Use of ERCP in the United States over the past decade

Abstract

Background and study aims With newer imaging modalities, indications for use of endoscopic retrograde cholangiopancreatography (ERCP) have changed in the last decade. Despite advances in ERCP, paucity in recent literature regarding utilization and outcomes of ERCP exists. Thus, the aim of this study was to assess the inpatient use of ERCP, outcomes, and most common indications. Patients and methods Retrospective-cohort study using the Nationwide Inpatient Sample 2007–2016. All patients with ICD9–10CM procedural codes for ERCP were included. The primary outcome was the use of ERCP. Secondary outcomes included determining procedural specifics (stenting, sphincterotomy and dilation), complications (post-ERCP pancreatitis [PEP], bile duct perforation), hospital length of stay, total hospital costs and charges. Multivariate regression analysis was used to adjust for confounders. Results A total of 1,606,850 patients underwent inpatient ERCP. The mean age was 59 years (60 % female). The total number of ERCPs increased over the last decade. Patients undergoing ERCP in 2016 had greater odds of undergoing bile duct stent placement, pancreatic duct (PD) stenting, biliary dilation, pancreatic sphincterotomy, PEP and biliary perforation. Inpatient mortality decreased. Hospital charges increased, while length of stay (LOS) decreased. Conclusions The number of ERCPs increased in the past decade. Odds of therapeutic interventions and complications increased. The most common principal diagnoses were choledocholithiasis and gallstone-related AP. Hence, physicians must be aware to promptly diagnose and treat complications. These findings may reflect the increased case complexity and fact that ERCP continues to evolve into an increasingly interventional tool, contrasting from its former role as a predominantly diagnostic and gallstone extraction tool.

Adverse events associated with endoscopic retrograde cholangiopancreatography: protocol for a systematic review and meta-analysis

“…Though ERCP in 2020 is primarily a therapeutic procedure, with minimal diagnostic indications, it remains one of the most commonly performed endoscopic procedures in the USA and world-wide, with volumes having increased over time. 5 6 Even though ERCP is a relatively safe procedure overall, AEs are more prevalent with its performance than any other endoscopic procedure. Thus, it behoves endoscopists performing ERCP to be acutely aware of the most precise and up-to-date estimates of risk possible.…”

“… 1–4 Although the role of standard ERCP has transitioned to that of a primarily therapeutic procedure, ERCP volumes have nevertheless risen over the past 10–15 years in the USA. 5 6 ERCP is performed across high-volume and low-volume centres, and by endoscopists of variable experience and specialties. 7 A steep learning curve during a specialised period of training results in an advanced skill set required to perform safe and effective ERCP.…”

Endoscopic retrograde cholangiopancreatography: Current practice and future research

“…The main indication for ERCP is choledocholithiasis[ 49 ] which can cause cholangitis, biliary obstruction, and pancreatitis. For routine stones < 1 cm, a sphincterotomy with stone extraction using a balloon or basket is performed.…”

Use of fully covered self-expanding metal biliary stents for managing endoscopic biliary sphincterotomy related bleeding

“…ERCP is now routinely used for the management of numerous benign and malignant pancreatobiliary diseases [2][3][4]. A recent report suggested that while the use of ERCP in the United States increased over the past decade, there has also been an increase in ERCP-related adverse events (AEs) [5].…”