title: Single-session endosonography and endoscopic retrograde cholangiopancreatography for biliopancreatic diseases is feasible, effective and cost beneficial.
abstract: BACKGROUND
  Endoscopic ultrasonography (EUS) and Endoscopic Retrograde Cholangiopancreatography (ERCP) are often required in patients with pancreaticobiliary disorders.
  
  
  OBJECTIVE
  To assess the clinical impact and costs savings of a single session EUS-ERCP.
  
  
  METHODS
  Patient and intervention data from April 2009 to March 2012 were prospectively recruited and retrospectively analyzed from a database at a tertiary hospital. Indications, diagnostic yield, procedure details, complications and costs were evaluated.
  
  
  RESULTS
  Fifty-five scheduled combined procedures were done in 53 patients. The accuracy of EUS-fine needle aspiration for malignancy was 90%. The main clinical indication was a malignant obstructing lesion (66%). The ERCP cannulation was successful in 67%, and in 11/15 failed ERCP (73%), drainage was completed thanks to an EUS-guided biliary drainage: 6 transmurals, 5 rendezvous. Eight patients (14%) had related complications: bacteremia (n = 3), pancreatitis (n = 2), bleeding (n = 2) and perforation (n = 1). The mean duration was 65 ± 22.2 min. The mean estimated cost for a single session was €3437, and €4095 for two separate sessions. The estimated cost savings using a single-session strategy was €658 per patient, representing a total savings of €36,189.
  
  
  CONCLUSIONS
  Combined EUS and ERCP is safe, technically feasible and cost beneficial. Furthermore, in failed ERCP cases, the endoscopic biliary drainage can be completed with EUS-guided biliary access in the same procedure.
authors: Department of Digestive Diseases, Hospital Universitari de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain. jgornals@bellvitgehospital.cat
authors: Joan B
authors: JB
authors: Gornals
authors: Ramon
authors: R
authors: Moreno
authors: Jose
authors: J
authors: Castellote
authors: Carme
authors: C
authors: Loras
authors: Roger
authors: R
authors: Barranco
authors: Isabel
authors: I
authors: Catala
authors: Xavier
authors: X
authors: Xiol
authors: Joan
authors: J
authors: Fabregat
authors: Xavier
authors: X
authors: Corbella
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001660:Biliary Tract Diseases / Q000150:complications / Q000175:diagnosis*; D044963:Biopsy, Fine-Needle / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000191:economics* / Q000379:methods / Q000706:statistics & numerical data; D003362:Cost-Benefit Analysis; D004322:Drainage / Q000191:economics / Q000379:methods; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration / Q000191:economics* / Q000379:methods; D019160:Endosonography / Q000191:economics* / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D010182:Pancreatic Diseases / Q000150:complications / Q000175:diagnosis*; D011446:Prospective Studies; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D013997:Time Factors