Colonoscopy has been a true revolution in the diagnosis and treatment of colorectal disease [1]. Indeed, it has improved the detection rate of lesions and most often allows for their appropriate treatment [1]-[4]. Among these conditions, colorectal cancer (CRC) remains formidable due to its generally poor prognosis, as the disease is often diagnosed at an advanced stage. However, early screening through colonoscopy has led to a 60% to 70% reduction in mortality [4]. This is further improved by the prevention of CRC through the detection of adenomas and dysplasia in chronic inflammatory bowel diseases (IBD) [2][3][5][6].

This diverse colorectal pathology also includes diverticular and angiodysplastic lesions, which sometimes cause significant symptoms requiring the use of colonoscopy [7].

In Africa, the introduction of this technology has made it possible to report certain pathologies that were previously unknown [8]-[10]. Indeed, Ndjitoyap Ndam et al. reported the frequency of polyps, colon cancers, and colitis in Cameroon [8]. Dia et al. and Mbengue et al. in Senegal also confirmed this diversity of colonic pathology by reporting, among other things, cases of IBD, colon cancers, polyps, and diverticula [9][10]. In Mali, an older study allowed, on a limited sample, the study of colorectal pathology through colonoscopy [11]. Diarra et al. reported that colorectal tumors, rectitis, UC, and diverticula were responsible for 15.1%, 8.6%, 6.5%, and 1.1% of rectal bleeding, respectively [12]. This activity was temporarily interrupted due to the unavailability of a colonoscope. Colonic pathologies have been reported by fragmented studies [11]-[13]. Colonoscopy is currently performed in Bamako. We proposed to update the reality of colorectal pathology through colonoscopy, and our objective was to study colorectal pathology during colonoscopy in Bamako.

Type and duration of the study

This was a retrospective, descriptive study conducted from August 2018 to June 2021.

Locations

Our study took place in Bamako at:

the “Farako” clinic;the “Les Angevins” clinic;the “Les Etoiles” clinic;the “Solidarité” clinic.Patients

The study involved all patients who underwent a colonoscopy at the study centers.

Inclusion criteria were:complete colonoscopy;incomplete colonoscopy due to organic stenosis;incomplete colonoscopy with a previously identified lesion.Exclusion criteria were: all incomplete colonoscopies without any previously visualized lesion (colonoscopy not reaching the cecum and no lesions seen in the examined portion).Methods

Data were collected from colonoscopy and pathology report registers.

The following parameters were collected:

sociodemographic data: age, gender, occupation;examination indications; observed lesions: type, location, number, size; biopsy histology. Support Data were recorded on a survey form and analyzed using Epi Info software version 7.2.

During the study period, 450 colonoscopies met our inclusion criteria, and a lesion was found in 297 of them, representing a frequency of 66% for pathological colonoscopies. The average age was 42.4 ± 12.8, ranging from 4 to over 91 years, with a sex ratio of 0.86. Civil servants and homemakers were the most represented. The most frequent indications for colonoscopy were rectal bleeding and diarrhea, accounting for 35.8% and 27.5% of cases, respectively (Table 1). Macroscopic lesions were dominated by polyps (25.3%), followed by colitis (22.2%) and malignant tumors (19.5%) (Table 2). Most of the lesions were located in the rectum and sigmoid colon (Table 3). Regardless of the type of lesion, the rectal location was significantly observed, while inflammatory lesions were most often pancolonic (Table 4). Benign tubular polyps were the most common, representing 61.3% of polyp cases, Lieberkuhnian adenocarcinoma was the most common malignant tumor, accounting for 84.5% of cases, and inflammatory pathology was dominated by no specific colitis, with 28.8% of cases (Table 5).

Table 1. Distribution of patients according to indications for colonoscopy.

Table 2. Distribution of patients according to observed endoscopic lesions.

Table 3. Distribution of patients according to the location of the lesion.

Table 4. Distribution of patients according to the type of lesion and its location.

Table 5. Répartition des patients selon le type histologique des lésions observées.

This was a retrospective, descriptive, and analytical study carried out in Bamako in several digestive endoscopy centers. In our study, the sample size was limited, certainly due to the financial cost of the examination and also to poor patient preparation, which often led to the cancellation of the endoscopy. However, 450 examinations could be interpreted, and all observed macroscopic lesions were biopsied for histological study. A lesion was found in 297 colonoscopies, representing a rate of 66% of pathological colonoscopies. Traoré et al. [11] and Mbengue et al. [10] reported frequencies of 66.27% and 61.97%, which were comparable to our result. The average age of our patients was 42.4 ± 12.8 years. This average age was comparable to that found in studies conducted in Mali [11][12], Senegal [9]. This relatively young age of our patients should lead to further studies on risk factors, particularly genetic and environmental ones, and to the implementation of a colorectal cancer screening policy in order to improve its management in our context. Our result is lower than that of Mbengue et al. [10] in Senegal, who found an average age of 52.3 years in a study on ulcerative colitis. Women were more represented than men in our study, with a sex ratio of 0.86. This result is comparable to that reported by Diouf et al. [14] in Dakar, who found a sex ratio of 0.68 in favor of women. The strong representation of women could be explained by the fact that they often consult for functional intestinal disorders. Civil servants and housewives were more represented, with respective frequencies of 33.7% and 28.9%. Again, this result could be explained by their easier financial accessibility Cameroon [8], and Togo [15], which were respectively 43 years, 42 years, 41 years, 38 years, and 47 years. Once again, this result could be explained by the easier financial accessibility of civil servants to the examination and the greater demand for the examination among housewives, who most often complain of functional intestinal disorders. Financial inaccessibility, as well as the attribution of certain digestive symptoms such as abdominal pain to functional intestinal disorders, can lead to a delayed diagnosis of colorectal cancer in our context. Rectal bleeding and diarrhea were the most frequent indications in our study, occurring in 35.8% and 27.5% of cases, respectively. The frequency of rectal bleeding is significantly higher than that reported by Coulibaly et al. [13], Diarra et al. [12], Traoré et al. [11], Bernardini et al. [7], and Bougouma et al. [16], which were respectively 30%, 24.6%, 18.7%, 13.5%, and 4.3%. It is lower than that reported by Dia et al. [9] in Dakar, Mbengue et al. [10] in Senegal, Ndjitoyap et al. [8] in Cameroon, and Djibril et al. [15] in Togo, who were respectively 56.3%, 38.0%, 38.8%, and 38.7%. This is due to the fact that this rectal bleeding is distressing for patients and constitutes a warning sign for doctors. The unavailability and inaccessibility of colonoscopy in our context mean that practitioners rely solely on anoscopy to investigate this rectal bleeding, which can delay the diagnosis of colorectal cancer, which must be ruled out in any case of rectal bleeding. The polyp was the most commonly observed macroscopic lesion in our study, accounting for 25.3% of cases, and was benign tubular in 61.3% of cases. Our result was higher than those reported by Ndjitoyap et al. [8] in Cameroon, Mbengue et al. [10] in Senegal, Traoré et al. [11] in Bamako, and Djibril et al. [15] in Togo, which were respectively 15.6%, 7.1%, 18.8%, and 1.18%. Inflammatory lesions were dominated by nonspecific colitis (22.2%), followed by IBD (17.4%). The change in lifestyle by adopting a Western lifestyle could explain these results. Screening campaigns would be necessary to detect and treat these polyps early in order to prevent colorectal cancer. In a country with a high prevalence of bacterial and parasitic infections like ours, a bacteriological and/or parasitological diagnosis combined with histology could reduce the rate of unspecified colitis found in our study. Colon cancer accounted for 19.5% of the lesions, and Lieberkühn adenocarcinoma was the predominant type, representing 84.5% of cases. Our result was higher than those reported by Coulibaly et al. [13] in Bamako, Konaté et al. [17], Djibril et al. [15] in Lomé, and Traoré et al. [11] in Bamako, which were 77.7%, 81.7%, 5.88%, and 3.75%, respectively. This high rate of colorectal cancers could be explained by genetic and environmental factors, highlighting the need to conduct further studies to describe these factors. The rectum was the most frequent location of lesions, accounting for 29.3%. This result is lower than those reported by El Housse et al. [18] in Morocco, Traoré et al. [11] in Bamako, and Diallo et al. [19] in Libreville, which were 57%, 37.7%, and 43%, respectively.

Colorectal pathology is not rare in Mali. Colonoscopy is an effective diagnostic tool. Its high cost and limited geographic accessibility in our context restrict the use of this examination. The reported colorectal lesions are varied, some having a serious prognosis. The higher frequency of rectal bleeding and diarrhea among the indications for colonoscopy encourages the use of this examination in the presence of these symptoms. This approach will allow the detection of lesions at a stage more beneficial for the patient. Proper preparation of the patient is necessary to explore the entire colon, even though the majority of lesions are located in the rectum and sigmoid colon.