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Sa1518 Evaluation of Carbon Dioxide Insufflation During ERCP Using Visual Analogue Scale Sores; a Prospective, Single-Blind, Randomized, Controlled Trial
Abstracts
Sa1518 Evaluation of Carbon Dioxide Insufflation During ERCP Using Visual Analogue Scale Sores; a Prospective, Single-Blind, Randomized, Controlled Trial Tesshin Ban*, Yu Nojiri, Toshihiro Ohwaki, Takashi Yoshimine, Miho Aoki, Hiroyasu Iwasaki, Yasuki Hori, Satoshi Nomura, Takaaki Kanamoto, Atsunori Kusakabe, Hiroshi Kanie, Tomonori Yamada, Katsumi Hayashi, Etsuro Orito Department of Gastroenterology, Nagoya Daini Red Cross Hospital, Nagoya, Japan
away from diagnostic ERCPs, better technology and technique development and the use of various strategies including NSAIDs to prevent post-ERCP pancreatitis might be some of the reasons for significant reduction in the complication rate and length of in-hospital stay. We hypothesize that the regional variation in ERCPs is due to the regional variation in the prevalence of cholelithiasis in the South which inturn is secondary to the regional variation in morbid obesity rates across US (Obesity is a known risk factor for cholelithiasis). Our data provide new insights into the temporal trends in ERCP in USA in a large hospital based cohort.
Background: Recently, Some authors reported that CO2 insufflation during ERCP made the patients feel more comfortable after their procedure than air insufflation, but one author’s findings did not agree. Objective: To investigate the efficacy of CO2 insufflation during ERCP as compared with air insufflation for reducing visual analogue scale score (VAS) after procedure. Design: Single-blind, randomized, controlled trial. Setting: Single center. Patients and Methods: From August 22nd, 2011 to July 17th, 2012. One hundred candidates were included and allocated into the CO2 group or the air group equally using the randomized number table. Main outcome measure was VAS and abdominal circumference change 3 hrs after the procedure and in the next morning. The body movement requiring extra midazolam i.v. injection during the procedure was also investigated. VAS score were from 0 to 10. Midazolam 0.1mg/kg and pentazocine 10mg were i.v. injected at the beginning of the procedure. Scopolamine Butybromide or Glucagon was used simultaneously as an antispasmodic drug. Statistics: SPSS Statistics ver.19 was used. Results: The characteristics of 49 patients and 50 patients allocated to the air group and the CO2 group were analyzed. There were no significant differences in the backgrounds between the two groups. VAS 3hrs after the procedure in the air group and the CO2 group were 0.82⫾1.52 and 1.19⫾2.02 (p ⫽ 0.336), respectively. VAS next in the morning in the air group and the CO2 group were 0.38⫾1.54 and 0.38⫾1.54 (p ⫽ 0.458), respectively. There were no significant differences in VAS between the two groups. The Abdominal circumference changes 3 hrs after the procedure and in the next morning in the two groups were -0.25⫾3.29 % vs -0.70⫾2.84 % (p⫽0.487) and -1.18 %⫾4.00 vs -1.31⫾3.03 % (p⫽0.861), respectively. The rates of body movement requiring extra midazolam i.v. injections during the procedure were 27.7% and 38.0% (p⫽0.279), respectively. There were no differences between the two groups. Conclusion: Our results did not support the efficacy of carbon dioxide insufflation during ERCP for relieving abdominal pain after the procedure.
Sa1519 Temporal and Regional Trends in Endoscopic Retrograde Cholangio-Pancreatography (ERCP) in USA Over the Last 18 Years Saurabh Sethi*1, Nidhi Sethi2, Alphonso Brown1 1 Division of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA; 2Division of Hepatology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
Trend of % inpatient mortality related to ERCP over the last 18 years
Background/Objectives: The introduction of non-invasive imaging for biliary and pancreatic diseases has changed the indications and volumes of endoscopic retrograde cholangiopancreatography (ERCP) over time. The objective of this study was to use a national database of U.S. hospitals to evaluate the trends in the number of ERCP procedures over the last 18 years. We also examined the patient demographic and regional variation related to ERCP. Methods: We analyzed the National Inpatient Sample Database (NIS) for all subjects who underwent ERCP (ICD-9 code: 51.10) during 1997-2010. The NIS is the largest publicly available all-payer inpatient care database in the US. The statistical significance of the difference in the number of hospital discharges, length of stay and hospital costs over the study period was determined by utilization of the chi-square test for trend. Results: A total of 500,323 procedures were reported during the study period. The number of inpatient ERCP procedures has decreased by 60.3 % from 39,658 in 1993 to 15,723 in 2010 (p⬍0.01). The mean length of stay related to ERCP decreased by 20.5 % (p⬍0.01). The average inhospital % mortality associated with ERCPs decreased substantially by 31.2 % (p⫽0.01). The mean hospital charges have gone up by more than 2.5 times from $ 12778 in 1993 to $ 46263 in 2010 (p⬍0.001). In 2010, 57.6 % of patients were females as compared to 62.1 % in 1997 (p⫽0.4). The patients in age-group 18-64 constituted 53.8 % of total ERCP procedures in 2010 and 50 % in 1997. Out of 4 regions in the US, ERCPs are performed the most in the South (34.4 % in 2010 and 39.2 % in 1997) which signifies regional variation. We also found that the number of discharges related to cholelithiasis (ICD-9 code: 574) was maximum in the South, at 36.7 % in 2010 and 38.8 % in 1997. Using the ICD-9 code for morbid obesity (278.01), we found that the number of discharges related to morbid obesity was again maximum in the South at 37.9 % in 2010. Conclusions: Possible explanation for the decline in volume of ERCPs performed is the thrust on using ERCPs mostly for therapeutics and relying on non-invasive imaging (CT and MRCP) for diagnoses of biliary-pancreatic diseases. We think that shying
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Trend of ERCP volume over the last 18 years
Sa1520 Hospital Volume Status Is Related to Technical Failure and AllCause 30-Day Mortality Following First ERCP: a PopulationBased, Nationwide, Register Linkage Study Evangelos Kalaitzakis* Department of Gastroenterology, Skåne University Hospital, Lund, Sweden Population-based data on hospital volume and outcome of endoscopic retrograde cholangiopancreatography(ERCP) are limited. Aim: To identify potential predictors of technical failure and all-cause 30-day mortality following ERCP and in particular to examine their potential relation to hospital procedure volume in a population-based cohort of patients with a first ERCP. Methods: All patients having had a first in-/outpatient ERCP between 04/2005-06/2008 in Sweden were identified from the Hospital Discharge Register. Data on indication, admission method(urgent/elective), and comorbid illness were extracted from diagnostic fields(ICD-10 codes) in the register. Patients with a code for surgical bile duct exploration and/or percutaneous transhepatic cholangiography registered in the same hospital episode as the index ERCP were considered to have had a failed ERCP. Patients were linked to the National Death Register to define dead/alive status and the National Cancer Register. Results: A total of 16478 patients with a first ERCP performed in 66 hospitals were identified (mean age 68 (17); 57%F; urgent admission 57%; diagnostic profile: gallstone-related 55.2%, cancer 22.5%, gallstone and cancer 1.4%, other 20.9%). Allcause 30-day mortality was 5% (14.9% in cancer and 1.9% in non-cancer cases). Specific procedural complication codes were identified in 1.8% of deaths(0.09% of ERCPs). Hospitals were divided according to the 25th-75th percentiles of first ERCP/ yr numbers, into low(ⱕ53 first ERCP/yr), intermediate(53-121 first ERCP/yr) and high volume(ⱖ121 first ERCP/yr) centers. 30-day mortality was lower for cases performed in low- vs intermediate- or high-volume centers (3.7% vs 5.4% vs 5.0%, p⫽0.014). The failed ERCP rate was 0.5%(1.3% in cancer and 0.3% in non-cancer cases) and it decreased with increasing hospital ERCP volume status (1% vs 0.6% vs 0.4%,
Volume 77, No. 5S : 2013
GASTROINTESTINAL ENDOSCOPY
AB235
Sa1518 Evaluation of Carbon Dioxide Insufflation During ERCP Using Visual Analogue Scale Sores; a Prospective, Single-Blind, Randomized, Controlled Trial Tesshin Ban*, Yu Nojiri, Toshihiro Ohwaki, Takashi Yoshimine, Miho Aoki, Hiroyasu Iwasaki, Yasuki Hori, Satoshi Nomura, Takaaki Kanamoto, Atsunori Kusakabe, Hiroshi Kanie, Tomonori Yamada, Katsumi Hayashi, Etsuro Orito Department of Gastroenterology, Nagoya Daini Red Cross Hospital, Nagoya, Japan
away from diagnostic ERCPs, better technology and technique development and the use of various strategies including NSAIDs to prevent post-ERCP pancreatitis might be some of the reasons for significant reduction in the complication rate and length of in-hospital stay. We hypothesize that the regional variation in ERCPs is due to the regional variation in the prevalence of cholelithiasis in the South which inturn is secondary to the regional variation in morbid obesity rates across US (Obesity is a known risk factor for cholelithiasis). Our data provide new insights into the temporal trends in ERCP in USA in a large hospital based cohort.
Background: Recently, Some authors reported that CO2 insufflation during ERCP made the patients feel more comfortable after their procedure than air insufflation, but one author’s findings did not agree. Objective: To investigate the efficacy of CO2 insufflation during ERCP as compared with air insufflation for reducing visual analogue scale score (VAS) after procedure. Design: Single-blind, randomized, controlled trial. Setting: Single center. Patients and Methods: From August 22nd, 2011 to July 17th, 2012. One hundred candidates were included and allocated into the CO2 group or the air group equally using the randomized number table. Main outcome measure was VAS and abdominal circumference change 3 hrs after the procedure and in the next morning. The body movement requiring extra midazolam i.v. injection during the procedure was also investigated. VAS score were from 0 to 10. Midazolam 0.1mg/kg and pentazocine 10mg were i.v. injected at the beginning of the procedure. Scopolamine Butybromide or Glucagon was used simultaneously as an antispasmodic drug. Statistics: SPSS Statistics ver.19 was used. Results: The characteristics of 49 patients and 50 patients allocated to the air group and the CO2 group were analyzed. There were no significant differences in the backgrounds between the two groups. VAS 3hrs after the procedure in the air group and the CO2 group were 0.82⫾1.52 and 1.19⫾2.02 (p ⫽ 0.336), respectively. VAS next in the morning in the air group and the CO2 group were 0.38⫾1.54 and 0.38⫾1.54 (p ⫽ 0.458), respectively. There were no significant differences in VAS between the two groups. The Abdominal circumference changes 3 hrs after the procedure and in the next morning in the two groups were -0.25⫾3.29 % vs -0.70⫾2.84 % (p⫽0.487) and -1.18 %⫾4.00 vs -1.31⫾3.03 % (p⫽0.861), respectively. The rates of body movement requiring extra midazolam i.v. injections during the procedure were 27.7% and 38.0% (p⫽0.279), respectively. There were no differences between the two groups. Conclusion: Our results did not support the efficacy of carbon dioxide insufflation during ERCP for relieving abdominal pain after the procedure.
Sa1519 Temporal and Regional Trends in Endoscopic Retrograde Cholangio-Pancreatography (ERCP) in USA Over the Last 18 Years Saurabh Sethi*1, Nidhi Sethi2, Alphonso Brown1 1 Division of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA; 2Division of Hepatology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
Trend of % inpatient mortality related to ERCP over the last 18 years
Background/Objectives: The introduction of non-invasive imaging for biliary and pancreatic diseases has changed the indications and volumes of endoscopic retrograde cholangiopancreatography (ERCP) over time. The objective of this study was to use a national database of U.S. hospitals to evaluate the trends in the number of ERCP procedures over the last 18 years. We also examined the patient demographic and regional variation related to ERCP. Methods: We analyzed the National Inpatient Sample Database (NIS) for all subjects who underwent ERCP (ICD-9 code: 51.10) during 1997-2010. The NIS is the largest publicly available all-payer inpatient care database in the US. The statistical significance of the difference in the number of hospital discharges, length of stay and hospital costs over the study period was determined by utilization of the chi-square test for trend. Results: A total of 500,323 procedures were reported during the study period. The number of inpatient ERCP procedures has decreased by 60.3 % from 39,658 in 1993 to 15,723 in 2010 (p⬍0.01). The mean length of stay related to ERCP decreased by 20.5 % (p⬍0.01). The average inhospital % mortality associated with ERCPs decreased substantially by 31.2 % (p⫽0.01). The mean hospital charges have gone up by more than 2.5 times from $ 12778 in 1993 to $ 46263 in 2010 (p⬍0.001). In 2010, 57.6 % of patients were females as compared to 62.1 % in 1997 (p⫽0.4). The patients in age-group 18-64 constituted 53.8 % of total ERCP procedures in 2010 and 50 % in 1997. Out of 4 regions in the US, ERCPs are performed the most in the South (34.4 % in 2010 and 39.2 % in 1997) which signifies regional variation. We also found that the number of discharges related to cholelithiasis (ICD-9 code: 574) was maximum in the South, at 36.7 % in 2010 and 38.8 % in 1997. Using the ICD-9 code for morbid obesity (278.01), we found that the number of discharges related to morbid obesity was again maximum in the South at 37.9 % in 2010. Conclusions: Possible explanation for the decline in volume of ERCPs performed is the thrust on using ERCPs mostly for therapeutics and relying on non-invasive imaging (CT and MRCP) for diagnoses of biliary-pancreatic diseases. We think that shying
www.giejournal.org
Trend of ERCP volume over the last 18 years
Sa1520 Hospital Volume Status Is Related to Technical Failure and AllCause 30-Day Mortality Following First ERCP: a PopulationBased, Nationwide, Register Linkage Study Evangelos Kalaitzakis* Department of Gastroenterology, Skåne University Hospital, Lund, Sweden Population-based data on hospital volume and outcome of endoscopic retrograde cholangiopancreatography(ERCP) are limited. Aim: To identify potential predictors of technical failure and all-cause 30-day mortality following ERCP and in particular to examine their potential relation to hospital procedure volume in a population-based cohort of patients with a first ERCP. Methods: All patients having had a first in-/outpatient ERCP between 04/2005-06/2008 in Sweden were identified from the Hospital Discharge Register. Data on indication, admission method(urgent/elective), and comorbid illness were extracted from diagnostic fields(ICD-10 codes) in the register. Patients with a code for surgical bile duct exploration and/or percutaneous transhepatic cholangiography registered in the same hospital episode as the index ERCP were considered to have had a failed ERCP. Patients were linked to the National Death Register to define dead/alive status and the National Cancer Register. Results: A total of 16478 patients with a first ERCP performed in 66 hospitals were identified (mean age 68 (17); 57%F; urgent admission 57%; diagnostic profile: gallstone-related 55.2%, cancer 22.5%, gallstone and cancer 1.4%, other 20.9%). Allcause 30-day mortality was 5% (14.9% in cancer and 1.9% in non-cancer cases). Specific procedural complication codes were identified in 1.8% of deaths(0.09% of ERCPs). Hospitals were divided according to the 25th-75th percentiles of first ERCP/ yr numbers, into low(ⱕ53 first ERCP/yr), intermediate(53-121 first ERCP/yr) and high volume(ⱖ121 first ERCP/yr) centers. 30-day mortality was lower for cases performed in low- vs intermediate- or high-volume centers (3.7% vs 5.4% vs 5.0%, p⫽0.014). The failed ERCP rate was 0.5%(1.3% in cancer and 0.3% in non-cancer cases) and it decreased with increasing hospital ERCP volume status (1% vs 0.6% vs 0.4%,
Volume 77, No. 5S : 2013
GASTROINTESTINAL ENDOSCOPY
AB235