title: A 13-year time trend analysis of 3724 small bowel video capsule endoscopies and a forecast model during the financial crisis in Greece.
abstract: BACKGROUND
  Since its introduction, small bowel video capsule endoscopy (VCE) use has evolved considerably.
  
  
  OBJECTIVE
  Evaluation of the temporal changes of small bowel VCE utilization in three tertiary centers in Greece in Era 1 (2002-2009) and Era 2 (2010-2014) and the development a forecast model for future VCE use during 2015-2017.
  
  
  METHODS
  Data from all small bowel VCE examinations were retrieved and analyzed in terms of the annual number of the performed examinations, their indications and the significance of their findings.
  
  
  RESULTS
  Overall, we evaluated 3724 VCE examinations. The number of studies peaked in 2009 (n=595) and then decreased to reach 225 in 2014. Overall, more (53.8 vs. 51.4%) patients with iron-deficiency anemia and obscure gastrointestinal bleeding (IDA/OGIB) and fewer (10.7 vs. 14%) patients with chronic diarrhea were evaluated in Era 2 compared with Era 1 (P=0.046). In Era 2, there were more nondiagnostic examinations (39.5 vs. 29.3%, P<0.001), whereas the rate of cases with relevant findings decreased from 47.8 to 40.9%. According to the time trend analysis, we developed a forecast model with two scenarios: the pessimistic and the optimistic. Validation of the model with 2015 data showed that reality was close to the pessimistic scenario: the number of exams further decreased to 190, studies carried out for IDA/OGIB increased to 67%, and there were more negative than positive exams (40.7 vs. 39.2%).
  
  
  CONCLUSIONS
  The number of VCE studies carried out after the emergence of the financial crisis decreased significantly and VCE indications were optimized. Our forecast model predicts lower numbers of VCE studies, with IDA/OGIB being the dominant indication. However, the predicted increase of negative exams requires further evaluation.
authors: aHepatogastroenterology Unit, Second Department of Internal Medicine - Propaedeutic, Research Institute and Diabetes Center, Medical School, National and Kapodistrian University of Athens, 'Attikon' University General Hospital bDepartment of Gastroenterology, Evangelismos Hospital cDepartment of Gastroenterology, NIMTS Hospital, Athens, Greece.
authors: Konstantinos
authors: K
authors: Triantafyllou
authors: Paraskevas
authors: P
authors: Gkolfakis
authors: Nikos
authors: N
authors: Viazis
authors: Panagiotis
authors: P
authors: Tsibouris
authors: Athanasios
authors: A
authors: Tsigaridas
authors: Periklis
authors: P
authors: Apostolopoulos
authors: John
authors: J
authors: Anastasiou
authors: Eleni
authors: E
authors: Hounda
authors: Ioannis
authors: I
authors: Skianis
authors: Konstantina
authors: K
authors: Katopodi
authors: Xhoela
authors: X
authors: Ndini
authors: George
authors: G
authors: Alexandrakis
authors: Demetrios G
authors: DG
authors: Karamanolis
mesh_terms: D000368:Aged; D018798:Anemia, Iron-Deficiency / Q000175:diagnosis*; D053704:Capsule Endoscopy / Q000639:trends*; D002908:Chronic Disease; D003424:Crohn Disease / Q000175:diagnosis*; D003967:Diarrhea / Q000175:diagnosis*; D057172:Economic Recession; D005260:Female; D005544:Forecasting; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis*; D006115:Greece; D006801:Humans; D007421:Intestine, Small; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015203:Reproducibility of Results; D012189:Retrospective Studies; D062606:Tertiary Care Centers