ERCP Utilization Declining in the United States

Abstract

Objectives: To evaluate nationwide trends in the utilization of endoscopic retrograde cholangiopancreatography (ERCP) in relation to the advent of non-invasive methods of inspecting the pancreaticobiliary system. Methods: The Nationwide Inpatient Sample (NIS) database was used to calculate the age-adjusted rate for ERCP performance from 1988 to 2002. ICD-9-CM procedure codes for ERCP were used to compile the data. Patient demographic data was also analyzed from the database. Results: The database contained 402,343 patients who had an ERCP performed from 1988 to 2002. The mean age of the patient population was 60.21 ± 19.56 years old. From 1988 to 1996, the age-adjusted rate for ERCP use increased by nearly three-fold, from 25.66 per 100,000 (95% CI = 22.94-28.38) in 1988 to 74.95 per 100,000 (95% CI = 67.76-82.15) in 1996 (p < 0.01). The rate of 74.95 per 100,000 in 1996 steadily declined to a rate of 59.70 per 100,000 (95% CI = 59.69-65.05) by the year 2002 (p < 0.01).The rate of ERCP use among females was 38.97 (95% CI = 29.95-47.98) in 1988-92 which increased to 68.93 (95% CI = 60.26-77.61) in 1993-97 and then leveled off at 66.52 (95% CI = 58.47-74.57) in 1998-02 (p = 0.30). For males, the rate of ERCP use was 35.05 (95% CI = 29.49-40.61) in 1988-92 which rose to 70.25 (95% CI = 59.78-80.73) in 1993-97 and then declined significantly to 57.26 (95% CI = 48.93-65.60) in 1998-02 (p < 0.01).The rate for Caucasians increased from 30.47 (95% CI = 25.38-35.56) in 1988-92 to 73.18 (95% CI = 64.01-82.35) in 1993-97 and then declined to 61.89 (95% CI = 53.93-69.85) in 1998-02. The rate for African Americans followed a similar trend from 25.40 (95% CI = 12.52-38.28) in 1988-92 to 64.90 (95% CI = 46.27-83.54) and then declined to 48.57 (95% CI = 34.35-62.79) in 1998-02. The rate for Asians was 39.57 (95% CI = 2.72-76.41) in 1988-92, increased to 63.18 (95% CI = 10.76-115.59) in 1993-97 and then increased again to 71.49 (95% CI = 22.16-12.82). Hispanics followed similar trend with a rate of 33.09 (95% CI = 17.57-48.60) in 1988-92 which enlarged to 64.81 (95% CI = 41.12-88.50) in 1993-97 and then dramatically increased again to 85.91 (95% CI = 57.61-114.21) in 1998-02. Conclusion: The utilization of ERCP increased from 1988 to 1996, however, since the increased use of noninvasive diagnostic techniques such as MRCP and EUS, there has been a steady decline in the implementation of ERCP's from 1996 to 2002. The decline in ERCP utilization is more notable among males when compared to females. ERCP use has been declining in Caucasians and African Americans but increasing among Asians and Hispanics.