Mo1099 Cost-Effectiveness Analysis of Endoscopic Ultrasound-Guided Biliary Drainage (EGBD) Versus Percutaneous Transheptatic Biliary Drainage (PTBD) for Malignant Biliary Obstruction After Failed ERCP (original) (raw)

Abstract

INTRODUCTION Is it well known that obstructive jaundice is a frequent cause of access in Emergency Department (ED), with or without cholangitis, and this requires a rapid management with hospitalization in surgical or gastroenterology unit to perform ERCP and to solve the problem. To reduce the problem of overcrowding and too many hospital admissions in Italian's ED were added Brief Observation Unit (BOU), small units located close to the ED in which patients are treated for 48-72h with a significant decrease of regular admission costs. Aim of our study was evaluate the efficacy of a new model of managing acute obstructive jaundice with ERCP procedures directly from BOU, instead of admitting patients to long and unnecessary periods of hospitalization PATIENTS AND METHODS We enrolled from July 2014 to November 2015, 172 consecutive patients (102M/70F mean age 66,7 +-13,5) who came to our ED of Gemelli Hospital with an acute obstructive jaundice with the indication to perform ERCP Routine blood tests including LFTs, chest x-ray, EKG, abdominal ultrasound (or CT scan if needed) were performed and the patient sent urgently to perform ERCP. After ERCP patients were hospitalized for a short observation in the BOU. RESULTS Indications for ERCP are summarized in the table Overall, 132 / 172 patients (76.7 %) were discharged the day after the procedure or within 48 hours from admission (p<0.0001). Biliary stent clogging, unresectable pancreatic cancer and removal of biliary stones are the diseases in which treatment determined a significantly high probability of discharge directly form BOU, differently from cholangitis with incomplete drainage from other facilities or acute biliary pancreatitis, which always require regular hospital admission (p<0.0001). This model allowed to significantly reduce the total costs of management of those diseases (291 vs 1058 USD per day for each patient; p<0.0001). DISCUSSION AND CONCLUSIONS Our study showed the effectiveness of BOU in the managing of patients with acute obstructive jaundice who needs ERCP, especially for those who underwent for removal of biliary stones or biliary stent clogging. All of these patients were admitted to BOU, thereby reducing the cost and time of hospitalization. This approach decreases unnecessary inpatient admission, reduces timing of procedures actuation and allows a faster and appropriate managing of the patients.

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