Trends in utilization of diagnostic and therapeutic ERCP and cholecystectomy over the past 25 years: a population-based study
Trends in utilization of diagnostic and therapeutic ERCP and cholecystectomy over the past 25 years: a population-based study
复制标题
DOI：
10.1016/j.gie.2013.08.028
复制
发表时间：
2014-04-01
影响因子：
7.7
通讯作者：
Bernstein, Charles N.
中科院分区：
文献类型：
--
作者：
Moffatt, Dana C.;Yu, B. Nancy;Bernstein, Charles N.
背景：在过去的30年里，北美地区缺乏关于ERCP使用情况的全面的、基于人群的数据。目的：建立1984年至2009年胆囊切除术技术与ERCP使用之间的相互作用，评估ERCP的适应症的变化。设计：回顾性、综合性、基于人群的研究。背景：1984年至2009年加拿大马尼托巴省所有住院和门诊ercp和胆囊切除术患者。患者：加拿大马尼托巴省所有有ERCP和/或胆囊切除术史的居民。干预:没有。主要结局测量：ERCP（诊断和治疗）和胆囊切除术（开放、腹腔镜和开放胆管探查）的年粗率和年龄调整率，以及患者和/或手术人口统计学。结果：ERCP率由1984年的7.70 /万人上升至2009年的13.86/万人（P = 0.001）。诊断性ERCP从7.28/10,000（1984）下降到1.11/10,000(2009)，治疗性ERCP从0.42/10,000（1984）上升到12.75/10,000 (2009)（P < 0.001）。ERCP在女性（62%）和老年人群（60-79岁，60- 80岁）中更为常见，老年人治疗性ERCP的发生率达到62.58/10,000。ERCP的主要适应症随着时间的推移而变化，胆道适应症从50.3%上升到67.3%，胰腺适应症从18.3%下降到8.1% （P < 0.05）。从开放胆囊切除术到腹腔镜胆囊切除术期间，治疗性ERCP率增加（1991-1994），而开放胆管探查（OBDE）从2.0 /10,000下降到0.18/10,000 （P < 0.001）。局限性：回顾性分析，行政数据。结论：ERCP的使用从1984年到2009年稳步增加，并从诊断方式向治疗方式转变。胆囊切除术技术的改变可能影响了ERCP的治疗性使用，同样，ERCP的可用性减少了OBDE的需求。
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.