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INTRODUCTION: Recent publications suggest that the order number of colonoscopy performance by the same endoscopist or "queue position" (QP) is the best parameter to assess endoscopist fatigue, playing a possible role in the rate of polypoid lesions found during the procedure. However, published results are scarce and totally contradictory. AIM: The purpose of this study is to evaluate in our environment the effect of endoscopist fatigue, assessed by means of QP, on the rate of diagnosed polyps and adenomas during colonoscopy. PATIENTS AND METHODS: We retrospectively studied 1000 consecutive outpatient colonoscopies performed under sedation (Propofol e.v.). Scheduled endoscopy session, including 9 colonoscopies and 3 upper GI endoscopies, was performed by the same team: staff endoscopist, endoscopy nurse and anaesthesiologist. The order number of colonoscopy performance determined QP score. Patients with poor colon cleansing were excluded. We analysed possible differences of QP score regarding gender, age < 65 years, presence of symptoms and previous history of polypectomy. Finally, we calculated the rate of diagnosed polyps and adenomas in relation with QP score. Fisher and square chi tests were used for statistical analysis, considering significant p < 0.05. RESULTS: 95 patients (9.5%) were excluded due to poor colon cleansing. Characteristics of the remaining 905 patients were: mean age = 57.4 + 13.9 years; gender (female = 54%/male = 46%); symptomatic patients = 440 (48.6%); asymptomatic patients = 465 (51.4%); polyp rate = 44.2%; adenomas rate = 32.3%. Colonoscopies were performed by 13 endoscopists and no differences were found among them, concerning polyps rate (p = 0.21) and adenomas rate (p = 0.27). No differences in QP score were found in relation with gender (p = 0.43), age (p = 0.30), presence of symptoms (p = 0.22) or previous polypectomy (p = 0.82). No significant differences were found neither in polyps rate (p = 0.60) nor in adenomas rate (p = 0.68) in relation with QP (order number of colonoscopy performance by the same endoscopist). CONCLUSIONS: 1. We found no differences in polyps detection rate and adenomas detection rate in relation with the order number of colonoscopy performance (QP) by the same explorer. 2. According to our results, the possible endoscopist fatigue after performing several consecutive procedures did not play any role in the rate of diagnosed polyps and adenomas during colonoscopy.

AIM: To evaluate need for and efficacy of a structured gastroenterology didactic session in expanding awareness and understanding of digestive disorders. METHODS: A four-day symposium was developed with didactic sessions (days 1, 2) and practical endoscopy (days 3, 4). Didactic sessions included case presentations highlighting pathophysiology and management. One nurse and four practicing gastroenterologists from the United Kingdom led lectures and supervised workshops with audience participation. Practical endoscopy focused on diagnostic and therapeutic procedures and their application to diagnosis and treatment of ailments of the gastrointestinal tract. Pre- and post-workshop questionnaires were distributed to participants during didactic sessions. A pre-workshop questionnaire gauged expectations and identified objectives to be met at the symposium. Post-workshop questionnaires were administered to assess efficacy of each session. Participants graded sessions from 1 (poor) to 5 (excellent) on quality of case presentations, knowledge, clarity and mode of presentation. We assessed if time allotted to each topic was sufficient, value of sessions, impact on practice and interest in future symposiums. RESULTS: There were 46 attendees on day 1: 41% undergraduates, 41% residents, 11% consultants and 4% unspecified. Day 2 (a Saturday) had 24 participants: 17% undergraduates, 71% residents, 9% consultants, 4% unspecified. Primary pre-workshop symposium expectation was to gain knowledge in: general gastroenterology (55.5%), practical endoscopy (13.8%), pediatric gastroenterology (5%), epidemiology of gastrointestinal disorders specific to Zambia (6%), and interaction with international speakers (6%). The post-symposium questionnaire was answered by 19 participants, of whom 95% felt specific aims were met; all would attend future conferences and recommend to others. CONCLUSION: The beneficial effect of a structured symposium in developing countries warrants further attention as a mechanism to improve disease awareness in areas where resources are limited.

HIV infection has been shown to increase the risk of developing some malignancies. We evaluated the possibility of an association between gastric cancer and HIV infection in patients seen at the University Teaching Hospital, Lusaka, Zambia. Other known risk factors such as infection with Helicobacter pylori (H. Pylori), presence of CagA, serum pepsinogen 1 to 2 ratios, smoking and alcohol intake were also evaluated.