Retrospective Cohort Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Feb 16, 2019; 11(2): 133-144
Published online Feb 16, 2019. doi: 10.4253/wjge.v11.i2.133
Age, socioeconomic features, and clinical factors predict receipt of endoscopic retrograde cholangiopancreatography in pancreatic cancer
Sheila D Rustgi, Sunil P Amin, Michelle K Kim, Satish Nagula, Nikhil A Kumta, Christopher J DiMaio, Paolo Boffetta, Aimee L Lucas
Sheila D Rustgi, Michelle K Kim, Satish Nagula, Nikhil A Kumta, Christopher J DiMaio, Aimee L Lucas, Henry D. Janowitz Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
Sunil P Amin, Division of Gastroenterology, Virginia Mason Medical Center, Seattle, WA 98101, United States
Paolo Boffetta, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
Author contributions: Rustgi SD, Amin SP and Lucas AL contributed to study conception and design; Rustgi SD, Amin SP and Lucas AL contributed to data acquisition, data analysis and interpretation, and writing of article; Rustgi SD, Amin SP, Kim MK, Nagula S, Kumta NA, DiMaio CJ, Boffetta P and Lucas AL contributed to editing, reviewing and final approval of article.
Supported by American Cancer Society Grant, No. 129387-MRSG-16-015-01-CPHPS (to Lucas AL).
Institutional review board statement: This study was approved by the Mount Sinai Hospital Institutional Review Board and the National Cancer Institute.
Conflict-of-interest statement: None.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Aimee L Lucas, MD, MSc, Associate Professor, Henry D. Janowitz Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1069, New York, NY 10029, United States.
Telephone: +1-212-2410101 Fax: +1-646- 5378647
Received: January 14, 2019
Peer-review started: January 14, 2019
First decision: January 21, 2019
Revised: February 1, 2019
Accepted: February 13, 2019
Article in press: February 13, 2019
Published online: February 16, 2019
Research background

Endoscopic retrograde cholangiopancreatography (ERCP) is an important therapeutic procedure in the management of pancreatic cancer; before endoscopic ultrasound use was widespread, it also served an important diagnostic role. Variations in its use by patient and sociodemographic factors have not previously been described.

Research motivation

Variability in diagnosis, management and survival of pancreatic cancer by patient factors such as race are well described. However, national trends and variations in use of endoscopic procedures such as ERCP for pancreatic cancer have not previously been described. We hypothesized that there would be variations that may partially explain some of the disparities in outcomes.

Research objectives

We sought to describe variations in receipt of ERCP by patient factors including sociodemographic status, regional location in the country, clinical factors such as stage and comorbidities, and receipt of cancer directed therapies.

Research methods

This is a retrospective cohort study of Medicare claims data. Logistic regression was used to identify patient characteristics associated with the use of ERCP.

Research results

Fourteen thousand seven hundred and four patients diagnosed with pancreatic cancer underwent ERCP between 2000 and 2011. After multivariable analysis, we found multiple factors were associated with receipt of ERCP, including marital status, age, race, living in a non-metropolitan area, year of diagnosis. Even amongst patients with an indication for ERCP (jaundice, cholangitis, pruritus) there were racial differences in use of ERCP. Whether or not these differences contribute to differences in outcomes is a future area of study.

Research conclusions

These findings suggest that use of ERCP in this country varies with non-clinical factors, such as patient race and marital status. This is similar to previous studies which suggest that there are disparities in stage at diagnosis, use of surgery and chemotherapy by sociodemographic factors. It is unclear what impact, if any, this may have on important patient outcomes such as survival.

Research perspectives

Further studies are needed to identify whether use of endoscopy in pancreatic cancer impacts outcomes, such as survival, and to guide appropriate use of biliary interventions in patients with pancreatic cancer.