Temporal trends in utilization and outcomes of endoscopic retrograde cholangiopancreatography in acute cholangitis due to choledocholithiasis from 1998 to 2012

Background and aims Expeditious endoscopic retrograde cholangiopancreatography (ERCP) in acute cholangitis with biliary decompression is associated with better outcomes. In this study, we evaluated the temporal trends of ERCP utilization and healthcare outcomes among patients hospitalized with acute cholangitis due to choledocholithiasis (CDC) from 1998 to 2012. Methods We identified patients with a combined diagnosis of cholangitis and choledocholithiasis from the national inpatient sample database. The temporal trends of ERCP usage and outcomes were analyzed. Based on timing of the procedure, we arbitrarily divided ERCPs into urgent (48 h) groups. In addition, trends in length of stay (LOS), hospital charges, and in-hospital mortality rates were evaluated. Results In-patient admissions for CDC increased by 105.7%. Overall ERCP rate also increased significantly from 66.5 ± 2.3% in 1998 to 80.3 ± 0.93% in 2012, particularly after 2006–2007. There was a significant increase in proportion of urgent and early ERCPs. In the early ERCP group, there was a significant decrease in LOS (6.4 ± 0.43 days in 1998 to 5.8 ± 0.24 days in 2012) and mortality rate (2.4 ± 1.4% in 1998 to 0.33 ± 0.33% in 2012). Hospital charges increased in all ERCP groups, but most significantly in delayed ERCP group ($20,448 ± 1611 in 1998 to $90,566 ± 6122 in 2012). Conclusion In-patient admissions for CDC and ERCP rates have increased significantly, particularly evident after 2006–2007. This may be attributed to increasing incidence of gallstones and wider implementation of Tokyo guidelines for the management of acute cholangitis. In-hospital morality and LOS reduced significantly in early ERCP group, whereas hospital charges increased most significantly in delayed ERCP group.