Trends in the utilization of endoscopic retrograde cholangiopancreatography (ERCP) in the United States

OBJECTIVES: To evaluate nationwide trends in the utilization of endoscopic retrograde cholangiopancreatography (ERCP) in relation to the advent of noninvasive methods of visualizing the biliary and pancreatic tree. METHODS: Retrospective cohort study. The Nationwide Inpatient Sample (NIS) database was used to calculate the age-adjusted rate for ERCPs performed from 1988 to 2002. The State Ambulatory Surgery Database (SASD) was used to evaluate trends in outpatient ERCPs from 1997 to 2003. Linear Poisson multivariate regression model was used to control for variations in age, gender, and ethnicity among the overall patient population. RESULTS: The NIS database contained 402,343 patients who had an ERCP performed from 1988 to 2002. The mean age for these patients was 60.21 +/- 19.56 yr old. From 1988 to 1996; the age-adjusted rate for ERCPs increased by nearly threefold, from 25.66 per 100,000 in 1988 to 74.95 in 1996. The rate of 74.95 in 1996 declined to a rate of 59.70 by the year 2002. The rates of diagnostic ERCPs in men and women were 26.76 and 31.58 per 100,000 in 1988-1990, respectively. This rate then increased to 35.66 and 43.18 per 100,000 in 1994-1996, which then declined to 29.01 and 29.06 in 2000-2002. The age-adjusted rate for therapeutic ERCPs in men and women was 13.74 and 15.61 per 100,000 in 1988-1990, respectively, which continued to increase throughout the time span to 38.76 and 43.75 in 2000-2002. The SASD revealed a continual decline in outpatient ERCPs from 25.45 per 100,000 in 1997 down to 16.17 per 100,000 in the year 2003. CONCLUSION: The utilization of ERCP dramatically increased from 1988 to 1996; however, since the advent of noninvasive diagnostic techniques such as endoscopic ultrasound (EUS) and magnetic resonance cholangiopancreatography (MRCP), there has been a steady decline in the utilization of diagnostic ERCPs from 1996 to 2002.