| Popis: |
Background Direct Peroral Cholangioscopy (POC) is a useful adjunct to facilitate lithotripsy in the management of large common bile duct stones during endoscopic retrograde cholangiopancreatograpy (ERCP) but has limitations due to its cost. In our centre, POC is limited to cases where anaesthesia care is available; this is not always the case due to resource constraints. Methods We retrospectively evaluated our ERCP cases for large stone (>10 mm) and compared cases where POC was used as the first-line vs cases where ‘standard of care’ was performed. Besides demographics, indications and number of ERCPs cost and use of POC were considered. Results In the 12-month period under consideration, a total of 46 cases met the inclusion criteria, with 6 cases of POC and 40 cases of standard ERCP. Cholangitis (47.8%), and choledocholithiasis without cholangitis (45.7%) accounted for most of the cases. Of the cases with first-line POC, 33.3% required further ERCP, whereas 42.5% of the standard ERCP patients required another procedure for stone therapy. Due to the low numbers, these proportion differences did not reach statistical significance, although data collection is ongoing. Of note, the cases with POC had a smaller average hospitalization bill size, 85.8% that of the standard ERCP. Although patients with POC had higher consumable fees, they had lower total hospitalization stay and hence had less total cost. (Figure 1). Conclusions In conclusion, although first-line POC has a high-upfront consumable cost, it is associated with shorter length of stay and fewer procedures required, and this saves not only patient and physician time and may also result in cost savings. Further data is required to confirm the robustness of these observations. |
