Our study took place in the endoscopy unit of the Hepatology and Gastroenterology Department at Gabriel Touré University Hospital.

This was a prospective, cross-sectional observational study conducted from January to June 2024.

Our study included all patients admitted for digestive endoscopy during the study period. These included hospitalized patients, outpatients, and patients referred from other healthcare facilities in Bamako; others came from other parts of the country or neighboring countries.

All patients who underwent digestive endoscopy and provided their consent were included in our study.

Patients who refused a digestive endoscopy.

Patients were kept fasting for a minimum of 6 hours before the upper gastrointestinal endoscopy, and numerous and varied preparations were offered, centered on a low-residue diet.

The goal of the preparation was to obtain a digestive tract completely free of food debris. The equipment used consisted of gastroscopes (Olympus GIF-HQ190 and FUJIFILM Corporation) with a multidirectional probe offering axial vision. Local anesthesia was administered using viscous lidocaine oral gel.

The sample size was exhaustive (all patients meeting the inclusion criteria).

Data were collected using a pre-established individual questionnaire, taking into account the study objectives.

Data were entered using Excel 2013 and Microsoft Office Word 2013 and then analyzed using SPSS Statistics 25.

Patients were informed about the nature of the study. Verbal consent was obtained from patients, and data collection was conducted while respecting their anonymity and the confidentiality of their information.

During the study period, a total of 673 endoscopies were performed in our unit, including 591 upper endoscopies and 82 lower endoscopies, representing 87.82% and 12.18% of all procedures, respectively.

Age range and sex:

The mean age of participants was 44.91 years ± 4.6 years, with a range of 5 to 80 years. The 45 and over age group was the largest, representing 49.9%. Females were the most represented, at 52%, with a sex ratio of 0.91.

Socioprofessional activities and residence:

Housewives were the most represented group at 36.9%, followed by manual laborers at 13.5%, and farmers and civil servants at 11.5%.

A significant proportion of patients resided outside Bamako (25.2%), followed by residents of Commune VI (23.4%) and Commune V (17.3%).

Purpose of endoscopy:

The majority of endoscopies were performed for diagnostic purposes (99.7%).

Indications:

Epigastric pain (45.5%) was the main indication, followed by the investigation of signs of portal hypertension (19%) and vomiting (10.6%).

Endoscopic appearance:

An abnormality was detected in 95.4% of patients, confirming a high prevalence of gastrointestinal disorders requiring endoscopic examination.

Endoscopic lesions:

The lesions were located in the gastric region in 90.7% of cases.

Esophageal Lesions:

Esophageal varices (47.5%) and peptic esophagitis (28.8%) were the most frequent lesions ( Figure 1 ).

Gastric lesions:

Erythematous pangastropathy (21.2%) and erythematous antral gastropathy (18.5%) were the most common gastric lesions. Suspected gastric tumors were present in 2.9% of cases ( Figure 2 ).

Duodenal lesions:

Duodenal ulcer (45.8%) and duodenitis (37.5%) were the most frequently observed lesions.

Ulcer/Sex relationship:

Ulcers were significantly more common in men (p = 0.021), with a statistically significant correlation.

During the study period, a total of 673 endoscopies were performed in our unit, including 591 upper endoscopies and 82 lower endoscopies. This represents 87.82% and 12.18% of all procedures, respectively. These results are similar to those reported by Traoré et al. in Mali in 2020, where upper endoscopy constituted approximately 85% of endoscopic examinations [8] . Similarly, a study conducted in Senegal by Diouf et al. in 2018 found a predominance of upper endoscopies at 82.5% [9] . These trends are also observed in Western countries, where upper endoscopy remains the most frequently prescribed endoscopic examination, although the indications differ slightly due to a higher prevalence of gastroesophageal reflux disease (GERD) in these regions [10] .

A quarter of the patients (25.2%) resided outside the capital, which is indeed a factor contributing to delays in diagnosis and treatment.

The mean age of the patients was 44.91 years ± 4.6 years, with a range of 5 to 80 years. The most represented age group was 45 years and older, which is consistent with several studies conducted in sub-Saharan Africa. A study carried out in Côte d’Ivoire by Konan et al. in 2019 reported a predominance of patients over 40 years of age [11] . Regarding sex, we observed a slight female predominance (52%), consistent with the work of Sow et al. in Senegal in 2017, who reported a female proportion of 54% [12] . However, these results contrast with some European studies where male predominance is more pronounced in digestive endoscopic examinations, which could be explained by socio-cultural factors influencing access to care [12] .

Indications for Endoscopy

Epigastric pain was the main indication (45.5%), followed by the search for signs of portal hypertension (19%). These results are comparable to those observed in Algeria by Bouziane et al. in 2018, who found rates of 47% and 21%, respectively [13] . It is interesting to note that in industrialized countries, the main indications also include monitoring precancerous lesions and screening for gastric cancer, particularly in at-risk populations [14] .

Lesions on Upper Endoscopy

We found an endoscopic abnormality in 95.4% of cases. This high rate is close to the results reported by Diarra et al. in 2021 in Burkina Faso, where 92% of patients presented with a digestive pathology detectable by endoscopy [15] . Esophageal varices were present in 47.5% of patients. This rate is lower than that reported by S. Kodio in 2025 (91.3%) [16] . This could be explained by the high frequency of post-hepatitis B cirrhosis in our context [17] . The lesions were located in the stomach in 90.7% of cases. Antral gastropathies were the most frequent (29.7%), including erythematous antral gastropathies (18.5%) and erosive antral gastropathies (11.2%), followed by erythematous pangastropathies (21.2%), which is consistent with the 2020 study by Gaye et al. in Senegal, who found a prevalence of 29% for this pathology [18] . Comparison with Asian studies reveals a higher frequency of Helicobacter pylori infections associated with antral gastropathies, with a prevalence reaching 70% in Japan and South Korea, highlighting the importance of screening for and eradicating this bacterium in the prevention of gastric diseases [19] [20] . The suspected gastric tumor rate was 2.9%. This result is identical to that of Sanogo SD 2.8% in 2023 in Mali [21] . This observation highlights the need to establish standardized biopsy protocols for endoscopic examinations to ensure reliable histological diagnosis. Furthermore, it underscores the importance of implementing local clinical and endoscopic follow-up strategies for patients with suspicious lesions.

We found a significant association between ulcer and male sex (p = 0.021). This observation is confirmed by the work of Koffi et al. (2019) in Côte d’Ivoire, who reported a higher prevalence of gastroduodenal ulcers in men (60%) [22] . Studies conducted in the United States have also shown that men have an increased risk of peptic ulcers, notably due to higher consumption of nonsteroidal anti-inflammatory drugs (NSAIDs) and alcohol [23] [24] . Furthermore, data related to risk factors were not collected in our study.