Tendencies and outcomes in endoscopic biliary sphincterotomies among people with or without type 2 diabetes mellitus in Spain, 2003-2013.
We aimed to compare incidence and outcomes for endoscopic biliary sphincterotomies in people with or without type 2 diabetes mellitus (T2DM) in Spain (2003-2013). We collected all cases of endoscopic biliary sphincterotomies using national hospital discharge data and evaluated annual incident rates stratified by T2DM status. We analyzed trends over time for in-hospital mortality (IHM) as the primary outcome and a composite of IHM or procedure-related complications (key secondary outcome). In multivariate analyses, we tested T2DM as an independent factor of IHM and IHM or complications. We identified 126,885 endoscopic biliary sphincterotomies (23,002 [18.1%] in T2DM people). Crude incidence rates of endoscopic biliary sphincterotomies were > 3-fold higher in people with vs without T2DM (85.5/105 vs 26.9/105 population, respectively). Annual incidence rates of endoscopic biliary sphincterotomies showed 11-year relative increments of 77.5% (from 60.0 to 106.5/105) in T2DM, and 53.7% (from 21.6 to 33.2/105) in non-T2DM people (p < 0.001). We found no significant changes in mortality trends over time for the populations with or without T2DM (p = 0.15 and p = 0.21, respectively). Rates of procedural pancreatitis decreased in people without T2DM (p < 0.001). In the multivariate analysis, older age, higher comorbidity and endoscopic biliary sphincterotomy during urgent admission were associated with a higher IHM. T2DM was associated with a lower IHM after an endoscopic biliary sphincterotomy (OR = 0.82 [0.74-0.92]). Time trend multivariate analyses 2003-2013 showed significant reductions in IHM over time only in people with T2DM (OR = 0.97 [0.94-1.00]). Further studies are needed to confirm a lower IHM for endoscopic biliary sphincterotomies in people with T2DM.
Medicina Interna, Hospital Gregorio Marañón, España.
Jose
J
de Miguel-Yanes
Hospital Clínico San Carlos.
Manuel
M
Méndez-Bailón
Universidad Rey Juan Carlos.
Rodrigo
R
Jiménez-García
Hospital Gregorio Marañón.
Cecilia
C
González-Asanza
Universidad Rey Juan Carlos.
Valentín
V
Hernández-Barrera
Hospital Infanla Leonor.
Nuria
N
Muñoz-Rivas
Universidad Rey Juan Carlos.
Ana
A
López-de-Andrés
D000368:Aged; D000369:Aged, 80 and over; D001660:Biliary Tract Diseases / Q000401:mortality / Q000601:surgery*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010182:Pancreatic Diseases / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies; D013030:Spain / Q000453:epidemiology; D016717:Sphincterotomy, Endoscopic / Q000379:methods* / Q000401:mortality / Q000706:statistics & numerical data; D016896:Treatment Outcome