The Next EPISOD: Trends in Utilization of Endoscopic Sphincterotomy for Sphincter of Oddi Dysfunction from 2010-2019.
The Next EPISOD: Trends in Utilization of Endoscopic Sphincterotomy for Sphincter of Oddi Dysfunction from 2010-2019.
复制标题
下一集：2010-2019 年内镜括约肌切开术治疗奥迪括约肌功能障碍的趋势。
DOI：
10.1016/j.cgh.2020.11.008
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发表时间：
2022
期刊：
影响因子：
--
通讯作者：
Chak,Amitabh
中科院分区：
文献类型：
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作者：
Smith,ZacharyL;Shah,Raj;Elmunzer,BJoseph;Chak,Amitabh
背景与目标多年来，这种疾病的内镜治疗一直存在争议，该疾病以前被称为 III 型奥迪括约肌功能障碍 (SOD)。 2013 年，奥迪括约肌功能障碍评估预测因素和干预措施 (EPISOD) 试验的结果表明，内镜下括约肌切开术对 III 型 SOD 患者没有任何益处。我们的目的是在 2010 年至 2019 年的大型人口数据库中评估内镜下括约肌切开术对 SOD 患者的使用情况。方法我们搜索了基于电子健康记录 (EHR) 的大型数据集，其中包含美国 300 多家个体医院（Explorys、IBM Watson health，Armonk，NY）。使用医学临床术语系统命名法 (SNOMED-CT)，我们从 2010 年至 2019 年每年都会识别出首次诊断为“奥迪括约肌疾病”的患者。使用 SNOMED-CT 代码对 SOD 类型进行子分类是不可行的。按年份分层，我们确定了接受内镜括约肌切开术的新诊断 SOD 患者和接受新处方药物治疗的患者的比例。 结果 研究期间，数据库中共有 39,950,800 名活跃患者，有 7,750 个 SOD 指数诊断。 2010 年至 2019 年，SOD 发病率从每 10 万人 2.4 人增加至 12.8 人（P < .001）。与此同时，胆道括约肌切开术（34.3% 至 24.5%）和胰腺括约肌切开术（25% 至 16.4%）的比率分别下降 (P< .001)。在整个研究期间，奥迪括约肌测压法 (SOM) 的使用频率不高，任何一年的使用次数均少于 20 次。 TCA、硝苯地平或血管扩张剂硝酸盐的新处方没有显着增加。结论在不使用常规 SOM 的广泛实践环境中，从 2013 年开始观察到新诊断 SOD 的内镜括约肌切开术率突然持续下降。这些发现强调了高质量、多中心、随机对照的至关重要性 内窥镜试验，以推动现实临床实践中基于证据的变化。
Background & AimsFor years, the endoscopic management of the disorder formerly known as Type III Sphincter of Oddi Dysfunction (SOD) had been controversial. In 2013, the results of the Evaluating Predictors and Interventions in Sphincter of Oddi Dysfunction (EPISOD) trial demonstrated that there was no benefit associated with endoscopic sphincterotomy for patients with Type III SOD. We aimed to assess the utilization of endoscopic sphincterotomy for patients with SOD in a large population database from 2010-2019.MethodsWe searched a large electronic health record (EHR)-based dataset incorporating over 300 individual hospitals in the United States (Explorys, IBM Watson health, Armonk, NY). Using Systematized Nomenclature of Medicine Clinical Terms (SNOMED-CT) we identified patients with a first-ever diagnosis of “disorder of Sphincter of Oddi” annually from 2010-2019. Subclassification of SOD types was not feasible using SNOMED-CT codes. Stratified by year, we identified the proportion of patients with newly-diagnosed SOD undergoing endoscopic sphincterotomy and those receiving newly-prescribed medical therapy.ResultsA total of 39,950,800 individual patients were active in the database with 7,750 index diagnoses of SOD during the study period. The incidence rates of SOD increased from 2.4 to 12.8 per 100,000 persons from 2010-2019 (P< .001). In parallel, there were reductions in the rates of biliary (34.3% to 24.5%) and pancreatic sphincterotomy (25% to 16.4%), respectively (P< .001). Sphincter of Oddi manometry (SOM) was infrequently utilized, <20 times in any given year, throughout the study duration. There were no significant increases in new prescriptions for TCAs, nifedipine, or vasodilatory nitrates.ConclusionsAmong a wide range of practice settings which do not utilize routine SOM, a sudden and sustained decrease in rates of endoscopic sphincterotomy for newly-diagnosed SOD was observed beginning in 2013. These findings highlight the critical importance of high-quality, multi-center, randomized controlled trials in endoscopy to drive evidence-based changes in real-world clinical practice.