Bansal R, Tierney W, Carpenter S, Thompson N, Scheiman J M
Division of Gastroenterology, Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, Michigan 48109, USA.
Gastrointest Endosc. 1999 Jan;49(1):19-25. doi: 10.1016/s0016-5107(99)70440-2.
Endoscopic ultrasonography (EUS) is highly accurate in the localization of small pancreatic tumors. We determined the cost effectiveness of EUS used early in the preoperative evaluation of pancreatic endocrine tumors.
In a study with a case-control design, 36 patients (19 men, 17 women) who underwent preoperative EUS were matched retrospectively with 36 patients who underwent surgical exploration immediately before the introduction of EUS. The number, cost, and effectiveness of preoperative localization studies, days of hospitalization, and surgical and anesthesia times were assessed.
The EUS group had reduced charges for preoperative localization studies: $2620 versus $4846 per patient (p < 0.05), largely because of reductions in the number of diagnostic angiograms and venous sampling procedures performed. Surgical and total anesthesia times were decreased, as were the number of preoperative admissions for angiographic procedures. The cost-effectiveness ratio for the EUS group was $3144 per tumor localized compared with $5628 per tumor localized for the group treated before EUS became available (p < 0.05).
EUS is highly accurate in the localization of pancreatic neuroendocrine tumors and is cost effective when used early in the preoperative localization strategy. EUS decreased the need for additional invasive tests and avoided unnecessary morbidity and resource consumption. EUS should play a primary role in preoperative localization of pancreatic neuroendocrine tumors.
内镜超声检查（EUS）在小胰腺肿瘤的定位方面具有高度准确性。我们确定了在胰腺内分泌肿瘤术前评估早期使用EUS的成本效益。
在一项病例对照研究中，对36例接受术前EUS检查的患者（19例男性，17例女性）进行回顾性匹配，与36例在EUS引入前立即接受手术探查的患者进行对照。评估术前定位研究的数量、成本和效果、住院天数以及手术和麻醉时间。
EUS组术前定位研究的费用降低：每位患者2620美元，而对照组为4846美元（p < 0.05），这主要是由于诊断性血管造影和静脉采样程序的数量减少。手术和总麻醉时间缩短，血管造影程序的术前入院次数也减少。EUS组每定位一个肿瘤的成本效益比为3144美元，而在EUS可用之前治疗的组为每定位一个肿瘤5628美元（p < 0.05）。
EUS在胰腺神经内分泌肿瘤的定位方面具有高度准确性，在术前定位策略早期使用时具有成本效益。EUS减少了对额外侵入性检查的需求，避免了不必要的发病率和资源消耗。EUS应在胰腺神经内分泌肿瘤的术前定位中发挥主要作用。
