Digestive endoscopy is essential for the diagnosis and treatment of gastrointestinal diseases. However, regions in the southern part of the country, characterized by predominantly rural populations and geographic challenges, face significant barriers in accessing specialized care. The reference center plays a crucial role in providing this care. This descriptive study analyzes patient characteristics, indications for endoscopic procedures, and obstacles encountered, with the aim of proposing adapted solutions.

This is a cross-sectional descriptive study conducted over six months, from September 2024 to March 2025, including 512 patients who underwent endoscopic procedures at the center, originating from both urban and rural areas of the southern region in a low-resource setting. Collected data included demographic information (age, sex, urban/rural origin), health coverage (social security schemes, private insurance, uninsured patients), type of procedures performed (colonoscopy, upper endoscopy, endoscopic ultrasound, ERCP, capsule endoscopy), indications (diagnostic or interventional), and delays and obstacles (average waiting time for an appointment, distance traveled, and financial costs). Data sources included medical records, hospital registries, patient questionnaires, and interviews with healthcare professionals.

The study included 512 patients, with a mean age of 51 years (range 19–85), with a predominance of males (58%). Most patients (68%) came from rural areas, mainly from Ouarzazate (20%), Zagora (18%), Taroudant (15%), Al Haouz (10%), and El Kelaâ des Sraghna (5%), while 32% came from urban areas such as Agadir, Ida-Outanane, Marrakech, and Guelmim. Colonoscopy accounted for 45% of procedures, mainly indicated for rectal bleeding (40%), colorectal cancer screening (25%), chronic diarrhea (15%), and polypectomies (10%). Upper endoscopy represented 35% of procedures, mainly for epigastric pain (30%), upper gastrointestinal bleeding (50%), suspected gastritis or ulcer (10%), and foreign body management (5%). Endoscopic ultrasound was performed in 10% of cases, primarily for pancreatic or biliary tumors (40%), cysts (30%), and suspected submucosal tumors (20%). ERCP accounted for 7% of interventions, mainly for bile duct stones (60%), cholangitis (20%), and biliary stent placement (20%). Capsule endoscopy, performed in 3% of cases, was mainly used for unexplained iron-deficiency anemia (60%) and obscure gastrointestinal bleeding (30%).

Regarding health coverage, 60% of patients were affiliated with social security schemes, 20% with other national programs, 10% had private insurance, and 10% were uninsured. Average waiting times varied by procedure, with four weeks for colonoscopy, six weeks for endoscopic ultrasound, and one to two weeks for ERCP. The average distance traveled to access care was 210 km, ranging from 30 to 950 km. Seventy-five percent of patients reported financial difficulties related to indirect costs, including transportation and accommodation.

In conclusion, the center serves as a major reference point for patients from the southern region in a low-resource setting, with most patients originating from rural areas. The study highlights major challenges in accessing digestive endoscopy due to geographic, financial, and organizational barriers. These findings align with international data from other low-resource and developing countries and underscore the urgent need to improve service delivery. Solutions such as mobile endoscopy units, strengthening local hospitals, and improving subsidies for indirect care costs could significantly transform access to digestive endoscopy in the region.