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©The Author(s) 2019.
World J Gastrointest Endosc. Jan 16, 2019; 11(1): 41-53
Published online Jan 16, 2019. doi: 10.4253/wjge.v11.i1.41
Published online Jan 16, 2019. doi: 10.4253/wjge.v11.i1.41
Table 1 International Classification of Diseases, ninth edition, clinical modification codes used in defining study variables
| Diagnosis/procedure | ICD-9 |
| Diagnosis | |
| Chronic pancreatitis | 577.1 |
| Acute Pancreatitis | 577 |
| Cholangitis | 576.1 |
| Abdominal pain | 789.x |
| Jaundice | 782.4 |
| Cholelithiasis | 574.0, 574.1, 574.2, 574.6, 574.7, 574.8, 574.9 |
| Choledocholithiasis | 574.3, 574.4, 574.5, 574.6, 574.7, 574.8, 574.9 |
| Biliary obstruction | 5762 |
| Cholangiocarcinoma of bile duct or intrahepatic duct | 1551, 1561 |
| Malignant neoplasm of pancreas | 157.x |
| Solid tumor without metastasis | 1400-1729, 1740-1759, 179-1958, 20900-20924, 20925-2093, 20931-20936, 25801-25803 |
| Metastatic cancer | 1960-1991, 20970-20975, 20979, 78951 |
| Septic shock | 785.52 |
| Severe Sepsis | 995.92 |
| Systemic inflammatory response syndrome with acute organ dysfunction | 995.94 |
| Acute respiratory failure | 518.81 |
| Acute kidney failure | 584.9 |
| Thrombocytopenia | 2875 |
| Altered mental status | 780.97 |
| Abnormal coagulation | 790.92 |
| Procedure | |
| ERCP | |
| ERCP general code | 51.1 |
| Endoscopic sphincterotomy and papillotomy | 51.85 |
| Biliary ERCP | |
| Endoscopic Retrograde Cholangiography | 51.11 |
| Endoscopic dilation of ampulla and biliary duct | 51.84 |
| Endoscopic insertion of stent (tube) into bile duct | 51.87 |
| Endoscopic removal of stone (s) from biliary tract | 51.88 |
| Pancreatic ERCP | |
| Endoscopic Retrograde Pancreatography | 52.92 |
| Endoscopic insertion of stent (tube) into pancreatic duct | 52.93 |
| Endoscopic removal of stone (s) from pancreatic duct | 52.94 |
| Endoscopic dilation of pancreatic duct | 52.98 |
Table 2 Clinical characteristics of adult discharges with cholangitis who underwent endoscopic retrograde cholangiopancreatography during their hospital stay (n = 4570), stratified by timing to endoscopic retrograde cholangiopancreatography, Nationwide Readmission Database January–November, 2014 n (%)
| ERCP timing | P Value | ||
| Late ERCP, 1528 (33.4) | Early ERCP, 3042 (66.6) | ||
| Clinical characteristics | |||
| Age, mean (SD), yr | 65.1 (18.3) | 63.6 (18.1) | 0.0089 |
| Age category | 0.0560 | ||
| Young adults (18-39 yr) | 179 (11.7) | 378 (12.4) | |
| Middle age (40-64 yr) | 472 (30.9) | 1031 (33.9) | |
| Older adults (> 65 yr) | 877 (57.4) | 1633 (53.7) | |
| Male sex | 717 (46.9) | 1485 (48.8) | 0.2271 |
| Abdominal pain | 87 (5.7) | 115 (3.8) | 0.0030 |
| Jaundice | 115 (7.5) | 178 (5.9) | 0.0292 |
| Cholelithiasis | 430 (28.1) | 918 (30.2) | 0.5810 |
| Choledocholithiasis | 968 (63.4) | 2093 (68.8) | 0.0088 |
| Biliary obstruction | 291 (19.0) | 436 (14.3) | < 0.0001 |
| Acute pancreatitis | 238 (15.6) | 428 (14.1) | 0.1734 |
| Chronic pancreatitis | 41 (2.7) | 57 (1.9) | 0.0747 |
| Malignant pancreatic neoplasm | 92 (6.0) | 117 (3.8) | 0.0009 |
| Cholangiocarcinoma of bile duct | 46 (3.0) | 69 (2.3) | 0.1300 |
| Solid tumor without metastasis | 95 (6.2) | 156 (5.1) | 0.1274 |
| Metastatic cancer | 78 (5.1) | 117 (3.8) | 0.0470 |
| Severe Cholangitis | 108 (7.1) | 233 (7.7) | 0.4729 |
| ≥ 4 Elixhauser comorbidities | 365 (23.9) | 549 (18.0) | < 0.0001 |
| Elixhauser mortality index mean (SD) | 6.9 (5.4) | 4.5 (3.9) | < 0.0001 |
| Elixhauser readmission index mean (SD) | 14.0 (14.3) | 11.4 (12.9) | < 0.0001 |
| ERCP techniques | |||
| Endoscopic sphincterotomy | 1057 (69.2) | 2,118 (69.6) | 0.7554 |
| Biliary/ampullary balloon dilation | 232 (15.2) | 394 (13.0) | 0.0385 |
| Biliary stent | 737 (48.2) | 1424 (46.8) | 0.3638 |
| Biliary stone extraction | 827 (54.1) | 1862 (61.2) | < 0.0001 |
| ERCP-pancreatic with intervention | 56 (3.7) | 108 (3.6) | 0.8442 |
| Admission characteristics | |||
| Weekend admission | 475 (31.1) | 615 (20.2) | < 0.0001 |
| Primary payer | 0.0002 | ||
| Medicare | 835 (54.7) | 1576 (51.8) | |
| Medicaid | 223 (14.6) | 379 (12.5) | |
| Private | 353 (23.1) | 882 (29.0) | |
| Self-pay/uninsured | 115 (7.5) | 203 (6.7) | |
| Discharge disposition | < 0.0001 | ||
| Discharged to home or self-care | 1086 (71.1) | 2441 (80.2) | |
| Transfer: Short-term hospital | 11 (0.7) | 29 (1.0) | |
| Transfer: Other type of facility | 171 (11.2) | 220 (7.2) | |
| Home health care | 217 (14.2) | 302 (9.9) | |
| Against medical advice | 6 (0.4) | 13 (0.4) | |
| Died in the hospital | 37 (2.4) | 36 (1.2) | |
Table 3 Length of stay, endoscopic retrograde cholangiopancreatography to discharge time, and hospitalization costs in patients with early and late endoscopic retrograde cholangiopancreatography
| Outcome | Late ERCP | Early ERCP | Adjusted mean difference of early vs late ERCP (95%CI) | P Value |
| Length of stay in days, mean (SD) | 6.9 (5.4) | 4.5 (3.9) | -2.1 d (1.9-2.4) | < 0.0001 |
| Hospitalization costs (mean) | $21459 | $16939 | -$3760 ($2803-$4718) | < 0.0001 |
- Citation: Mulki R, Shah R, Qayed E. Early vs late endoscopic retrograde cholangiopancreatography in patients with acute cholangitis: A nationwide analysis. World J Gastrointest Endosc 2019; 11(1): 41-53
- URL: https://www.wjgnet.com/1948-5190/full/v11/i1/41.htm
- DOI: https://dx.doi.org/10.4253/wjge.v11.i1.41