Pancreaticobiliary endoscopic ultrasound in England 2007 to 2016: Changing practice and outcomes

Umair Kamran; Dominic King; Amandeep Dosanjh; Ben Coupland; John Leeds; Manu Nayar; Prashant Patel; Nigel Trudgill; Kofi W Oppong

doi:10.1055/a-1534-2558

Pancreaticobiliary endoscopic ultrasound in England 2007 to 2016: Changing practice and outcomes

Endosc Int Open. 2021 Nov 12;9(11):E1731-E1739. doi: 10.1055/a-1534-2558. eCollection 2021 Nov.

Authors

Umair Kamran¹, Dominic King¹, Amandeep Dosanjh², Ben Coupland², John Leeds^{3

4}, Manu Nayar³, Prashant Patel², Nigel Trudgill¹, Kofi W Oppong^{3

5}

Affiliations

¹ Department of Gastroenterology, Sandwell and West Birmingham Hospitals NHS Trust, United Kingdom.
² Health Informatics, University Hospitals Birmingham NHS Foundation Trust, United Kingdom.
³ HPB Unit and Department of Gastroenterology, Newcastle upon Tyne Hospitals NHS Foundation Trust, United Kingdom.
⁴ Population Health Sciences Institute, Newcastle University, United Kingdom.
⁵ Institute of Translational and Clinical Research, Newcastle University, United Kingdom.

Abstract

Background and study aims Population-level data on the outcomes of pancreaticobiliary endoscopic ultrasound (PB-EUS) are limited. We examined national PB-EUS and fine-needle aspiration (FNA) activity, its relation to pancreatic cancer therapy, associated mortality and adverse events. Patients and methods Adults undergoing PB-EUS in England from 2007-2016 were identified in Hospital Episode Statistics. A pancreatic cancer cohort diagnosed within 6 months of PB-EUS were studied separately. Multivariable logistic regression models examined associations with 30-day mortality and therapies for pancreatic cancer. Results 79,269 PB-EUS in 68,908 subjects were identified. Annual numbers increased from 2,874 (28 % FNA) to 12,752 (35 % FNA) from 2007 to 2016. 8,840 subjects (13 %) were diagnosed with pancreatic cancer. Sedation related adverse events were coded in 0.5 % and emergency admission with acute pancreatitis in 0.2 % within 48 hours of PB-EUS. 1.5 % of subjects died within 30 days of PB-EUS. Factors associated with 30-day mortality included increasing age (odds ratio 1.03 [95 % CI 1.03-1.04]); male sex (1.38 [1.24-1.56]); increasing comorbidity (1.49 [1.27-1.74]); EUS-FNA (2.26 [1.98-2.57]); pancreatic cancer (1.39 [1.19-1.62]); increasing deprivation (least deprived quintile 0.76 [0.62-0.93]) and lower provider PB-EUS volume (2.83 [2.15-3.73]). Factors associated with surgical resection in the pancreatic cancer cohort included lower provider PB-EUS volume (0.44 [0.26-0.74]) and the least deprived subjects (1.33 [1.12-1.57]). 33 % of pancreatic cancer subjects who underwent EUS, did not subsequently receive active cancer treatment. Conclusions Lower provider PB-EUS volume was associated with higher 30-day mortality and reduced rates of both pancreatic cancer surgery and chemotherapy. These results suggest potential issues with case selection in lower-volume EUS providers.

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