title: Trends in the Use of Endoscopic Retrograde Cholangiopancreatography for the Management of Chronic Pancreatitis in the United States.
abstract: OBJECTIVE
  The aim of this study was to characterize current trends in the use of endoscopic retrograde cholangiopancreatography (ERCP) in the United States for patients hospitalized with chronic pancreatitis.
  
  
  BACKGROUND
  Historically, ERCP was the primary tool for diagnostic and therapeutic management of chronic pancreatitis. With increased availability of magnetic resonance imaging and endoscopic ultrasound, indications for ERCP are being redefined.
  
  
  METHODS
  We performed a retrospective cohort study using the Nationwide Inpatient Sample from 1998 to 2010. We identified patients with a primary discharge diagnosis of chronic pancreatitis who underwent ERCP. We excluded patients diagnosed with biliary, gallbladder, or pancreatic neoplasm and patients who underwent gallbladder or pancreatic operation during the same admission. We analyzed patient and hospital characteristics, length of stay, and in-hospital mortality, and adjusted for weighted sample schema.
  
  
  RESULTS
  During the study period, 29,318 patients with chronic pancreatitis (mean age 52 y, 57.2% female) underwent ERCP during their hospitalization. The majority of patients were white (56.1%). The majority of procedures were performed at large (72.4%), urban (95.2%), and academic (69.0%) hospitals. Mean hospital charges were $32,929 (SE= $1605). Mean length of stay was 6 days (SE=0.3), with in-hospital mortality of 0.76%. Over the study period, the number of procedures has decreased significantly (P<0.001).
  
  
  CONCLUSIONS
  In the United States, ERCP has been an important diagnostic and therapeutic tool for chronic pancreatitis. Over the last decade, ERCP has become an uncommon inpatient procedure for chronic pancreatitis.
authors.affiliation: *Department of General Surgery, Division of Surgical Oncology †Division of Public Health Sciences ‡Department of Internal Medicine, Division of Gastroenterology, Wake Forest Baptist Health, Winston-Salem, NC §Department of Surgery, Cleveland Clinic of Florida, Weston, FL.
authors.forename: Clancy J
authors.initials: CJ
authors.lastname: Clark
authors.forename: Nora F
authors.initials: NF
authors.lastname: Fino
authors.forename: Norman
authors.initials: N
authors.lastname: Clark
authors.forename: Armando
authors.initials: A
authors.lastname: Rosales
authors.forename: Girsh
authors.initials: G
authors.lastname: Mishra
authors.forename: Rishi
authors.initials: R
authors.lastname: Pawa
mesh_terms: D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods* / Q000639:trends; D015331:Cohort Studies; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D050500:Pancreatitis, Chronic / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies; D014481:United States