Prospective assessment of the accuracy of ASGE and ESGE guidelines for choledocholithiasis.

Background and study aims American Society of Gastrointestinal Endoscopy (ASGE) and European Society of Gastrointestinal Endoscopy (ESGE) guidelines recommend categorizing patients by risk for choledocholithiasis to determine management. The goal of our study was to compare the accuracy of criteria proposed in these guidelines. Patients and methods All patients with suspected choledocholithiasis at our institution were prospectively identified. Based upon initial test results, patients were categorized as low, intermediate, and high risk for choledocholithiasis per ASGE 2010 and 2019, and ESGE criteria. Patients were followed until 30 days post-discharge. Results of endoscopic retrograde cholangiography (ERCP), endoscopic ultrasound, and magnetic resonance cholangiopancreatography were used as criteria standard for choledocholithiasis. The accuracy of each criterion for choledocholithiasis was computed. Results During the study period, 359 consecutive patients with suspected choledocholithiasis were identified, of whom 225 had choledocholithiasis. Median patient age was 69 years and 55.3% were women. ESGE criteria categorized 47.9% as high-risk, lower than ASGE 2010 (62.7%, P <0.01), and 2019 criteria (54.6%, P =0.07). In high-risk patients, choledocholithiasis was noted in 83.1% for ESGE criteria, similar for ASGE 2019 (81.6%, P =0.7) and 2010 criteria (79.1%, P =0.3). The percentage of patients who underwent unnecessary ERCP was 8.1% per ESGE criteria, lower than ASGE 2010 (13.1%, P =0.03), but similar to 2019 criteria (10%, P =0.4). No difference in accuracy for choledocholithiasis was noted among the three criteria. No 30-day readmissions for choledocholithiasis were noted in the low-risk category. Conclusions ESGE and ASGE guidelines have similar accuracy for diagnosis of choledocholithiasis. However, ESGE criteria result in more patients needing additional testing, but also a smaller proportion of patients undergoing unnecessary ERCP.

Confidentiality and Conflicts of Interest: An Assessment of Twitter Posts in Gastrointestinal Endoscopy.

INTRODUCTION: To evaluate compliance with confidentiality and conflicts of interest (COI) in tweets sharing gastrointestinal (GI) endoscopy videos/images. METHODS: Physicians' tweets containing GI endoscopy videos/images were assessed for confidentiality and COI compliance. RESULTS: Identifiable details in tweets included procedure date (17.9%), date of birth (0.8%), and patient's face visible (0.5%). Ninety-five tweets (10%) mentioned the name/brand of a medical device. Of the 19 posted by US physicians, 7 came from physicians who had received payments from the device manufacturer. None of these physicians disclosed relevant COI. DISCUSSION: GI endoscopy tweets describing clinical cases or procedures may insufficiently address issues of confidentiality and COI.

Risk Factors Associated With Hospital Readmission and Costs for Pouchitis.

Background: Pouchitis is the most common long-term complication in patients with restorative proctocolectomy and ileal pouch-anal anastomosis. This study aimed to identify readmission rates for pouchitis and risk factors associated with readmissions in an extensive national database. Methods: We performed a retrospective analysis using the National Readmission Database to determine if patient demographics and clinical characteristics were predictors of hospital readmission within 30 days for adult patients (age >18 years) discharged with a principal diagnosis of pouchitis (ICD-9 code-569.71) from January 2013 to December 2013. Both univariable and multivariable analyses were performed to assess factors associated with 30-day readmission. Results: A total of 1538 patients with pouchitis who were discharged alive were identified. 10.2% [95% confidence interval: 7.6, 12.7] of these were readmitted within 30 days of discharge. The average days to readmission were 18.6 ± 1.01. Multivariable analysis of risk factors associated with readmission showed older age as a protective factor for readmission [odds ratio (OR) = 0.88 (0.81, 0.96); P < 0.005]. Sex and the presence of permanent ileostomy were not associated with readmission in patients with pouchitis. The length of stay during readmissions was associated with postoperative wound infection [OR = 7.7 (94.0, 11.30); P < 0.001], ileus [OR = 4.5 (1.6, 7.4); P < 0.002], permanent ileostomy [OR = 3.7 (1.7, 5.7); P < 0.001], and long-term use of nonsteroidal anti-inflammatory drugs [OR = 3.2 (1.06, 5.3); P < 0.003]. Conclusions: Readmissions in pouchitis patients are frequent. Long-term use of nonsteroidal anti-inflammatory drugs, ileus, permanent ileostomy, and postoperative wound infection is associated with increased length of stay in readmissions.

Hospital Utilization in Patients With Gastric Cancer and Factors Affecting In-Hospital Mortality, Length of Stay, and Costs.

INTRODUCTION: Although gastric cancer (GC) rates have been declining in the United States, it continues to be a major cause of morbidity. This study examined trends in hospital admissions, in-hospital mortality, length of stay (LOS), and inpatient costs related to GC. In addition, various factors associated with in-hospital mortality, LOS, and inpatient costs were examined. METHODS: National inpatient sample-the largest publicly available all-payer inpatient care database-was interrogated to obtain information about various demographic and hospital-related factors (including those mentioned above) in patients who were primarily admitted for GC between the years 1998 to 2013. These trends were analyzed. Multivariate analysis was also performed to identify risk factors associated with LOS, costs, and mortality. RESULTS: A total of 679,330 hospital discharges with the principal diagnosis of GC were obtained. Hospital stays increased by approximately 340 stays per year (±110; P=0.00079). However, inpatient mortality rate and LOS declined by 0.36% per year (±0.024%; P<0.0001), and 0.11 days per year (±0.01; P<0.0001), respectively. The inpatient charges have increased at the rate of $3241 per year (±133.3; P<0.0001). Differences in mortality rate, LOS, and inpatient costs were affected by multiple factors. CONCLUSIONS: Despite the overall decline in GC incidence, the incidence of hospitalizations per 100,000 US population related to GC did not change significantly. Although LOS and mortality declined, inpatient charges increased over the study period.

Outcomes Associated With Timing of ERCP in Acute Cholangitis Secondary to Choledocholithiasis.

GOALS: To determine the outcomes associated with timing of endoscopic retrograde cholangiopancreatography (ERCP) in patients with acute cholangitis due to choledocholithiasis, from a population-based study. BACKGROUND: Although ERCP is the cornerstone in the management of patients with acute cholangitis due to choledocholithiasis, the effect of timing of ERCP on health care outcomes is not well known. MATERIALS AND METHODS: In this retrospective study, national inpatient sample (NIS) data were used to identify patients with a combined primary or secondary diagnosis of cholangitis and choledocholithiasis from 1998 to 2012. Patients were divided into 4 groups based on timing of ERCP after admission: (1) ERCP performed within 24 hours (urgent ERCP); (2) ERCP performed between 24 and 48 hours (early ERCP); (3) ERCP performed after 48 hours (delayed ERCP); and (4) no ERCP performed. Main outcomes measured were length of stay (LOS), hospitalization charges, and in-hospital mortality. RESULTS: A total of 107,253 patients were identified of which 77,323 patients underwent ERCP at any point in time. Urgent ERCP group had shortest LOS, while delayed ERCP group had significantly longer LOS than all other groups (P<0.001). Delayed ERCP group had also the highest costs (P<0.001). In-hospital mortality was highest in no ERCP group, followed by delayed ERCP group (P<0.001); there was no difference in mortality between urgent ERCP and early ERCP. CONCLUSIONS: This study provides robust, population-based evidence that ERCP should not be delayed for >48 hours in patients with acute cholangitis due to choledocholithiasis.

Healthcare utilization and costs associated with gastroparesis.

AIM: To use a national database of United States hospitals to evaluate the incidence and costs of hospital admissions associated with gastroparesis. METHODS: We analyzed the National Inpatient Sample Database (NIS) for all patients in whom gastroparesis (ICD-9 code: 536.3) was the principal discharge diagnosis during the period, 1997-2013. The NIS is the largest publicly available all-payer inpatient care database in the United States. It contains data from approximately eight million hospital stays each year. The statistical significance of the difference in the number of hospital discharges, length of stay and hospital costs over the study period was determined by regression analysis. RESULTS: In 1997, there were 3978 admissions with a principal discharge diagnosis of gastroparesis as compared to 16460 in 2013 (P < 0.01). The mean length of stay for gastroparesis decreased by 20 % between 1997 and 2013 from 6.4 d to 5.1 d (P < 0.001). However, during this period the mean hospital charges increased significantly by 159 % from $13350 (after inflation adjustment) per patient in 1997 to $34585 per patient in 2013 (P < 0.001). The aggregate charges (i.e., "national bill") for gastroparesis increased exponentially by 1026 % from $50456642 ± 4662620 in 1997 to $568417666 ± 22374060 in 2013 (P < 0.001). The percentage of national bill for gastroparesis discharges (national bill for gastroparesis/total national bill) has also increased over the last 16 years (0.0013% in 1997 vs 0.004% in 2013). During the study period, women had a higher frequency of gastroparesis discharges when compared to men (1.39/10000 vs 0.9/10000 in 1997 and 5.8/10000 vs 3/10000 in 2013). There was a 6-fold increase in the discharge diagnosis of gastroparesis amongst type 1 DM and 3.7-fold increase amongst type 2 DM patients over the study period (P < 0.001). CONCLUSION: The number of inpatient admissions for gastroparesis and associated costs have increased significantly over the last 16 years. Inpatient costs associated with gastroparesis contribute significantly to the national healthcare bill. Further research on cost-effective evaluation and management of gastroparesis is required.

Health Care Utilization and Costs Associated With Acute Pancreatitis.

OBJECTIVE: Acute pancreatitis is a common inpatient diagnosis among gastrointestinal disorders. The aim of this study was to evaluate the incidence of inpatient admissions, costs, and mortality rates associated with acute pancreatitis in the United States. METHODS: We analyzed the National Inpatient Sample for all patients in which acute pancreatitis (International Classification of Diseases, Ninth Revision code: 577.0) was the principal discharge diagnosis during the period 1997-2012. The statistical significance of the difference in the hospital discharges, length of stay, and costs over the study period was determined by utilization of regression analysis. RESULTS: In 1997, there were 164,776 admissions with a principal discharge diagnosis of acute pancreatitis as compared with 275,170 in 2012 (P < 0.001). The mean length of stay for acute pancreatitis decreased from 6.4 days in 1997 to 4.7 days in 2012 (P < 0.001). However, during this period, the mean hospital charges increased by 118.6% from $15,433 in 1997 to $33,744 in 2012 (P < 0.001). The in-hospital mortality rate decreased significantly from 1.9% in 1997 to 0.78% in 2012 (P < 0.001). CONCLUSIONS: Inpatient admissions for acute pancreatitis and associated costs have increased markedly over the last 16 years in the United States. However, the lengths of stay and mortality rates have decreased significantly.

Healthcare utilization and costs associated with cholangiocarcinoma.

BACKGROUND AND AIMS: Cholangiocarcinoma is a rare but devastating malignancy associated with a poor prognosis and a high mortality rate. With the recent advances in detection and treatment, it is unclear if the incidence and outcomes of cholangiocarcinoma are improving in the United States. The aim of this study was to evaluate the trends in the incidence, costs and mortality rates of cholangiocarcinoma- related hospital admissions in the USA. METHODS: We utilized the National Inpatient Sample Database (NIS) from 1997-2012 for all patients in whom cholangiocarcinoma (ICD-9 code 155.1, 156) was the principal discharge diagnosis. The temporal trends in the number of hospital admissions, length of stay and, hospitalization costs along with mortality rates over the study period were determined by using regression analysis for trends. RESULTS: There was a significant increase in the number of hospital admissions for cholangiocarcinoma as the principal diagnosis from 1997 to 2012 (10 357 vs 11 970, P<0.001). The mean length of stay for cholangiocarcinoma decreased by 17 % between 1997 and 2012 from 9.5 days to 7.9 days (P<0.001). However, during the same period, the mean hospital charges per patient (adjusted for inflation) increased 113.25% from $36 460 in 1997 to $77 753 in 2012. The in-hospital mortality rate decreased from 9.3% in 1997 to 6.4% in 2012 (P<0.001). CONCLUSIONS: There was a significant increase in the number of hospital admissions and associated costs from cholangiocarcinoma in the USA between 1997 and 2012. However, this was accompanied by a decrease in the inpatient mortality rates from cholangiocarcinoma.

Inpatient burden of constipation in the United States: an analysis of national trends in the United States from 1997 to 2010.

OBJECTIVES: Constipation is one of the most common outpatient diagnoses in primary care and gastroenterology clinics; however, there is limited data on the inpatient burden of constipation in the United States. The aim of this study was to evaluate inpatient admission rates, length of stay, and associated costs related to constipation from 1997 to 2010. METHODS: We analyzed the National Inpatient Sample Database for all patients in which constipation (ICD-9 codes: 564.0-564.09) was the principal discharge diagnosis from 1997 to 2010. The statistical significance of the difference in the number of hospital discharges, length of stay, and hospital costs over the study period was determined by utilizing the Spearman's coefficient to describe various trends. RESULTS: Between 1997 and 2010, the number of hospitalizations for patients with a primary discharge diagnosis of constipation increased from 21,190 patients to 48,450 (P<0.001, GoF test), whereas the mean length of hospital stay increased only slightly from 3.0 days to 3.1 days (b=0.008 (0.003-0.014); P=0.004). The mean charges per hospital discharge for constipation increased from $8869 in 1997 (adjusted for long-term inflation) to $17,518 in 2010 (b=745.4 (685.3-805.6); P<0.001)), whereas the total costs increased from $188,109,249 (adjusted for inflation) in 1997 to $851,713,263 in 2010. Although the elderly (65-84 years) accounted for the largest percentage of constipation discharges, patients in the 1-17 years age group had the highest frequency of constipation per 10,000 discharges. CONCLUSIONS: The number of inpatient discharges for constipation and associated costs has significantly increased between 1997 and 2010.