Endoscopy 2018; 50(02): 109-118
DOI: 10.1055/s-0043-121268
Original article
© Georg Thieme Verlag KG Stuttgart · New York

The economic impact of using single-operator cholangioscopy for the treatment of difficult bile duct stones and diagnosis of indeterminate bile duct strictures

Pierre H. Deprez
1  Department of Hepatogastroenterology, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
,
Rodrigo Garces Duran
1  Department of Hepatogastroenterology, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
,
Tom Moreels
1  Department of Hepatogastroenterology, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
,
Gianluca Furneri
2  Health Economics and Outcome Research Department, EBMA Consulting, Milan, Italy
,
Federica Demma
2  Health Economics and Outcome Research Department, EBMA Consulting, Milan, Italy
,
Len Verbeke
3  Department of Gastroenterology and Hepatology, University Hospital Gasthuisberg, Leuven, Belgium
,
Schalk W. Van der Merwe
3  Department of Gastroenterology and Hepatology, University Hospital Gasthuisberg, Leuven, Belgium
,
Wim Laleman
3  Department of Gastroenterology and Hepatology, University Hospital Gasthuisberg, Leuven, Belgium
› Author Affiliations
Further Information

Publication History

Submitted: 24 April 2017

Accepted after revision: 14 September 2017

Publication Date:
24 November 2017 (eFirst)

Abstract

Background and study aim Conventional endoscopic retrograde cholangiopancreatography (ERCP) combines endoscopy and radiography to diagnose and treat pathological conditions of the bile duct. The aim of the present analysis was to evaluate the clinical and economic impact of the use of single-operator intraductal cholangioscopy (IDC), which allows for direct visualization of the bile duct, as an alternative to ERCP for the treatment of difficult bile duct stones and the diagnosis of bile duct strictures.

Patients and methods The clinical and economic consequences of single-operator IDC use were evaluated using two decision-tree models, one for management of difficult-to-remove stones and one for stricture diagnosis. A hospital perspective was adopted. Data to populate the models were derived from two Belgian hospitals that specialize in endoscopic procedures of the bile duct. Overall, the examined population consisted of 62 patients with difficult stones and 49 patients with indeterminate strictures.

Results In the model for difficult stone management, the use of IDC determined a decrease in the number of procedures (– 27 % relative reduction) and costs (– €73 000; – 11 % relative reduction) when compared with ERCP. In the model for stricture diagnosis, the use of IDC determined a decrease in the number of procedures (– 31 % relative reduction) and costs (– €13 000; – 5 % relative variation) when compared with ERCP.

Conclusions The single-operator IDC system performed better than ERCP for the treatment of difficult bile duct stones and the diagnosis of bile duct strictures, and reduced the overall expenditure in hospitals in Belgium.