Esophagogastroduodenal fibroscopy is a method of visual exploration of the upper digestive tract (the esophagus, stomach, and the duodenum). Upper digestive endoscopy or gastroscopy was initially developed as a diagnostic tool and had become a treatment tool (extraction of foreign bodies, dilations, polypectomies, sclerotherapy and thermo-coagulation) . It is done through natural channels or after an incision to enter certain cavities in the body. Depending on the techniques used (intraluminal, pancreatobiliary or transluminal), the gestures are performed under local or general anesthesia. Studies on the practice of this examination have been carried out in Bamako by Maïga et al. 1996  and Sylla et al. 2010 . In a study of Fibroscopy conducted by Sylla et al. the male sex was predominant at 52%, the average age of patients was 42.25 years with extremes of 5 and 92 years and the age group 46 - 60 years was the majority . The most common insincation found in the Sylla et al. study was epigastralgia in 96% of cases and endoscopy was macroscopically normal in 49.0% of cases . However, none of these previous studies investigated the practice of upper digestive endoscopies in the mother-child hospital in Mali. In this study, our aim was to determine the main socio-demographic data of patients referred to the endoscopy unit of the mother-child hospital in Mali for esogastroduodenal endoscopy and to assess the clinical information for referrals as well as the results of the endoscopy.
2. Material and Methods
This was a retrospective, descriptive study on the results of reviews of esogastroduodenal fibroscopy performed in the digestive endoscopy unit of the hepato-gastroenterology department of the Mother-Child Hospital of Bamako from January to December 2018. Inclusion criteria: All patients received during the study period and who were seen in upper gastrointestinal endoscopy. Exclusion criteria: all patients who received for other endoscopy. Endoscopic examinations were carried out by a team made up of two gastroenterologists and a nurse. The endoscopy was performed under local oropharyngeal anesthesia with oral xylocaine gel. The equipment used was an Olympus optical fiberscope with an axial vision and in cold light (Olympus GIF-XQ30).
The patients were seen endoscopically in the morning on an empty stomach. Oral xylocaine gel was used for oropharyngeal anesthesia before each endoscopy. The biopsy pieces were packaged in vials, fixed with 10% formalin and given to the patients for shipment to one of the various anatomo-pathology laboratories in Bamako. The disinfection of the equipment after use was carried out with a solution of Hexanios® and sterilization in a solution of Steranios® 2%. The socio-demographic data (last and first names, age, sex, and address), the indications for upper gastrointestinal endoscopy, the detailed endoscopic report and the conclusion were recorded. Informed and verbal consent was obtained in all of our patients. Data were typed in EXCEL 2013 and analyzed using SPSS software 20.
The chi-square test was used for comparison with a p value <0.05 considered significant.
We recorded 465 patients including 231 males and 234 females i.e. a sex ratio of 0.98 (Table 1). The mean age was 46.69 ± 7.5 years old with extremes of 8 and 90 years old. The most represented age group was 31 - 40 years old (Table 2). Housewives accounted for 31.5%. The main indications were epigastralgia in 50.5% (Table 3). Esogastroduodenal fibroscopy was normal in 24.7%. Tumors were found in 9.03% and inflammatory lesions in 20.7%. The lesions were esophageal in 11.83%, gastric in 27.1% and duodenal in 2.3%. In our study, inflammatory pathology was predominant in 296 patients or 63.66%. This result is comparable to those of Laté et al. (56.3%) ; Alandry (49.5%)  and Ismaila (39.3%) . This could be explained by the frequency of bile reflux 53.5% of cases in our study. According to the site, esophageal pathologies represented 11.83%, gastric pathologies 27.1% and duodenal pathologies 2.3% (Table 4).
Our patients came from the hospital setting and from the various health centres across the country. We found a female predominance as in the Togolese and Nigerian series   while Sylla B , other African   and Asian  series found a male predominance. This female predominance in our study could be explained by the fact that the majority of patients attending the structure were women . Our patients were adults with an average age of 46.69 years old and
Table 1. Gender of patients.
Table 2. Age ranges of patients referred for the upper digestive endoscopy.
Table 3. Reasons for referrals for esogastroduodenal fibroscopy.
*Others: ATDC gastrectomy (n = 3), cardiomyotomy (n = 1), gastric ulcer (n = 6), polyp (n = 1), cholestasis (n = 1).
Table 4. Sites of the pathology found on the endoscopy.
the most represented age group was 31 - 40 years old. This result is different from that obtained by Sylla B  for which the age group most represented was 46 - 60 years old. This is due to the size of the Sylla B study population (n = 1130) . On the other hand, our result is close to data from most African     and Asian   studies. This could be explained by the fact that the majority of the population of developing countries is young. Upper digestive tract fibrosis was normal in 115 patients (24.7%). Our result is comparable to that obtained by Laté et al. or 22.29% . This rate is higher than that noted by Ismaila (15.6%)  but lower than that rated by Taye (28%) , Aduful (41.1%)  and Shah (78.5%) . Epigastralgias were the main indication of high digestive fibrosis in our study as in the other series    . Duodenogastric reflux was the main result observed in 151 patients or 32.5%. This result is comparable to that of Laté et al. . In our study, inflammatory pathology pred was predominated in 296 patients or 63.66%. This result is comparable to that of Laté et al. (56.3%) ; Alandry (49.5%)  and Ismaila (39.3%) . This could be explained by the frequency of bile reflux 53.5% of cases in our study. According to the site, esophageal pathologies accounted for 11.83%, gastric pathologies 27.1% and duodenal pathologies 2.3% (Table 4).
Esogastroduodenal fibroscopy is an important complementary examination in the management of digestive pathologies in general. Its daily clinical His practice at the Mother-Child Hospital in Mali has made it possible to highlight the contribution of fibroscopy into the diagnosis of various digestives pathologies.
 Laté, M.L.-A., et al. (2014) La fibroscopie digestive haute chez 2795 patients au centre hospitalier universitaire campus de Lomé: Les particularités selon le sexe. Pan African Medical Journal, 19, 262.
 Sehonou, J., Addra, B. and Kodjoh, N. (2006) étude descriptive de 2722 oeso-gastroduodénopathies à l'hôpital militaire de Cotonou: Inflammations chez les femmes, ulcères chez les hommes. Acta Endoscopica, 36, 179-186.
 Aljebreen, A.M., Alswat, K. and Almadi, M.A. (2013) Appropriateness and Diagnosis Yield of upper Gastrointestinal Endoscopy in an Open-Access Endoscopy System. Saudi Journal of Gastroenterology, 19, 219-222.
 Khurram, M., Khaar, H.T., Hasan, Z., Umar, M., Javed, S., Asghar, T., et al. (2003) A 12 Years Audit of Upper Gastrointestinal Endoscopic Procedure. Journal of College of Physicians and Surgeons Pakistan, 13, 321-324.
 Shah, M.Y., Shah, F.Y. and Shah, F.Y. (2012) Open Access Upper Gastrointestinal Endoscopy: A 2-Year Experience from 2001 to 2003. Indian Journal of Gastroenterology, 31, 171-174.