Availability and utilization of endoscopic retrograde cholangiopancreatography at children's hospitals

• Published in: Journal of pediatric gastroenterology and nutrition Vol. 78; no. 5; pp. 1180 - 1189
• Main Authors: Pathak, Sagar J., Attard, Thomas, Hall, Matthew, Arain, Mustafa, Heyman, Melvin B., Perito, Emily R.
• Format: Journal Article
• Language: English
• Published: United States 01.05.2024
• Subjects: Adolescent; Biliary Tract Diseases - therapy; Child; Child, Preschool; Cholangiopancreatography, Endoscopic Retrograde - statistics & numerical data; Female; health equity; Health Services Accessibility - statistics & numerical data; Healthcare Disparities - statistics & numerical data; hepatobiliary; Hospitals, Pediatric - statistics & numerical data; Humans; Infant; Male; Pancreatic Diseases - surgery; Pancreatic Diseases - therapy; pancreatitis; pediatric; Retrospective Studies; United States; United States; hepatobiliary; health equity; pancreatitis; pediatric
• ISSN: 0277-2116; 1536-4801
• DOI: 10.1002/jpn3.12183

Objectives No study has explored whether availability of endoscopic retrograde cholangiopancreatography (ERCP) is adequate and equitable across US children's hospitals. We hypothesized that ERCP availability and utilization differs by geography and patient factors. Methods Healthcare encounter data from 2009 to 2019 on children with pancreatic and biliary diseases from the Pediatric Health Information System were analyzed. ERCP availability was defined as treatment at a hospital that performed pediatric ERCP during the year of service. Results From 2009 to 2019, 37,946 children (88,420 encounters) had a potential pancreatic or biliary indication for ERCP; 7066 ERCPs were performed. The commonest pancreatic diagnoses leading to ERCP were chronic (47.2%) and acute pancreatitis (43.2%); biliary diagnoses were calculus (68.3%) and obstruction (14.8%). No ERCP was available for 25.0% of pancreatic encounters and 8.1% of biliary encounters. In multivariable analysis, children with public insurance, rural residence, or of Black race were less likely to have pancreatic ERCP availability; those with rural residence or Asian race were less likely to have biliary ERCP availability. Black children or those with public insurance were less likely to undergo pancreatic ERCP where available. Among encounters for calculus or obstruction, those of Black race or admitted to hospitals in the West were less likely to undergo ERCP when available. Conclusions One‐in‐four children with pancreatic disorders and one‐in‐12 with biliary disorders may have limited access to ERCP. We identified racial and geographic disparities in availability and utilization of ERCP. Further studies are needed to understand these differences to ensure equitable care. What is Known Endoscopic retrograde cholangiopancreatography (ERCP) is effective for treating pancreaticobiliary disorders in children and adolescents. ERCP remains a highly specialized procedure that may not be available to all patients, an issue partly attributable to equity of distribution of pediatric specialists trained to perform ERCP. What is New A large proportion of children with pancreatic or biliary disorders are admitted to a hospital without in‐house ERCP availability. In hospitals where ERCP is offered, compared to children from other races, Black children are less likely to undergo ERCP for pancreatic diagnoses, and for biliary calculi or obstruction. Children with public insurance are less likely to undergo pancreatic ERCP at centers that perform ERCP.