The economic impact of using single-operator cholangioscopy for the treatment of difficult bile duct stones and diagnosis of indeterminate bile duct strictures

Abstract

Background and study aim Conventional endoscopic retrograde cholangiopancreatography (ERCP) combines endoscopy and radiography to diagnose and treat pathological conditions of the bile duct. The aim of the present analysis was to evaluate the clinical and economic impact of the use of single-operator intraductal cholangioscopy (IDC), which allows for direct visualization of the bile duct, as an alternative to ERCP for the treatment of difficult bile duct stones and the diagnosis of bile duct strictures.

Patients and methods The clinical and economic consequences of single-operator IDC use were evaluated using two decision-tree models, one for management of difficult-to-remove stones and one for stricture diagnosis. A hospital perspective was adopted. Data to populate the models were derived from two Belgian hospitals that specialize in endoscopic procedures of the bile duct. Overall, the examined population consisted of 62 patients with difficult stones and 49 patients with indeterminate strictures.

Results In the model for difficult stone management, the use of IDC determined a decrease in the number of procedures (– 27 % relative reduction) and costs (– €73 000; – 11 % relative reduction) when compared with ERCP. In the model for stricture diagnosis, the use of IDC determined a decrease in the number of procedures (– 31 % relative reduction) and costs (– €13 000; – 5 % relative variation) when compared with ERCP.

Conclusions The single-operator IDC system performed better than ERCP for the treatment of difficult bile duct stones and the diagnosis of bile duct strictures, and reduced the overall expenditure in hospitals in Belgium.

• References

• 1 Endoscopic retrograde cholangiopancreatography (ERCP). PubMed health glossary. Available from https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0022879/ Accessed 25 September 2017
• 2 Ramchandani M, Reddy DN, Lakhtakia S. et al. Per oral cholangiopancreatoscopy in pancreatic biliary diseases – expert consensus statements. World J Gastroenterol 2015; 21: 4722-4734
• 3 Draganov P. The SpyGlass^® direct visualization system for cholangioscopy. Gastroenterol Hepatol (N Y) 2008; 4: 469-470
• 4 Laleman W, Verraes K, Van Steenbergen W. et al. Usefulness of the single-operator cholangioscopy system SpyGlass in biliary disease: a single-center prospective cohort study and aggregated review. Surg Endosc 2017; 31: 2223-2232
• 5 Chang WH, Chu CH, Wang TE. et al. Outcome of simple use of mechanical lithotripsy of difficult common bile duct stones. World J Gastroenterol 2005; 11: 593-596
• 6 Navaneethan U, Njei B, Lourdusamy V. et al. Comparative effectiveness of biliary brush cytology and intraductal biopsy for detection of malignant biliary strictures: a systematic review and meta-analysis. Gastrointest Endosc 2015; 81: 168-176
• 7 Mauskopf JA, Sullivan SD, Annemans L. et al. Principles of good practice for budget impact analysis: report of the ISPOR Task Force on good research practices – budget impact analysis. Value Health 2007; 10: 336-347
• 8 Chen YK, Parsi MA, Binmoeller KF. et al. Single-operator cholangioscopy in patients requiring evaluation of bile duct disease or therapy of biliary stones (with videos). Gastrointest Endosc 2011; 74: 805-814
• 9 Patel SN, Rosenkranz L, Hooks B. et al. Holmium-yttrium aluminum garnet laser lithotripsy in the treatment of biliary calculi using single-operator cholangioscopy: a multicenter experience (with video). Gastrointest Endosc 2014; 79: 344-348
• 10 Wong JC, Tang RS, Teoh AY. et al. Efficacy and safety of novel digital single-operator peroral cholangioscopy-guided laser lithotripsy for complicated biliary stones. Endosc Int Open 2017; 5: E54-E58
• 11 Tummala P, Munigala S, Eloubeidi MA. et al. Patients with obstructive jaundice and biliary stricture ± mass lesion on imaging: prevalence of malignancy and potential role of EUS-FNA. J Clin Gastroenterol 2013; 47: 532-537
• 12 Navaneethan U, Hasan MK, Kommaraju K. et al. Digital, single operator cholangiopancreaticoscopy in the diagnosis and management of pancreatobiliary disorders: a multicentre clinical experience (with video). Gastrointest Endosc 2016; 84: 649-655
• 13 Belgium Government. APR-DRG tariffs. Available from: https://tct.fgov.be/webetct/etct-web/anonymous?lang=fr Accessed 4 November 2016
• 14 Boston Scientific Corp. Data on file.
• 15 Moon JH, Ko BM, Choi HJ. et al. Direct peroral cholangioscopy using an ultra-slim upper endoscope for the treatment of retained bile duct stones. Am J Gastroenterol 2009; 104: 2729-2733
• 16 Parsi MA, Stevens T, Vargo JJ. Diagnostic and therapeutic direct peroral cholangioscopy using an intraductal anchoring balloon. World J Gastroenterol 2012; 18: 3992-3996
• 17 Parsi MA. Direct peroral cholangioscopy. World J Gastrointest Endosc 2014; 6: 1-5
• 18 Njei B, McCarty TR, Varadarajulu S. et al. Cost utility of ERCP-based modalities for the diagnosis of cholangiocarcinoma in primary sclerosing cholangitis. Gastrointest Endosc 2017; 85: 773-781.e10