Utilization trends in inpatient endoscopic retrograde cholangiopancreatography (ERCP): A cross-sectional US experience

Abstract

Study aims The goal of our study was to determine the current trends for inpatient utilization for endoscopic retrograde cholangiopancreatography (ERCP) and its economic impact in the United States between 2002 and 2013. Patients and methods A Nationwide Inpatient Sample from 2002 through 2013 was examined. We identified ERCPs using International Classification of Diseases (ICD-9) codes; Procedure codes 51.10, 51.11, 52.13, 51.14, 51.15, 52.14 and 52.92 for diagnostic and 51.84, 51.86, 52.97 were studied. Rate of inpatient ERCP was calculated. The trends for therapeutic ERCPs were compared to the diagnostic ones. We analyzed patient and hospital characteristics, length of hospital stay, and cost of care after adjusting for weighted samples. We used the Cochran-Armitage test for categorical variables and linear regression for continuous variables. Results A total of 411,409 ERCPs were performed from 2002 to 2013. The mean age was 59 ± 19 years; 61 % were female and 57 % were white. The total numbers of ERCPS increased by 12 % from 2002 to 2011, which was followed by a 10 % decrease in the number of ERCPs between 2011 and 2013.There was a significant increase in therapeutic ERCPs by 37 %, and a decrease in diagnostic ERCPs by 57 % from 2002 to 2013. Mean length of stay was 7 days (SE = 0.01) and the mean cost of hospitalization was $20,022 (SE = 41). Conclusions Our large cross-sectional study shows a significant shift in ERCPs towards therapeutic indications and a decline in its conventional diagnostic utility. Overall there has been a reduction in inpatient ERCPs.

Regional and racial variations in the utilization of endoscopic retrograde cholangiopancreatography among pancreatic cancer patients in the United States

“…Last, there was a downtrend in the number of ERCPs performed over our study and especially in 2013. However, this trend has been observed in prior studies evaluating the trend of ERCP in the US …”

“…However, this trend has been observed in prior studies evaluating the trend of ERCP in the US. 24,25 To the best of our knowledge, this is the first populationbased study to examine variations in access to ERCP across the United States. The findings suggest that utilization of ERCP varies according to race/ethnicity and geographic location in the United States.…”

Recent 5-Year Trend of Endoscopic Retrograde Cholangiography in Korea Using National Health Insurance Review and Assessment Service Open Data

“…A previous study showed that in the United States, the frequency of therapeutic ERCP was 5.9 times higher than that of diagnostic ERCP in 2013, which is similar to the findings of this study. 17 Among the 10 administrative divisions, Seoul and Jeonbuk had a much greater adjusted numbers of patients per 100,000 than other divisions. In case of Seoul, it can be guessed that many patients from other divisions were treated in Seoul, and there were many tertiary or general hospitals.…”

“…With respect to the ratio of therapeutic to diagnostic ERCP, the average annual number of therapeutic ERCPs performed was far higher than that of diagnostic ERCPs, which was also seen in other studies. [2][3][4]17,18 Moreover, therapeutic procedures continuously increased throughout the 5-year period; however, there was no increase in the number of diagnostic ERCPs performed. Nonetheless, the frequency of diagnostic ERCP may still seem very high, with about 7,000 diagnostic ERCPs performed per year.…”

The future of ERCP

“…In the current issue of Endoscopy International Open, Ahmed, et al discuss trends for utilization of endoscopic retrograde cholangio-pancreatography in the United States over the years 2002 to 2013 1. Not surprising has been a shift from diagnostic to therapeutic ERCP and an accompanying fall in total procedures in the years between 2011 and 2013.…”