Original ArticleNoninvasive vs. selective invasive biliary imaging for acute biliary pancreatitis: an economic evaluation by using decision tree analysis
Section snippets
Patients
The hypothetical cohort considered in the model comprised nonpregnant adult patients presenting within 48 hours of the clinical onset of acute pancreatitis, associated with cholelithiasis or a history of gallstones, with or without prior cholecystectomy, who did not have another identifiable cause for pancreatitis, especially recent heavy consumption of alcohol, and who were not suspected to have cholangitis. Patients who already had transabdominal US before entering the model with a US
Results
The main results are summarized in Table 3. The EUS-first strategy was less costly (on average $58 CDN less per patient) than standard care and less costly than MRCP (on average $130 CDN less per patient). The average number of ERCPs needed per patient was 0.23 fewer per patient in the EUS-first arm compared with the standard care arm (also with 1.2 fewer ERCP-related deaths per 1000 patients). There were 0.25% more cases of recurrent pancreatitis, giving a total rate for pancreatitis,
Discussion
Although ABP is a common clinical problem, optimal management is not entirely clear. It appears that a subgroup of patients (those with severe ABP or those with residual bile-duct stones) benefits from early ductal clearance at ERCP. A noninvasive test with high accuracy for detecting bile-duct obstruction that could be easily converted to an invasive therapeutic procedure when a stone is identified, would be ideal; EUS-guided ERCP potentially meets these criteria. Same-site MRCP and ERCP is
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Cited by (68)
ASGE guideline on the role of endoscopy in the evaluation and management of choledocholithiasis
2019, Gastrointestinal EndoscopyCitation Excerpt :Among patients at indeterminate risk, EUS before ERCP may obviate the need for the latter.31,32 MRCP overcomes the limitations of transabdominal US, particularly the obfuscation of the distal bile duct because of intraductal air.19 In the meta-analysis of head-to head studies by Meeralam et al,24 the specificities of both EUS and MRCP were very high (.97 vs .92), consistent with a Cochrane meta-analysis,33 which primarily used indirect comparison of the 2 tests.
Endoscopic Ultrasound in Bile Duct, Gallbladder, and Ampullary Lesions
2018, Endosonography, Fourth EditionEndoscopic treatment of acute biliary diseases: Have we optimized the value of inpatient endoscopic retrograde cholangiopancreatography?
2014, Clinical Gastroenterology and HepatologyEUS in Bile Duct, Gallbladder, and Ampullary Lesions
2014, Endosonography, Third editionEndoscopic retrograde cholangiopancreatography for suspected choledocholithiasis: Testing the current guidelines
2013, Digestive and Liver DiseaseCitation Excerpt :MRCP is an option to consider in those institutions where the expertise and/or equipment for EUS are not available, as a recent systematic review and prospective study have demonstrated that both techniques have statistically similar diagnostic accuracy, sensitivity and specificity [16,17]. Unfortunately, MRCP has been shown to be more expensive than EUS and would add significant amount of cost to the patients hospital stay and care [18]. In our view in institutions without EUS capabilities, laparoscopic cholecystectomy and intraoperative cholangiogram may be the best approach as all patients will eventually require surgical removal of their gallbladder.
Presentation at the Canadian Annual Gastroenterology Meeting, February 27, 2004, Banff, Alberta, Canada (Can J Gastroenterol 2003;17:95A [Abstract]) and at Digestive Diseases Week (DDW), Annual Meeting of the AGA, Orlando, Fla, 2003, May 15, 2004 (Gastrointest Endosc 2003;57:AB112 [Abstract]).
Drs. Romagnuolo and Currie are population health investigators funded by the Alberta Heritage Foundation for Medical Research.