Where do ERCP, endoscopic ultrasound, magnetic resonance cholangiopancreatography, and intraoperative cholangiography fit in the management of acute biliary pancreatitis? A decision analysis model

Citation
Mr. Arguedas et al., Where do ERCP, endoscopic ultrasound, magnetic resonance cholangiopancreatography, and intraoperative cholangiography fit in the management of acute biliary pancreatitis? A decision analysis model, AM J GASTRO, 96(10), 2001, pp. 2892-2899
Citations number
43
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Gastroenerology and Hepatology
Journal title
AMERICAN JOURNAL OF GASTROENTEROLOGY
ISSN journal
0002-9270 → ACNP
Volume
96
Issue
10
Year of publication
2001
Pages
2892 - 2899
Database
ISI
SICI code
0002-9270(200110)96:10<2892:WDEEUM>2.0.ZU;2-Y
Abstract
OBJECTIVES: The role of ERCP in acute biliary pancreatitis (ABP) is controv ersial. Magnetic resonance cholangiopancreatography (MRCP) and endoscopic u ltrasonography (EUS) are modalities for bile duct visualization that could lower costs and prevent FRCP-related complications. We analyzed costs and e xamined the cost-effectiveness of these modalities to define their role in ABP. METHODS: A decision analysis model of ABP was constructed. The strategies e valuated were 1) FRCP, 2) MRCP followed by ERCP if positive for common bile duct stones (CBDS) or if biliary sepsis ensued, 3) EUS followed by FRCP if positive or if biliary sepsis ensued, and 4) observation with intraoperati ve cholangiography at the time of cholecystectomy with FRCP only if biliary sepsis ensued. We compared costs and performed cost-effectiveness analysis between strategies at probabilities of CBDS ranging from 0% to 100%. The o utcome measures were total costs and costs per ABP death prevented. RESULTS: At probabilities of CBDS < 15%, observation with intraoperative ch olangiography is the least expensive strategy, whereas EUS and ERCP are the least expensive strategies at probabilities of 15-58% and >58%, respective ly. In terms of cost-effectiveness, at probabilities of CBDS of 7-45%, EUS is the most cost-effective alternative, and at a probability of >45% ERCP i s the most cost-effective option. CONCLUSIONS: Total costs and cost-effectiveness ratios of these strategies in patients with ABP are highly dependent on the probability of CBDS. (Am J Gastroenterol 2001;96: 2892-2899. (C) 2001 by Am. Coll. of Gastroenterolog y).