Wilcox Charles Mel, Kilgore Meredith
Department of Medicine, Division of Gastroenterology and Hepatology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL 35294-0007, USA.
Pancreas. 2009 Mar;38(2):117-21. doi: 10.1097/MPA.0b013e31818ab69c.
Both endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasonography (EUS) are commonly performed in the evaluation of idiopathic pancreatitis. However, comparative trials of these modalities are lacking, and thus the ideal endoscopic diagnostic strategy to evaluate idiopathic pancreatitis remains unknown.
A decision analysis model of patients with 2 attacks of idiopathic pancreatitis with gallbladder in situ was constructed using TreeAge software. We analyzed cost and overall diagnostic ability of 3 strategies, namely, EUS, ERCP with manometry and bile aspiration, and laparoscopic cholecystectomy.
Using the base case analysis, initial EUS was the preferred initial modality for the diagnosis. The expected cost for initial EUS was $4469 compared with $4615 for ERCP and $6268 for laparoscopic cholecystectomy. For cholecystectomy to be the preferred strategy, the total cost would need to be less than $1314, well below any realistic cost estimate. If the prevalence of microlithiasis/sludge was greater than 80%, then cholecystectomy would be preferred, whereas ERCP would be preferred with a prevalence of less than 41%.
This cost minimization study identifies EUS as the least costly initial test for the diagnostic evaluation of patients with idiopathic pancreatitis with gallbladder in situ.
内镜逆行胰胆管造影术（ERCP）和内镜超声检查（EUS）在特发性胰腺炎评估中均常用。然而，缺乏这些方式的对比试验，因此评估特发性胰腺炎的理想内镜诊断策略仍不明确。
使用TreeAge软件构建胆囊原位的特发性胰腺炎发作2次患者的决策分析模型。我们分析了3种策略的成本和总体诊断能力，即EUS、带测压和胆汁抽吸的ERCP以及腹腔镜胆囊切除术。
采用基础病例分析，初始EUS是首选的初始诊断方式。初始EUS的预期成本为4469美元，而ERCP为4615美元，腹腔镜胆囊切除术为6268美元。要使胆囊切除术成为首选策略，总成本需低于1314美元，远低于任何实际成本估计。如果微结石/胆泥的患病率大于80%，则首选胆囊切除术，而患病率低于41%时则首选ERCP。
这项成本最小化研究确定EUS是胆囊原位的特发性胰腺炎患者诊断评估中成本最低的初始检查。
