A shortage of endoscopists, endoscopy technicians, and nurses creates a bottleneck in procedure rooms. A standard endoscopy unit requires: the lead physician + 1–2 nurses + a machine technician + disinfection staff. Missing even one link reduces capacity by 30–50%. Power outages further increase risk during polypectomy or hemostasis. On the management side, understaffed hospitals at night or weekends are forced to transfer gastrointestinal bleeding cases to distant centers, delaying the golden intervention window. Quality also suffers: continuous training, internal audits, and indicators such as ADR (adenoma detection rate), cecal intubation rate (≥95% for screening colonoscopy), and withdrawal time (≥6 minutes) become difficult to maintain.
Typical cases reflect how the system is strained:
- Six-week wait for colonoscopy: means losing the chance for early polyp removal. Adenomas >10 mm progress more rapidly toward cancer, so every week of delay adds cumulative risk.
- Severe IBS due to stress: fewer doctors means less time for counseling, leading patients to overuse medications or follow extreme diets, disturbing gut microbiota and worsening quality of life.
- Nighttime GI bleed transfer: if the initial hospital lacks clips, banding devices, hemostatic powder, or experiences a blackout – the risks of hypotension, acidosis, greater transfusion needs, and complications all increase.
A high-quality gastroenterology unit requires more than “just a scope.” At minimum:
- Equipment: HD/4K endoscopy system, CO₂ insufflation (reduces bloating), multi-mode electrosurgical unit, stable light source, AER reprocessor, UPS/generators.
- Interventional tools: snares of different sizes, hemostatic clips, banding kits, adrenaline injection needles, hemostatic powders, dilation tools, stents.
- Protocols: pre-procedure risk stratification, safety checklists, anesthesia support, standardized disinfection (water source, chemicals, logging).
- Personnel: certified endoscopists, trained nurses/technicians, CME programs, regular audits (ADR, complications, bowel prep quality ≥85%).
The benefits include earlier diagnosis, timely intervention, fewer complications, and seamless transition from detection to treatment in a single session.
The digestive and cardiovascular systems intersect on multiple levels:
- Pre-procedure: cardiovascular screening minimizes anesthesia risk; anticoagulants/antiplatelets (DOACs/warfarin/DAPT) must be adjusted according to bleeding risk (high: large polypectomy, EMR/ESD; low: diagnostic scopes).
- During procedure: patients with CAD or arrhythmias require continuous monitoring, emergency drugs (nitroglycerin, atropine), and medical gases readily available.
- Post-procedure: anticoagulation must be restarted at the right time; collaboration with cardiology is essential in high-risk patients.
Proper cardiac screening and management reduce anesthesia, bleeding, and thrombotic complications, shorten hospital stay, and lower costs.
Delays create a double burden:
- Clinical: polyp → cancer; H. pylori gastritis → ulcer/bleeding; uncontrolled IBD → strictures/perforation/hospitalization.
- Socioeconomic: prolonged work absence, caregiver strain, intercity travel costs, higher healthcare expenses due to advanced disease.
Psychologically, patients endure prolonged anxiety, often spiraling into “Google – self-treatment – complications,” leaving physicians to “undo” damage rather than simply treat.
1) Strengthening international standards at the point of care
- Quality bundle: ADR ≥25–30% (per guideline), cecal intubation ≥95%, post-polypectomy bleeding <1%, perforation <0.1%.
- Standardizing observation positions & withdrawal techniques, using virtual chromoendoscopy/NBI for flat lesions.
- Equipment maintenance & power backup: UPS/generators, documented servicing of electrosurgical units, light sources, AER.
2) Optimizing resources with digital health
- Tele-IBD/GERD/IBS: symptom, weight, and food diary monitoring; flare alerts for priority endoscopy.
- Remote triage: risk scores (e.g., Glasgow-Blatchford for UGIB) to decide admission vs outpatient care.
- Smart scheduling: “clinical priority slots” (positive FIT, iron deficiency anemia, weight loss, hematochezia) to shorten time to endoscopy.
3) Cross-disciplinary & inter-hospital collaboration
- Hotline transfer pathways with cardiology, anesthesia, hematology; unified anticoagulation protocols.
- Shared access to rare tools (stents, ESD kits) across hospital clusters; rotating teams to relieve overloaded regions.
4) Transparency & accountability
- Public reporting of quality metrics (ADR, complications, waiting times).
- Incident reporting & learning (M&M), focusing on system improvement, not individual blame.
Personal commitment: I will continue practicing in Lebanon, training junior doctors, expanding telemedicine for rural patients, and anchoring every clinical decision in safety, evidence, and humanity.
Digestive health cannot wait for the system to heal itself. Early diagnosis (screening endoscopy, H. pylori testing, FIT), integrated cardiac care, and choosing accredited centers are the three pillars that allow patients to “buy back time.” Amid workforce shortages and instability, every standardized process, every early polyp detection, every safely treated GI bleed is a concrete victory. My colleagues and I will continue pursuing these small victories – for each patient, and for the future of healthcare in Lebanon.
