Published online Feb 16, 2019. doi: 10.4253/wjge.v11.i2.133
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
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.
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.
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.
This is a retrospective cohort study of Medicare claims data. Logistic regression was used to identify patient characteristics associated with the use of ERCP.
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.
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.
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.