Forecast models to predict the demand for endoscopic procedures in a tertiary unit: a prospective validation.

Over the past few decades, there has been an exponential increase in the utilization of endoscopic procedures. Accurately predicting the demand is crucial for effective capacity planning and resource allocation in the endoscopic unit. However, predictive models are not integrated into current endoscopy software. To overcome this limitation, our group used data on the demand in our tertiary unit from 2015 to 2021 (83 months) to develop forecast models using exponential smoothing techniques adjusted for trend and seasonality (derivation phase). These models were recently published at the Revista Española de Enfermedades Digestivas.

Predicting the future: introducing business analytics to endoscopy units

Background and aims: currently, most endoscopy software only provides limited statistics of past procedures, while none allows patterns to be extrapolated. To overcome this need, the authors applied business analytic models to predict future demand and the need for endoscopists in a tertiary hospital Endoscopy Unit. Methods: a query to the endoscopy database was performed to retrieve demand from 2015 to 2021. The graphical inspection allowed inferring of trends and seasonality, perceiving the impact of the COVID-19 pandemic, and selecting the best forecasting models. Considering COVID-19’s impact in the second quarter of 2020, data for esophagogastroduodenoscopy (EGD) and colonoscopy was estimated using linear regression of historical data. The actual demand in the first two quarters of 2022 was used to validate the models. Results: during the study period, 53,886 procedures were requested. The best forecasting models were: a) simple seasonal exponential smoothing for EGD, colonoscopy and percutaneous endoscopic gastrostomy (PEG); b) double exponential smoothing for capsule endoscopy and deep enteroscopy; and c) simple exponential smoothing for endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS). The mean average percentage error ranged from 6.1 % (EGD) to 33.5 % (deep enteroscopy). Overall, 8,788 procedures were predicted for 2022. The actual demand in the first two quarters of 2022 was within the predicted range. Considering the usual time allocation for each technique, 3.2 full-time equivalent endoscopists (40 hours-dedication to endoscopy) will be required to perform all procedures in 2022. Conclusions: the incorporation of business analytics into the endoscopy software and clinical practice may enhance resource allocation, improving patient-focused decision-making and healthcare quality (AU)

Predicting the future: introducing business analytics to endoscopy units.

BACKGROUND AND AIMS: currently, most endoscopy software only provides limited statistics of past procedures, while none allows patterns to be extrapolated. To overcome this need, the authors applied business analytic models to predict future demand and the need for endoscopists in a tertiary hospital Endoscopy Unit. METHODS: a query to the endoscopy database was performed to retrieve demand from 2015 to 2021. The graphical inspection allowed inferring of trends and seasonality, perceiving the impact of the COVID-19 pandemic, and selecting the best forecasting models. Considering COVID-19's impact in the second quarter of 2020, data for esophagogastroduodenoscopy (EGD) and colonoscopy was estimated using linear regression of historical data. The actual demand in the first two quarters of 2022 was used to validate the models. RESULTS: during the study period, 53,886 procedures were requested. The best forecasting models were: a) simple seasonal exponential smoothing for EGD, colonoscopy and percutaneous endoscopic gastrostomy (PEG); b) double exponential smoothing for capsule endoscopy and deep enteroscopy; and c) simple exponential smoothing for endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS). The mean average percentage error ranged from 6.1 % (EGD) to 33.5 % (deep enteroscopy). Overall, 8,788 procedures were predicted for 2022. The actual demand in the first two quarters of 2022 was within the predicted range. Considering the usual time allocation for each technique, 3.2 full-time equivalent endoscopists (40 hours-dedication to endoscopy) will be required to perform all procedures in 2022. CONCLUSIONS: the incorporation of business analytics into the endoscopy software and clinical practice may enhance resource allocation, improving patient-focused decision-making and healthcare quality.

[Symptomatic acute hepatitis C: the importance of diagnosis]. / Hepatite C aguda sintomática--a importância do diagnóstico.

Chronic infection by the hepatitis C virus (HCV) is one of the leading causes of chronic liver disease with an estimate worldwide prevalence of over 200 million people. Acute hepatitis C infection is usually asymptomatic and rarely identified in clinical practice, leading to chronic infection in about 80% of all cases. However, when symptomatic, only about 50% of acute infections progress to chronicity. Correctly identifying acute HCV infection is of paramount importance once it presents itself as an unique treatment opportunity with sustained virological response of about 90%, which is very distant from the 30% to 80% of sustained virological response achieved with standard chronic HCV treatment. The authors present four cases of acute HCV infection. There was spontaneous viral clearance in two pa- tients at week 12 of follow-up. In one case viral RNA was positive at week 12 but sustained virological response was eventually achieved after peginterferon alpha2a monotherapy.

Hepatite C aguda sintomática--a importÔncia do diagnóstico. / [Symptomatic acute hepatitis C: the importance of diagnosis].

Chronic infection by the hepatitis C virus (HCV) is one of the leading causes of chronic liver disease with an estimate worldwide prevalence of over 200 million people. Acute hepatitis C infection is usually asymptomatic and rarely identified in clinical practice, leading to chronic infection in about 80

of all cases. However, when symptomatic, only about 50

of acute infections progress to chronicity. Correctly identifying acute HCV infection is of paramount importance once it presents itself as an unique treatment opportunity with sustained virological response of about 90

, which is very distant from the 30

to 80

of sustained virological response achieved with standard chronic HCV treatment. The authors present four cases of acute HCV infection. There was spontaneous viral clearance in two pa- tients at week 12 of follow-up. In one case viral RNA was positive at week 12 but sustained virological response was eventually achieved after peginterferon alpha2a monotherapy.

Hepatite C aguda sintomática--a importÔncia do diagnóstico / [Symptomatic acute hepatitis C: the importance of diagnosis].

Chronic infection by the hepatitis C virus (HCV) is one of the leading causes of chronic liver disease with an estimate worldwide prevalence of over 200 million people. Acute hepatitis C infection is usually asymptomatic and rarely identified in clinical practice, leading to chronic infection in about 80

of acute infections progress to chronicity. Correctly identifying acute HCV infection is of paramount importance once it presents itself as an unique treatment opportunity with sustained virological response of about 90

, which is very distant from the 30

of sustained virological response achieved with standard chronic HCV treatment. The authors present four cases of acute HCV infection. There was spontaneous viral clearance in two pa- tients at week 12 of follow-up. In one case viral RNA was positive at week 12 but sustained virological response was eventually achieved after peginterferon alpha2a monotherapy.

Hematoma retroperitoneal tras tratamiento de lesión de Dieulafo y duodenal / Retroperitoneal hematoma after treatment of Dieulafoy's lesion of the Duodenum

La lesión de Dieulafoy es una causa poco frecuente de sangrado del tracto gastrointestinal que puede tener consecuencias graves como hipotensión y hemorragia recurrente si no es tratada.Los autores publican el caso de una paciente anciana con múltiples comorbilidades que debuta con hemorragia digestiva, causada por una lesión de Dieulafoy a nivel duodenal, que se trato por via endoscopica y luego se complicó con la formación de un hematoma retroperitoneal. Teniendo en cuenta el riesgo quirúrgico los autores optaron por tratar nuevamente la lesion por via endoscopica lo que resultó ser un enfoque razonable en este paciente en particular(AU)

Dieulafoy's lesion is an uncommon cause of brisk arterial bleeding from the gastrointestinal tract that can have severe consequences such as rebleeding and hypotension if left untreated.The authors report the case of an elderly woman with several comorbidities who presented with duodenal bleeding caused by a Dieulafoy lesion. The lesion was treated endoscopically and was subsequently complicated by the formation of a retroperitoneal hematoma. Given the surgical risk, the authors opted to retreat endoscopically, which proved to be a reasonable approach in this particular patient(AU)

[Retroperitoneal hematoma after treatment of Dieulafoy's lesion of the duodenum]. / Hematoma retroperitoneal tras tratamiento de lesión de Dieulafoy duodenal.

Dieulafoy's lesion is an uncommon cause of brisk arterial bleeding from the gastrointestinal tract that can have severe consequences such as rebleeding and hypotension if left untreated. The authors report the case of an elderly woman with several comorbidities who presented with duodenal bleeding caused by a Dieulafoy lesion. The lesion was treated endoscopically and was subsequently complicated by the formation of a retroperitoneal hematoma. Given the surgical risk, the authors opted to retreat endoscopically, which proved to be a reasonable approach in this particular patient.

Erythema induratum and chronic hepatitis C infection.

Erythema induratum, or nodular vasculitis, was initially described as a type of cutaneous tuberculosis. Currently, it is considered a multifactorial syndrome of lobular panniculitis of unknown cause. An association between erythema induratum and hepatitis C virus (HCV) has been suggested in previous reports. We report the case of a 49-year-old male presenting with a 3-year history of itchy, painful red to violaceous cutaneous nodules and plaques on both legs that had been unresponsive to topical dermatologic treatments. Evaluation of persistent serum transaminase elevations led to a diagnosis of chronic hepatitis C with bridging liver fibrosis. A thorough evaluation to exclude mycobacterial infection was performed, and anti-tuberculosis treatment was started based on a positive QuantiFERON test. There was no improvement in the skin lesions with this treatment. The patient then received standard antiviral therapy with pegylated interferon and ribavirin for 48 weeks. Treatment produced an early virologic response with significant improvement in the skin lesions, pain and pruritus. Six months after antiviral treatment, virologic relapse occurred without recurrence of the cutaneous lesions. There appears to be an association between erythema induratum and hepatitis C infection, probably mediated by circulating immune complexes. Interestingly, lesions improve with antiviral treatment and, as shown in this case, the effect may be sustained after stopping treatment despite virologic relapse.