Trends in the Use of Endoscopic Retrograde Cholangiopancreatography for the Management of Acute Pancreatitis in the United States

Abstract

Introduction: Acute Pancreatitis (AP) is one of the most frequent gastrointestinal causes for hospitalization in US. The incidence of AP has increased over time. Endoscopic retrograde cholangiopancreatography (ERCP) has historically provided a means for both diagnosis and treatment of AP. Methods: We performed a retrospective cohort study using the Nationwide Inpatient Sample from 2002-2014. We identified patients with a primary discharge diagnosis of AP who underwent ERCP via ICD-9 codes. We further categorized acute pancreatitis into two categories i.e biliary and alcoholic AP. We analyzed patient and hospital characteristics, length of stay, and in-hospital mortality, and adjusted for weighted sample schema. Results: From 2002 to 2014, the AP discharges increased from 235589 (81.9 discharges per 100,000 persons) to 279145 (87.5 discharges per 100,000 persons). The percentage of discharges with ERCP declined from 10.84% in 2002 to 6.91% in 2014. For Biliary AP, the ERCP declined from 32.71% in 2002 to 24.04% in 2014. For Alcoholic AP, ERCP declined from 1.36% to 0.77%. Patients undergoing ERCP in biliary AP have decreased mortality than without (0.77% Vs 1.37%, P=0.001). In alcoholic AP, patients undergoing ERCP have increased mortality than without (1.24 Vs 0.64% P=0.002). The odds of getting ERCP was more with age above 70, female gender, Asian race, Medicare insurance status, urban teaching and large hospitals. The odds of having complications like shock, altered mental status, Acute Kidney injury, pleural effusion, acute respiratory failure & pseudocyst formation was more with alcoholic AP undergoing ERCP than with biliary AP. Median length of stay and median total hospital charges were more in hospitalizations with ERCP than without in both biliary and alcoholic pancreatitis. Conclusion: Over the last twelve years ERCP use in US hospitalizations with AP is declining because of newer imaging modalities. ERCP use in biliary AP was associated with having odds of decreased mortality, but in alcoholic AP it was associated with increased mortality. The Alcoholic AP patients undergoing ERCP were having more odds of complications as well. The cohort that underwent ERCP had increased total costs and charges. Further prospective studies are needed to elucidate whether increased mortality in alcoholic AP patients undergoing ERCP is because of procedure itself or these patients are sicker to begin with.801_A Figure 1. Complications and Procedures during Acute Pancreatitis Hospitalizations801_B Figure 2. Trends of In-Hospital Mortality, Median Length of Stay and Median Cost of Care in Acute Pancreatitis patients undergoing ERCP.