title: Trends in utilization of diagnostic and therapeutic ERCP and cholecystectomy over the past 25 years: a population-based study.
abstract: BACKGROUND
  Comprehensive, population-based data on ERCP use over the last 30 years in North America are lacking.
  
  
  OBJECTIVE
  To establish crude and age-adjusted population-based rates of ERCP, evaluate for changing indications for ERCP, and evaluate for interactions between cholecystectomy technique and ERCP use from 1984 to 2009.
  
  
  METHODS
  Retrospective, comprehensive, population-based study.
  
  
  METHODS
  All inpatient and outpatient ERCPs and cholecystectomies in Manitoba, Canada from 1984 to 2009.
  
  
  METHODS
  All residents of Manitoba, Canada with a history of ERCP and/or cholecystectomy.
  
  
  METHODS
  None.
  
  
  METHODS
  Yearly crude and age-adjusted rates of ERCP (diagnostic and therapeutic) and cholecystectomy (open, laparoscopic, and with open bile duct exploration), and patient and/or procedure demographics.
  
  
  RESULTS
  The rate of ERCP/10,000 people increased from 7.70 (1984) to 13.86/10,000 (2009) (P = .001). Diagnostic ERCP declined from 7.28/10,000 (1984) to 1.11/10,000 (2009), and therapeutic ERCP increased from 0.42/10,000 (1984) to 12.75/10,000 (2009) (P < .001). ERCPs were more common in women (62%) and in older populations (60-79 years, >80 years), with rates of therapeutic ERCP reaching 62.58/10,000 in the elderly. The primary indication for ERCP has changed over time, with biliary indications increasing from 50.3% to 67.3% and pancreatic indications decreasing from 18.3% to 8.1% (P < .05). The rate of therapeutic ERCP increased during the transition from open to laparoscopic cholecystectomy (1991-1994), whereas open bile duct exploration (OBDE) decreased from 2.0 to 0.18/10,000 (P < .001).
  
  
  CONCLUSIONS
  Retrospective analysis, administrative data.
  
  
  CONCLUSIONS
  ERCP use increased steadily from 1984 to 2009, and changed from a diagnostic modality to a therapeutic one. Changes in cholecystectomy technique may have influenced therapeutic ERCP use and likewise, the availability of therapeutic ERCP has decreased the need for OBDE.
authors.affiliation: University of Manitoba Department of Internal Medicine, Winnipeg, Manitoba, Canada.
authors.forename: Dana C
authors.initials: DC
authors.lastname: Moffatt
authors.affiliation: University of Manitoba Centre for Global Public Health, Winnipeg, Manitoba, Canada.
authors.forename: B Nancy
authors.initials: BN
authors.lastname: Yu
authors.affiliation: University of Manitoba Centre for Global Public Health, Winnipeg, Manitoba, Canada.
authors.forename: Wiechun
authors.initials: W
authors.lastname: Yie
authors.affiliation: University of Manitoba Department of Internal Medicine, Winnipeg, Manitoba, Canada; University of Manitoba IBD Clinical and Research Centre, Winnipeg, Manitoba, Canada.
authors.forename: Charles N
authors.initials: CN
authors.lastname: Bernstein
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002170:Canada; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000706:statistics & numerical data* / Q000639:trends; D002763:Cholecystectomy / Q000706:statistics & numerical data* / Q000639:trends; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult