Prospective evaluation of ERCP accessories utilization at two institutions

The costs of ERCP may be sometimes prohibitive. Much of these costs are related to equipment, accessories for attaining and keeping ductal cannulation and for therapeutic procedures in particular. Aim: To compare the utilization of ERCP accessories at two training institutions and to estimate the costs derived from it. Setting: Endoscopy Units at a VA Medical Center (VAMC) and Good Samaritan Regional Medical Center (GSRMC). Statistical Analysis: Student's-t and Chi-square tests. Material and Methods: ERCPs performed by Third Year Fellows in training at the two teaching institutions over a 1-year period were prospectively analyzed. At the VAMC, accessories are re-used after sterilization until they are deemed of no use by the endoscopist. At the GSRMC, all equipment is new, disposable and not re-used. Number of accessories and their costs using the discount VA price were calculated for both institutions. Diagnostic and therapeutic procedures were tabulated. Results: A total of 270 ERCPs were performed over the study period (145 at GSRMC and 125 at VAMC). Of these, 57.8$ were therapeutic and the remaining 42.2%, diagnostic ERCPs. At VAMC, 30.4% of ERCPs were performed exclusively with used accessories. The mean (±SEM) number of accessories used per ERCP both diagnostic (DX) and therapeutic (RX) as well as the mean cost derived from accessories is depicted below. Accessories (n) Accessories DX (n) Accessories RX (n) Accessories Costs ($) VAMC 3.3±0.2*2.6±0.3*5.1±0.2*173.5±13. 3*GSRMC 2.8±0.1 1.9±0.1 3.4±0.1 283.9±13.5*p<0.05 between VAMC and GSRMC Conclusions: 1) The utilization of ERCP accessories was significantly greater at VAMC compared to GSRMC. 2) The accessory-related costs were significantly lower at VAMC compared to GSRMC and probably related to the re-use of equipment. 3) Although the utilization of re-used accessories saves money, it carries the disadvantage of utilizing more accessories at each ERCP.