnosing,
surveillance, or segregating important large bowel
disorders ranging from inflammation, polyps to colorectal
cancer  (CRC).[1] Indications could be diagnostic and
or therapeutic.[2] In average‑risk individuals for CRC,
colonoscopy is one of acclaimed screening modalities,
while high‑risk individuals for CRC have colonoscopy
as the only gold standard investigation of choice
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CRC in normal risk individuals from the age of 50 years,
to investigate gastrointestinal (GI) bleeding, suspected
CRC, chronic abdominal pain, unexplained changes in
Address for correspondence: Dr. Y Musa,
Department of Internal Medicine, Federal Medical Centre Katsina,
Katsina State, Nigeria.
E‑mail: yusuf.musa@npmcn.edu.ng
This is an open access journal, and articles are distributed under the terms of the
Creative Commons Attribution‑NonCommercial‑ShareAlike 4.0 License, which allows
others to remix, tweak, and build upon the work non‑commercially, as long as
appropriate credit is given and the new creations are licensed under the identical
terms.

For reprints contact: WKHLRPMedknow_reprints@wolterskluwer.com

DOI: 10.4103/njcp.njcp_497_20

How to cite this article: Musa Y, Abdulkadir YM, Manko M, Umar YS,
PMID: ******* Mohammed AN, Yusuf I, et al. A 10-year review of colonoscopy at aminu
Kano teaching hospital, Kano Nigeria. Niger J Clin Pract 2021;24:1072-6.

1072 © 2021 Nigerian Journal of Clinical Practice | Published by Wolters Kluwer ‑ Medknow

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Musa, et al.: Colonoscopy at AKTH, Kano Nigeria
bowel habit, or when an abnormality is found on colonic
imaging. Similarly, patients with history of polyps,
CRC, and those with history suggestive of hereditary
CRC syndrome may need to be on surveillance
colonoscopies.[2] Positive results for fecal occult blood
test especially using the fecal immunohistochemistry
is practically an indication for colonoscopy in most
cases.[3] Unlike developed societies where colonoscopy
is routinely used for screening and other diagnostic as
well as therapeutic means, in Nigeria such services are
scarcely available making data on it scarce as well.[2]
It has been more than 30  years from the first published
series on availability and utilization of colonoscopy in
Nigeria; however, it’s still in youthful stage in most part
of the country.[4] However, there is generally observed
increase in colonoscopy utilization by both family and
general physicians in developing societies due to newer
machineries, bowel preparatory methods, and conducive
atmosphere for the procedure.[5] In African continent and
subcontinents, appreciating variable pathological findings
on colposcopy still remains elusive from underreporting
and poor detection methods with very long waiting
time ranging from weeks to months.[6] Many quality
indices have been studied to optimize endoscopy
procedure from the perspective of both the patient and
the physician. Cecal intubation rate  (CIR), adenoma
detection rate, withdrawal time, and quality of the
reporting are among the variables that determine the
effectiveness of the procedure which defines quality
of the examination.[7,8] For screening studies, 95% CIR
or more is the American Society for Gastrointestinal
Endoscopy recommendation and 90% is acceptable for
diagnostic colonoscopies. However, even among experts,
the failure rate of accurate diagnosis is up to 30%, while
the missed adenoma rate is between 33% and 46% due
to poor bowel preparation.[8]
We conducted this study in order to share with the world
our experience concerning lower GI endoscopy, and
we collaborate further with histopathologist to confirm
some of the identified lesions during the course of our
procedures.
Methodology
It’s a 10‑year retrospective descriptive study that
analyzed all colonoscopies conducted at Aminu Kano
Teaching Hospital (AKTH), Kano, Nigeria from January
2008 to December 2017. AKTH has a diagnostic center
where the endoscopy suite receives requests from
Jigawa, Katsina, Bauchi, Yobe, Borno, and Zamfara
states.
The endoscopy unit has colonoscopy suite that is
equipped with an Olympus‑adjustable procedure couch,
Nigerian Journal of Clinical Practice  ¦  Volume 24  ¦  Issue 7  ¦  July 2021
Pentax EPK‑1000 video colonoscope, Olympus Optera
CV‑170 video system with CF‑H170 colonoscope.
The common agent used for bowel preparation was oral
Bisacodyl (Dulcolax) 10–15 mg twice daily for 3 days
with rectal Dulcolax a night prior to and morning of the
procedure plus 20% mannitol diluted with soft drinks
300–500 ml taken orally a day to the procedure. Other
agents used include castor oil 2–4 bottles taken within
2 days with 300–500 ml of 20% mannitol taken orally
a day to the procedure. Bowel preparation is given for
3 days with patients placed on low residue diet 3–2 days
to procedure, and clear fluid such as exotic drink, soda
water, and other noncolored beverages taken a day to
procedure. Boston Bowel Preparation Score is the most
common guide used for assessing the adequacy of bowel
preparation.
Colonoscopy registers for the procedures conducted
during the stated time were reviewed, and relevant data
on patients’ demography, presentation or indication for
the procedure, and endoscopic findings were recorded
accordingly. The biopsies taken were followed at the
histopathology department of the same institution for
histological diagnosis of presumed lesions identified
during the procedure.
Variables were recorded in a Microsoft Excel sheet
version  2016, and after data cleaning, the data were
analyzed using a computer‑based Statistical Program
for Social Sciences version  20.0  (SPSS Inc., Chicago
IL, USA). Qualitative/Continuous variables were
summarized using mean and standard deviations and
their differences determined using the t‑test. Quantitative/
Categorical variables were grouped into proportions,
median, interquartile range, and percentages and their
associations determined using the χ2 test. A  confidence
interval of 95% was used, and a P value of  <0.05 was
considered significant.
Results
A total of 839  patient records that had colonoscopy over
the period under review were analyzed. Over 62.2% (522)
of the patients were males with male‑to‑female ratio
of 1.7:1. The mean age  ±  standard deviation was
43.86  ±  18.36, with a range of 8–96  years; however,
4.9%  (41) of the patients have no specific age recorded.
The 30–39  years constituted the modal age group with
168 subjects  (20.0%), followed by 40–49  years with
160 (19.1%) and 50–59 years with 159 (19.0%). Table 1
depicts the age distribution of study subjects.
Bleeding per rectum and abdominal pain constituted
the modal presentation/indication for colonoscopy.
There was statistically significant difference between
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Musa, et al.: Colonoscopy at AKTH, Kano Nigeria

60 45
56.9 MELENA
PR BLEEDING 40 42.3
ABDOMINAL PAIN
50 48.8 35
DIARRHEA
ABDOMINAL SWELLING 30

PERCENTAGE
WEIGHT LOSS
40
CONSTIPATION 25
PERCENTAGES

AMEMIA 20
30 28.1 18.1
26.5 15 16.5

10
20
16.7 8.4
5 7
4.1
0
10 7.4 FINDINGS
HEMARRHOIDS COLORECTAL CANCER DIVERTICULOSIS
3.3
INFLAMATORY BOWEL POLYPS OTHERS
0 DISEASE

Figure 1: Indications for colonoscopy (original) Figure 2: Colonoscopic findings (original)

ANAL CANAL,
7%

ASCENDINGCOLON,
14%

TRANSVERSE COLON,
7%
RECTOSIGMOID, 63%
DESCENDING
COLON, 9%

Figure 3: Distribution of suspected colonic tumor (original) Figure 4: Hemorrhoid

Figure 6: Colonic polyp

Majority of the study subjects  (92.7%) had good bowel

Figure 5: Colonic inflammation
males and female in the case of diarrhea as an
indication (P = 0.025) as well as weight loss (P = 0.045).
Such association was lacking in other presentations.
Figure  1 highlights various presentations or indications
for colonoscopy at the study center.
preparations with a minimum score of 6 or more
on Boston Bowel Preparation Score;[9] this leads to
successful completion of the procedure in more than
90% (CIR of 98.2%).
Hemorrhoids were the commonest finding seen in
355 subjects  (42.3%) while diverticulosis was the least
frequently identified lesions seen in 35 subjects  (4.2%).
Most of the patients with hemorrhoids fall within the

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Musa, et al.: Colonoscopy at AKTH, Kano Nigeria

confirmed cases of Crohn’s disease, 20 ulcerative colitis,

6 each for both lymphocytic colitis and infective colitis
as well as 45  cases of nonspecific colitis. Others were
ischemic colitis and indeterminate colitis which were
recorded once during the study period.
Similarly, histological record of polyps removed revealed
adenoma in 80%, with 14.3% as hyperplastic polyp,
while inflammatory polyp  (from chronic schistomiasis)
and a fibro‑epithelial polyp were one each.
Figures  4–7 depict real colonoscopic images of the
common endoscopic findings.

Discussion
Figure 7: Suspected colonic tumor This is a study conducted to identify the common
presentation, demographic characteristics, and findings
Table 1: Age distribution of study subjects (original) on colonoscopies done over a period of 10 years in a
Age groups (years) Frequency Percentage tertiary public health facility in the northwestern part
Not available 41 4.9 of Nigeria. Predominant percentage of patients coming
1‑17 14 1.7 for colonoscopy were males similar to what was
18‑19 3 0.4 reported from various centers in Nigeria,[2,4,7] Zambia,[6]
20‑29 107 12.8 Lebanon,[10] Turkey,[5] and India.[3] This may be due to
30‑39 168 20.0 the general setting of our society where males are more
40‑49 160 19.1 financially capable than females. Majority of the patients
50‑59 159 19.0 were in their fourth to sixth decade of life; however, the
60‑69 108 12.9 mean age of presentation is about a decade lower than
70‑79 59 7.0 the one reported by researchers from Africa, Asia, and
80‑89 17 2.0
Middle East[2,4,5,7] but similar to Indian report.[3]
≥90 3 0.4
There was no single screening colonoscopy requested
age range of 40–59, followed by those under 40  years throughout the study period, this is worrisome
with those over  60  years having the least frequency. especially with the increasing prevalence of colonic
The male‑to‑female ratio is that of 2:1. Details of cancer worldwide. Rectal bleeding was the commonest
colonoscopic findings are shown in Figure 2. presentation of our patents. We recorded very good
bowel preparation during the study period despite
Young patients below the age of 40  years were using an improvised agent for that purpose, a factor
the commonest population with suspected that determines quality of every colonoscopic
inflammation  (44.59%), while those between 40 and examination.[3,8,11] This is an important finding that may
59  years had about 39.86% with those above 60  years allow other endoscopists in our society to adapt such
making 15.54%. The male‑to‑female ratio was 1.4:1. cheap and readily available cleaning methods. The CIR
Similarly, colonic tumor was commoner among age was excellent; this may as well be the result of adequate
group  40–59  years having 36.76% followed by those bowel preparation recorded in most of the study subjects.
below 40  years  (35.29%) with male‑to‑female ratio of The commonest colonoscopic finding was hemorrhoids
1.8:1, mostly seen at Recto‑sigmoid colon, followed which is similar to most researches in Africa, Asia,
by ascending, descending, and transverse colons in
Middle East, and Europe.[2‑7] Predominant percentage of
decreasing frequency with anal canal having the lowest
those with hemorrhoids fall under the middle age group
tumor frequency as shown in Figure 3.
which is the common age group affected worldwide.[12]
Other findings in order of decreasing frequency were
Suspected IBD was the next in frequency among the
proctitis, evidence of external compression, anal tag,
finding; this is contrary to the common thinking of IBD
anal fistula, angiodysplasia, anal fissure, rectal varices,
being rare in our society.[13] It cuts across all histological
worms, and entero‑colic fistula.
types of IBD; however, most of the analyzed samples
Review from histopathology register of our suspected yielded nonspecific colitis. However, contrary to most
inflammatory bowel disease  (IBD) samples revealed 4 reports, our patients were mainly in their youthful age.

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Musa, et al.: Colonoscopy at AKTH, Kano Nigeria
Colonic tumor is the third most common finding
among patients during the study period. As reported
in most parts of the world, left colon is the most
affected site.[14‑17] However, most of the patients were at
younger age group as opposed to the common findings
in the world;[15‑18] this is an eye opener with regard
to common assumption about the scarcity of colonic
tumors in sub‑Saharan Africa and hence the need for
more surveillance using both invasive and noninvasive
methods in order to detect the tumor early among our
teeming youths.
In conclusion, rectal bleeding is the commonest
indication for lower GI endoscopy; hemorrhoid is the
most common finding during the procedure. Significant
percentage of patients was found to have suspected IBD
and CRC.
Acknowledgments
Dr. Mansur F. Mohammed, Dr. Nurudeen O. Muhammad,
Dr. Abdulrashid O. Abdulrahim, Dr. Maryam Hussain,
Dr. Dada, Dr. Ibrahim Mohammed, and endoscopic
nurses are gratefully acknowledged.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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