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

Abstract：

BACKGROUND:Comprehensive, population-based data on ERCP use over the last 30 years in North America are lacking. OBJECTIVE:To establish crude and age-adjusted population-based rates of ERCP, evaluate for changing indications for ERCP, and evaluate for interactions between cholecystectomy technique and ERCP use from 1984 to 2009. DESIGN:Retrospective, comprehensive, population-based study. SETTING:All inpatient and outpatient ERCPs and cholecystectomies in Manitoba, Canada from 1984 to 2009. PATIENTS:All residents of Manitoba, Canada with a history of ERCP and/or cholecystectomy. INTERVENTION:None. MAIN OUTCOME MEASUREMENTS:Yearly crude and age-adjusted rates of ERCP (diagnostic and therapeutic) and cholecystectomy (open, laparoscopic, and with open bile duct exploration), and patient and/or procedure demographics. RESULTS:The rate of ERCP/10,000 people increased from 7.70 (1984) to 13.86/10,000 (2009) (P = .001). Diagnostic ERCP declined from 7.28/10,000 (1984) to 1.11/10,000 (2009), and therapeutic ERCP increased from 0.42/10,000 (1984) to 12.75/10,000 (2009) (P < .001). ERCPs were more common in women (62%) and in older populations (60-79 years, >80 years), with rates of therapeutic ERCP reaching 62.58/10,000 in the elderly. The primary indication for ERCP has changed over time, with biliary indications increasing from 50.3% to 67.3% and pancreatic indications decreasing from 18.3% to 8.1% (P < .05). The rate of therapeutic ERCP increased during the transition from open to laparoscopic cholecystectomy (1991-1994), whereas open bile duct exploration (OBDE) decreased from 2.0 to 0.18/10,000 (P < .001). LIMITATIONS:Retrospective analysis, administrative data. CONCLUSION:ERCP use increased steadily from 1984 to 2009, and changed from a diagnostic modality to a therapeutic one. Changes in cholecystectomy technique may have influenced therapeutic ERCP use and likewise, the availability of therapeutic ERCP has decreased the need for OBDE.

journal_name

Gastrointest Endosc

journal_title

Gastrointestinal endoscopy

authors

Moffatt DC,Yu BN,Yie W,Bernstein CN

doi

10.1016/j.gie.2013.08.028

subject

Has Abstract

pub_date

2014-04-01 00:00:00

pages

615-22

issue

4

eissn

0016-5107

issn

1097-6779

pii

S0016-5107(13)02315-8

journal_volume

79

pub_type

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