Trends in utilization of diagnostic and therapeutic ERCP and cholecystectomy over the past 25 years: a population-based study

被引:56
作者
Moffatt, Dana C. [1 ]
Yu, B. Nancy [2 ]
Yie, Wiechun [2 ]
Bernstein, Charles N. [1 ,3 ]
机构
[1] Univ Manitoba, Dept Internal Med, Winnipeg, MB, Canada
[2] Univ Manitoba, Ctr Global Publ Hlth, Winnipeg, MB, Canada
[3] Univ Manitoba, IBD Clin & Res Ctr, Winnipeg, MB, Canada
基金
加拿大健康研究院;
关键词
RETROGRADE CHOLANGIOPANCREATOGRAPHY ERCP; BILE-DUCT STONES; ENDOSCOPIC SPHINCTEROTOMY; EPIDEMIOLOGY; COMPLICATIONS; MANAGEMENT; AMPULLA; DISEASE; VATER;
D O I
10.1016/j.gie.2013.08.028
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
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.
引用
收藏
页码:615 / 622
页数:8
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