The aim of this study was to evaluate the benefits of upper gastrointestinal endoscopy at central hospital level in Malawi and to draw conclusions from its use in the treatment of patients presenting with dysphagia and dyspepsia to health institutions in rural Africa. This retrospective study was carried out in order to investigate the endoscopic findings in 455 patients who presented to Zomba Central Hospital, Malawi, with upper gastrointestinal symptoms. Fifty-six percent of patients presenting with dysphagia were found to have oesophageal carcinoma. In 50% of patients with epigastric pain and 44% with abdominal pain, an endoscopy did not reveal any pathological findings. The intended treatment was frequently altered as a result of performing the endoscopy. We were able to treat patients according to their specific diagnosis in a significantly higher number than before: 51% versus 18% of those presenting with dysphagia, 96% versus 24% of those with epigastric pain and 90% versus 39% of those with abdominal pain. Upper gastrointestinal endoscopy is a feasible diagnostic tool in developing countries which improves the detection and treatment of diseases of the gastrointestinal tract.