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Decreasing mortality from biliary diseases requiring ERCP

The latest Clinical Gastroenterology & Hepatology reports decreasing mortality from biliary diseases that require endoscopic retrograde cholangiopancreatography.

News image

Mortality among patients admitted for acute biliary conditions who underwent an ERCP in the United States from 1998 to 2008.

Dr Steven Heitman and colleagues examined the percentage of cases in which an open cholecystectomy was performed, and percentage of unsuccessful ERCPs among patients admitted for acute biliary conditions who underwent an ERCP in the United States from 1998 to 2008.

The team found that the management of acute biliary diseases often involves endoscopic retrograde cholangiopancreatography (ERCP), but it is not clear whether this technique reduces mortality.

The research team investigated whether mortality from acute biliary diseases that require ERCP has been reduced over time and explored factors associated with mortality.

The team conducted a cohort study using the Nationwide Inpatient Sample.

Unsuccessful ERCPs decreased from 6% to 3%
Clinical Gastroenterology & Hepatology

The researchers identified hospitalizations for choledocholithiasis, cholangitis, and acute pancreatitis that involved ERCP.

Multivariate analyses were used to determine the effects of time period, patient factors, hospital characteristics, features of the ERCP procedure, and types of cholecystectomies on mortality, length of stay, and costs.

The team observed that from 1998 to 2008 there were 166,438 admissions for acute biliary conditions that met the inclusion criteria, corresponding to more than 800,000 patients nationwide.

During this interval, the team noted that mortality decreased from 1% to 0.6% , diagnostic ERCPs decreased from 29% to 10%, hospitals performing fewer than 100 ERCPs per year decreased from 38% to 27%, open cholecystectomies decreased from 12% to 6%, and unsuccessful ERCPs decreased from 6% to 3%.

The research team found that unsuccessful ERCP, open cholecystectomy, cholangitis, older age, having Medicare health insurance, and comorbidity were associated with increased mortality.

Dr Heitman's team comments, "In-hospital mortality from acute biliary conditions requiring ERCP in the United States has decreased over time."

"Reductions in the rate of unsuccessful ERCPs and open cholecystectomies are associated with this trend."

Clin Gastroenterol Hepatol 2014: 12(7): 11511159.e6
01 July 2014

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