Trends in the Utilization of ERCP in the United States

[Guest guest]

Trends in the Utilization of Endoscopic Retrograde Cholangiopancreatography (ERCP) in the United

States

Authors: Mazen Jamal, M.; Yoon, Eugene J.; Saadi, Altaf; Sy,

Y. Theodore; Hashemzadeh, Mehrtash

Source:

The American

Journal of Gastroenterology, 5, May 2007, pp. 966-975(10)

Publisher: Blackwell

Publishing

OBJECTIVES:

To evaluate nationwide trends in the utilization of endoscopic retrograde cholangiopancreatography

(ERCP) in relation to the advent of noninvasive methods of visualizing the

biliary and pancreatic tree.

METHODS:

Retrospective cohort study. The

Nationwide Inpatient Sample (NIS) database was used to calculate the

age-adjusted rate for ERCPs performed from 1988 to 2002. The

State Ambulatory Surgery Database (SASD) was used to evaluate trends in

outpatient ERCPs from 1997 to 2003. Linear Poisson multivariate

regression model was used to control for variations in age, gender, and

ethnicity among the overall patient population.

RESULTS: The NIS database contained 402,343 patients who

had an ERCP performed from 1988 to 2002. The mean age

for these patients was 60.21 ± 19.56 yr old. From 1988

to 1996; the age-adjusted rate for ERCPs increased by nearly threefold, from

25.66 per 100,000 in 1988 to 74.95 in 1996. The rate

of 74.95 in 1996 declined to a rate of 59.70 by the year 2002.

The rates of diagnostic ERCPs in men and women were 26.76 and 31.58 per

100,000 in 1988-1990, respectively. This rate then

increased to 35.66 and 43.18 per 100,000 in 1994-1996, which then declined to

29.01 and 29.06 in 2000-2002. The age-adjusted rate

for therapeutic ERCPs in men and women was 13.74 and 15.61 per 100,000 in

1988-1990, respectively, which continued to increase throughout the time span

to 38.76 and 43.75 in 2000-2002. The SASD revealed a

continual decline in outpatient ERCPs from 25.45 per 100,000 in 1997 down to

16.17 per 100,000 in the year 2003.

CONCLUSION:

The utilization of ERCP dramatically increased from

1988 to 1996; however, since the advent of noninvasive diagnostic techniques

such as endoscopic ultrasound (EUS) and magnetic

resonance cholangiopancreatography (MRCP), there has

been a steady decline in the utilization of diagnostic ERCPs from 1996 to 2002.   (Am J Gastroenterol 2007;102:966-975)

Barb in Texas - Together in the Fight, Whatever it Takes!

Son Ken (33) UC 91 - PSC 99 Listed 7/21 @ Baylor Dallas