Trends in utilization of diagnostic and therapeutic ERCP and cholecystectomy over the past 25 years: a population-based study

Moffatt, Dana C.; Yu, B. Nancy; Yie, Wiechun; Bernstein, Çharles N.

doi:10.1016/j.gie.2013.08.028

Cited by 60 publications

(47 citation statements)

References 24 publications

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“…This is in large part due to the fact that the predictive value of preoperative risk stratification algorithms has been disappointing; thus, some have continued to advocate for universal application of IOC during LC performed for therapy of gallstone disease 8–13. Not unexpectedly, this has led to a marked increase in the use of ERCP in the era of laparoscopic gallbladder surgery 1 3 4 14 15. Despite the almost universal adoption of ERCP as a follow-up study to abnormalities identified on IOC, the optimal evaluation of patients with abnormal IOC findings is incompletely defined.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of patients with abnormalities on intraoperative cholangiogram: time to abandon endoscopic retrograde cholangiopancreatography as the initial follow-up study

Bill

Kushnir

Mullady

et al. 2015

Frontline Gastroenterol

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Section: Discussionmentioning

confidence: 99%

Evaluation of patients with abnormalities on intraoperative cholangiogram: time to abandon endoscopic retrograde cholangiopancreatography as the initial follow-up study

Bill

Kushnir

Mullady

et al. 2015

Frontline Gastroenterol

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“…(2) To emulate a case mix in clinical practice, we assumed that some individuals with symptomatic CBD stones had concomitant obstructive jaundice and cholangitis. In 2012, 23% of U.S. hospitalizations principally for CBD stones were complicated by cholangitis.…”

Section: Methodsmentioning

confidence: 99%

“…(1) ERCP is the gold standard for the management of a variety of disorders, including symptomatic common bile duct (CBD) stones, biliary cholangitis, and pancreatic and biliary malignancy. (2) Unique to ERCP is the duodenoscope, an endoscope with an elevator channel that allows for the placement of guidewires, catheters and other endoscopic accessories into the operator’s visual field. While the design of this endoscope permits technically advanced and precise biliary procedures, the difficult to access elevator channel poses a challenge for effective duodenoscope reprocessing and decontamination.…”

Section: Introductionmentioning

confidence: 99%

Cost Utility of Competing Strategies to Prevent Endoscopic Transmission of Carbapenem-Resistant Enterobacteriaceae

Almario

May

Shaheen

et al. 2015

American Journal of Gastroenterology

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OBJECTIVES Prior reports have linked patient transmission of carbapenem-resistant Enterobacteriaceae (CRE, or “superbug”) to endoscopes used during endoscopic retrograde cholangiopancreatography (ERCP). We performed a decision analysis to measure the cost-effectiveness of four competing strategies for CRE risk management. METHODS We used decision analysis to calculate the cost-effectiveness of four approaches to reduce the risk of CRE transmission among patients presenting to the hospital for symptomatic common bile duct stones. The strategies included: (1) perform ERCP followed by U.S. Food and Drug Administration (FDA)-recommended endoscope reprocessing procedures; (2) perform ERCP followed by “endoscope culture and hold”; (3) perform ERCP followed by ethylene oxide (EtO) sterilization of the endoscope; and (4) stop performing ERCP in lieu of laparoscopic cholecystectomy (LC) with common bile duct exploration (CBDE). Our outcome was incremental cost per quality-adjusted life year (QALY) gained. RESULTS In the base-case scenario, ERCP with FDA-recommended endoscope reprocessing was the most cost-effective strategy. Both the ERCP with culture and hold ($4,228,170/QALY) and ERCP with EtO sterilization ($50,572,348/QALY) strategies had unacceptable incremental costs per QALY gained. LC with CBDE was dominated, being both more costly and marginally less effective versus the alternatives. In sensitivity analysis, ERCP with culture and hold became the most cost-effective approach when the pretest probability of CRE exceeded 24%. CONCLUSIONS In institutions with a low CRE prevalence, ERCP with FDA-recommended reprocessing is the most cost-effective approach for mitigating CRE transmission risk. Only in settings with an extremely high CRE prevalence did ERCP with culture and hold become cost-effective.

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“…Although this is the first description of rates of BDS in the United States, a study of the single Canadian province of Manitoba also indicated a marked decrease in rates of open bile duct exploration coincident with the growth of therapeutic ERCP between 1984 and 2009. 18 …”

Section: Discussionmentioning

confidence: 99%

Evolution in the utilization of biliary interventions in the United States: results of a nationwide longitudinal study from 1998 to 2013

Huang

Thosani

Barakat

et al. 2017

Gastrointestinal Endoscopy

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Background and Aims Bile duct surgery (BDS), percutaneous transhepatic cholangiography (PTC), and endoscopic retrograde cholangiopancreatography (ERCP) are alternative interventions used to treat biliary disease. We aim to describe trends in ERCP, BDS, and PTC on a nationwide level in the United States. Methods We used the National Inpatient Sample to estimate age-standardized utilization trends of inpatient diagnostic ERCP, therapeutic ERCP, BDS, and PTC between 1998 and 2013. We calculated average case fatality, length of stay, patient demographic profile (age, gender, payer), and hospital characteristics (hospital size and metropolitan status) for these procedures. Results Total biliary interventions decreased over the study period from 119.8 to 100.1 per 100,000. Diagnostic ERCP utilization decreased by 76%, and therapeutic ERCP utilization increased by 35%. BDS rates decreased by 78%, and PTC rates decreased by 24%. ERCP has almost completely supplanted surgery for the management of choledocholithiasis. Fatality from ERCP, BDS, and PTC have all decreased, whereas mean length of stay has remained stable. The proportion of, Medicare-insured, Medicaid-insured and uninsured patients undergoing biliary procedures has increased over time. The majority of the increase in therapeutic ERCP and decrease in BDS occurred in large, metropolitan hospitals. Conclusions Although therapeutic ERCP utilization has increased over time, the total volume of biliary interventions has decreased. BDS utilization has experienced the most dramatic decrease, possibly a consequence of the increased therapeutic capacity and safety of ERCP. ERCPs are now predominantly therapeutic in nature. Large urban hospitals are leading the shift from surgical to endoscopic therapy of the biliary system.

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Trends in utilization of diagnostic and therapeutic ERCP and cholecystectomy over the past 25 years: a population-based study

Abstract: Design:Retrospective, comprehensive population-based study.

Cited by 60 publications

References 24 publications

Evaluation of patients with abnormalities on intraoperative cholangiogram: time to abandon endoscopic retrograde cholangiopancreatography as the initial follow-up study

Evaluation of patients with abnormalities on intraoperative cholangiogram: time to abandon endoscopic retrograde cholangiopancreatography as the initial follow-up study

Cost Utility of Competing Strategies to Prevent Endoscopic Transmission of Carbapenem-Resistant Enterobacteriaceae

Evolution in the utilization of biliary interventions in the United States: results of a nationwide longitudinal study from 1998 to 2013

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