Indications, résultats et rendement de la coloscopie dans un environnement économique défavorable : le cas du Cameroun.

Objectif  : le rendement diagnostique de la coloscopie depend de plusieurs facteurs, notamment les indications. La pertinence de ces indications est influencee par l’environnement economique et les structures locales. Le but de notre etude etait d’analyser les indications et les resultats des coloscopies, et d’evaluer leur rendement diagnostique afin de juger de la pertinence de ces indications. Materiels et Methodes : un recueil retrospectif de donnees de coloscopies realisees de janvier 2001 a juin 2011 dans trois hopitaux universitaires de Yaounde, Cameroun a ete effectue. Les variables enregistres etaient l’âge, le sexe, les indications et les resultats. Resultats  : un total de 908 protocoles de coloscopie ont satisfait a nos criteres de selection (dont 622 hommes (68,5%)). L’âge median etait de 48 ans (IQR 36-59 ans). Les indications principales etaient les rectorragies 281(30,9%) patients, les douleurs abdominales 267 (29,4%) patients et les diarrhees chroniques 107(11,8%) patients. L’examen etait normal 451 (49,7%) fois. Les lesions retrouvees etaient les polypes colorectaux 110 cas (12,1% ; IC 95% : 10,1-14,5), les hemorroides 104 cas (11, 5% ; IC 95% : 9,5-13,7), la diverticulose 71 cas (7,8% ; IC 95% : 6,2-9,8) le cancer colorectal 64 cas (7,0% ; IC 95% : 5,5-9,0) et les colites 64 cas (7,0% ; IC 95% : 5,5-9,0). Le rendement diagnostique de la coloscopie pour le cancer colorectal selon les indications etait eleve en cas d’image radiologique suspecte (27,7%), de masse abdominale (25%) et d’anemie ferriprive (22,2%). les douleurs abdominales et/ou TFI non accompagnees de perte de sang macroscopique ou occulte, la constipation et le depistage du cancer colorectal avaient un rendement faible. Conclusion : le rendement diagnostique de la coloscopie dans la detection des principales lesions coliques n’est pas different dans un environnement economique defavorable malgre les indications peu pertinentes. Les symptomes digestifs avec une valeur predictive positive elevee pour le diagnostic de cancer colorectal sont retrouves. Les polypes et les hemorroides constituent les principales lesions colorectales au Cameroun. Tandis que le cancer colorectal a une prevalence elevee et inattendue meritant notre attention. Background : The yield of colonoscopy depends on several factors amongst which the indication. A list of indications of colonoscopy has been established by a team of European experts. Factors influencing the relevance of these indications include the economic context and the local infrastructures. The goal of our study was to evaluate the diagnostic yield of colonoscopy in Cameroon with respect to indications, and to weigh the relevance of the indications. Materials and Methods : A retrospective analysis of data from colonoscopies done from January 2001 to June 2011 in three university teaching hospitals in Yaounde, Cameroon was conducted. Variables studied were age, sex, indications and results. Results : A total of 908 files met our selection criteria. There were 622 (68.5%) men and 286 (31.5%) women. The median age was 48 years old (IQR 36 – 59 years). Forty four patients (4.8%) were less than 20 years old, 79 (8.7%) were between 20 and 29 years old, 147 (16.2%) between 30 and 39 years old, 212 (23.3%) between 40 and 49 years old, 426 (46.9%) were aged 50 and above. The main indications were hematochezia found in 281 patients (30.9%), abdominal pain in 267 patients (29.4%), and chronic diarrhea in 107 patients (11.8%). Colonoscopy was normal in 451 (49.7%) patients. The main anomalies found were colorectal polyps in 110 patients (12.1%; 95%CI: 10.1 – 14.5%), hemorrhoids in 104 patients (11.5%; 95%CI: 9.5 – 13.7%), diverticulosis in 71 patients (7.8%; 95%C I: 6.2 – 9.8%), colorectal cancers in 64 patients (7.0%; 95%CI: 5.5 – 9.0%) and colitis in 64 patients (7.0%; 95%CI: 5.5 – 9.0%). The yield of colonoscopy in the diagnosis of colorectal cancer was relatively greater in case of the presence of an abnormal finding at imaging (27.7%), abdominal mass (25%), iron deficiency anemia (22.2%), weight loss (9.1%), and the presence of an inflammatory bowel disease (9.1%). Conclusion : The diagnostic yield of colonoscopy in detecting major colic lesions is not different in low income countries like Cameroon.  Indications known to bear the highest positive predictive values in western countries for the diagnosis of colorectal cancer are similar in our milieu.