Post written by Patrick Yachimski, MD, MPH, from the Division of Gastroenterology, Hepatology & Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
This study was conducted to assess whether there has been a change over time in the use of ERCP among patients with surgically unresectable pancreas cancer, and if so, if there was any associated change in clinical outcomes.
There has been considerable refinement in the role of diagnostic and therapeutic ERCP, which has been borne out in studies examining annual ERCP volumes in the United States. There has also been evolution in ERCP techniques and technology, including options for endoprosthesis (stent) therapy. However, there has been little if any reported data on trends or changes in ERCP performance among the population of patients with unresectable pancreas cancer, who often require palliative intervention for relief of biliary obstruction.
Using the SEER-Medicare linked database, we were able to demonstrate that the proportion of patients with unresectable pancreas cancer who ever underwent ERCP declined between 2001 and 2015. In addition, among patients who underwent ERCP, the total number of ERCP per patient also declined during this time period—suggesting that fewer patients required ERCP reintervention(s). We suspect that these trends are related to an increasingly prevalent use of self-expanding metal stents to treat bile duct obstruction, which are less likely to require elective or on-demand reintervention for stent maintenance compared to plastic stents. An insightful Twitter commentator has also suggested that decline in ERCP performance may also be in part due to a decline in the use of ERCP as a diagnostic tool alone in patients with pancreas cancer, given the now widespread availability and performance of endoscopic ultrasound with tissue sampling for this purpose. Despite the decline in ERCP use during the study time period, overall patient survival improved.
We hope these data are reflective of the increasingly judicious use of ERCP, ideally limited to patients likely to achieve benefit from endoscopic intervention and limiting unnecessary exposure to potential adverse events by reducing the need for reintervention.
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