INCREASED ERCP RATE FOLLOWING THE INTRODUCTION OF LAPAROSCOPIC CHOLECYSTECTOMY

Over the past 5 years there has been a remarkable change in the manner in which symptomatic gallstones are surgically managed. In this study we reviewed the experience of a large HMO to determine the relationsh ip between the rate of increase of ERCP and that of cholecystectomy. A ll individuals enrolled in US Healthcare's HMO-PA, in the region of so uth-eastern Pennsylvania from 1988 through 1993, were included in the analysis. Using the HMO claims database, patients who underwent an ope n or laparoscopic cholecystectomy during the study period were identif ied. We then identified those patients who had a pre- or post-operativ e ERCP. Over the study period, there has been a substantial increase i n cholecystectomies per 1000 members-from 1.37 in 1988 to 2.16 (p < 0. 0001) in 1993. In our study population there were 1261 ERCPs performed in 979 patients with an average of 1.3 ERCPs per patient during the s tudy period. The ERCP rate per 1000 members has increased from 0.16 to 0.56 (p < 0.0001) from 1988 to 1993, at the same time that the cholec ystectomy rate was substantially increasing. The correlation for the E RCP and cholecystectomy rates from 1988 to 1993 was 0.994 (p < 0.0001) . Since the introduction of laparoscopic cholecystectomy in 1989-1990, many more ERCPs are now being performed. It is necessary to determine the implications related to the rapid diffusion of laparoscopic chole cystectomy, including the effect that this technology has had on other older and stable technologies such as ERCP. Our results describe the dramatic effect that laparoscopic cholecystectomy has had on the utili zation of ERCPs.