Small bowel capsule endoscopy and deep enteroscopy procedure load in France: a nationwide population-based study over 7 years

Abstract

Background and aims: Capsule endoscopy (CE) is a diagnostic tool mainly used to explore the small bowel (SB), whereas device-assisted enteroscopy (DAE) is preferred for therapeutics. We aimed to describe the procedure load of SB endoscopy in France from 2015 to 2021. Patients and Methods: Using the French national health data system and the French national hospital discharge database, we identified all SBCE and DAE reported between January 2015 and December 2021. Information on DAE was crosschecked with data on purchase or maintenance from manufacturers. Centres and procedures were described by type, year, type of practice, and according to the 13 French administrative regions in the mainland and in those overseas. Results: 151,096 SBCE and 6,802 for DAE were considered over the study period. SBCE service was offered in all regions, in both public and private settings, and case load increased from 18,956 to 24,183 (+27.6%). The number of DAE decreased nationwide, from 1,030 to 932 (-9.5%). Eighty-seven percent of all DAE were performed in public, university hospitals. Retrograde route varied between 18.8% and 22.8% of all DAE, yearly. The number of centres offering DAE varied from 0 to 5, over regions and years. DAE case load increased in five regions but stopped, decreased or did not even start in the nine remaining regions. Conclusion: SB endoscopy in France is marked by a 22-fold unbalanced procedure load in CE (nationwide coverage) and in DAE (absent in some regions). This gap has widened over years, from 2015 to 2021.