Multicenter evaluation of the utilization of endoscopic ultrasound.

Abstract

There are currently no data regarding the number and type of endoscopic ultrasound (EUS) procedures being carried out in the USA. The aims of the present study are to: (i) estimate the annual number of EUS procedures being carried out in a nationwide database; (ii) describe the indications and types of EUS carried out; and (iii) examine short-term trends in volume. Retrospective analysis from the Clinical Outcomes Research Initiative (CORI) of EUS procedures carried out on patients >18years of age from 1 January 2010 through 31 December 2013. EUS cases (n=7614) were carried out by 68 endoscopists at 18 sites over the study period, representing 1.7% of the total number of endoscopic procedures. The most common indications were evaluation of a pancreatic mass (14.7%), diagnostic sampling with fine-needle aspiration (14.1%), and evaluation of a pancreatic cyst (14.0%). The number of EUS examinations and cases undergoing same-day endoscopic retrograde cholangiopancreatography (ERCP) increased over the study period (P<0.0001). Use of general anesthesia or deep sedation increased markedly from 37.8% to 82.8% of procedures (P<0.0001). This is the largest survey of EUS practice in the USA. Evaluation of the pancreas accounts for approximately 40% of the indications for EUS. Use of EUS increased over the study period, and the proportion carried out with deep sedation or general anesthesia also increased. These data may have implications regarding the number of endosonographers who should be trained, as well as cost issues pertaining to increasing use of anesthesia providers and same-day ERCP.