Trends in utilization of diagnostic and therapeutic ERCP and cholecystectomy over the past 25 years: a population-based study.
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Date
2014-04
Authors
Moffat, DC
Bernstein N., Charles
Yu, B. Nancy
Yie, Wiechun
Journal Title
Journal ISSN
Volume Title
Publisher
Gastroentestinal Endoscopy
Abstract
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.
Description
Keywords
ERCP, Diagnostic, Therapeutic, cholecystectomy
Citation
2014 Apr;79(4):615-22