National Trends of Endoscopies Performed in Inflammatory Bowel Disease Patients From 2008 to 2012

Abstract

BACKGROUND: Inflammatory bowel diseases (IBD) are frequent causes of repeated hospital admission and invasive procedures. Endoscopy plays an essential role in diagnosing IBD patients, differentiation Crohn's disease from Ulcerative Colitis, monitoring disease activities, and providing treatment. In this study, we analyzed the most common invasive procedures done in IBD in-patients nationwide and showed the trend of endoscopic procedures done in those patient during period of 2008 to 2012. METHODS: We analyzed the invasive procedures performed in 102,822 IBD in-patients using validated International Classification of Diseases, 9th Revision and Clinical Modification (ICD-9M codes) using Nationwide inpatient sample (NIS) from 2008-2012. Percentage of upper GI endoscopy (EGD) with biopsy, colonoscopy and proctosigmoidoscopy (PSS) with closed rectal biopsy were calculated and compared for statistical significance. RESULTS: Out of 102,822 IBD patients admitted as in-patient nationwide from 2008-2012, 62847 (61. 1%) patients undergo invasive procedures among which 23514 in-patients (37. 4%) were done endoscopies. While the percentage of total endoscopies remain relatively constant over the years (from 36. 8% in 2008 to 37. 48% in 2012), frequency of colonoscopies decreases from 27. 6% in 2008 to 26. 13% in 2012 (P<0. 01). However, frequency of EGD with biopsy increases from 7. 30% in 2008 to 8. 58% in 2012 in EGD (P<0. 001) and PSS with closed rectal biopsy increases from 1. 8% in 2008 to 2. 76% in PSS (P<0. 05) CONCLUSION(S): The data demonstrates that nearly two-thirds of IBD in-patients underwent procedures, with colonoscopy being the most common procedure being performed, followed by EGD as second most common. The decreasing trend of colonoscopy and increasing trend of PSS would emphasize the preference of less invasive procedures over the years or advancement of medical therapy with biologic agents leading to better control of symptoms. Increasing trends of EGD indicates that upper GI involvement might be increasingly prevalent in IBD patients. This study helps us understand the current trends of endoscopic procedures in nationwide level hence help us find ways to reduce morbidity and cost.