A study led by the Medical University of South Carolina (MUSC) Global Surgery Program, in partnership with George Regional Hospital in South Africa, reported that a traveling mobile endoscopy team performed more than 500 procedures across five rural hospitals in South Africa's Western Cape. The study was published in BMJ Open Gastroenterology in December 2025. |
Between January and November 2024, the team performed procedures on adults at district hospitals where endoscopy is not routinely available. The findings highlighted both the heavy burden of treatable gastrointestinal disease in rural communities and the feasibility of bringing diagnostic care directly to patients' doorsteps. The outreach substantially reduced patient travel, while uncovering high rates of gastrointestinal disease, including early cancers, pointing to a scalable model for expanding specialist care in low-resource settings. A health care gap that costs lives Across rural South Africa, access to timely gastrointestinal care remains a major barrier to health. The country has only 0.1 gastroenterologists per 100,000 people, leaving vast regions without specialist services and forcing patients to wait up to nine weeks for a routine endoscopy. At the same time, South Africa has one of the world's highest rates of Helicobacter pylori |
infection, or H. pylori, a known driver of gastritis, peptic ulcers and gastric cancer. Together, these factors contribute to delayed diagnoses and more advanced disease, particularly in remote communities where travel to care can be costly, time-consuming, or simply not an option. To address this gap, clinicians piloted a mobile endoscopy-on-wheels program at George Regional Hospital. A small traveling team transported portable endoscopy equipment by car to five district hospitals. Sites were visited two to four times per month based on referral volume. The program was supported through the MUSC Global Surgery Program, with key leadership |
from Mike Mallah, M.D., and local champion Hugo Stark, M.D., at George Regional Hospital. Lead author of the study, Michael Deal, M.D., of the MUSC General Surgery program, praised the qualities that define Stark's work and his commitment to patients. "Dr. Stark is an unending well of empathy. That's what drew him to medicine, what drives him to do surgery and what drives him to lead this program, on these long drives to deliver care to his patients." |
Who received treatment |
The team performed 515 adult procedures on 495 unique patients, most of whom were women with an average age of 56. The vast majority of procedures – 94% – were upper endoscopies. Colonoscopies made up 5% of procedures, and 0.2% were proctoscopies. The mobile program revealed a high burden of treatable gastrointestinal diseases. Gastritis was identified in 76% of patients, hiatal hernia in 70% and esophagitis in 69%. Duodenitis was found in 19% of patients while gastric ulcers were present in 7%. Many patients had overlapping conditions, most commonly the classic triad of gastritis, |
esophagitis and hiatal hernia, consistent, Deal explained, with long-standing untreated reflux disease. A small percentage of patients were diagnosed with malignancy, including 12 cases of esophageal cancer and five cases of gastric cancer. Seven of these patients were referred to George Regional Hospital for advanced management, such as stenting or surgery, highlighting the program's role in earlier cancer detection and medical care. Most patients received immediate treatment, typically proton pump inhibitors, and a subset were scheduled for local follow-up. Deal emphasized the community component of care, noting the unique connection built with patients. "They recognize that you have come to their community to deliver the same level of care they would receive at a major regional hospital. I think it does a lot for that patient-provider relationship." Dramatically cutting travel burdens |
Perhaps the most tangible impact of the program was how much travel it reduced. On average, patients traveled over 8 miles to a mobile site, compared with about 63 miles to reach George Regional Hospital. For the most remote location, patients saved an average of 137 miles per visit. A small group of 18 ultra-rural patients, individuals living in remote and underdeveloped areas with little access to health care, collectively avoided over 1,864 miles of travel during the study period. Their average travel distance dropped from 59 to just under 7 miles per visit. Deal noted that distance is only part of the barrier. "Not only did they possibly not have reliable transportation, but they might have jobs or family responsibilities that even by missing half a day |
to make that travel would be a significant barrier." By reducing geographic obstacles, the program also improved continuity of care, ensuring that patients could receive follow-up care when needed. |
A scalable model for low-resource settings The success of this initiative aligns with prior mobile endoscopy programs conducted in rural India, where similar efforts proved both feasible and scalable. The study suggests that portable, |
cost-conscious specialist services can meaningfully expand access to care in low- and middle- income countries facing workforce shortages. At the same time, the authors acknowledged key limitations: Most upper endoscopies were performed with topical throat anesthesia, which, while cost-effective, could potentially limit the detection of subtle lesions. Secondly, the study was conducted in a single region only. And lastly, long-term patient outcomes were not tracked. Future work, the team concluded, may include analyzing cost-effectiveness and expanding into |
other regions. Looking ahead, Deal sees broader potential. "To take this type of program and expand it to include additional clinical support throughout South Africa would be incredible," said Deal. "I think that would be the next translatable step. We've done this for endoscopy. Can we do this for minimally invasive surgery?" By bringing diagnostic endoscopy directly to rural communities, the mobile outreach program reduced inequities in gastrointestinal care, enabled earlier detection of serious disease and saved patients thousands of miles in travel. The study demonstrated that mobile specialist care can be both practical and transformative for underserved communities in South Africa and beyond. |
