S129 National Trends in Endoscopic Retrograde Cholangiopancreatography Utilization and Indications: A Comparative Analysis From 2018 to 2021

Introduction: Endoscopic retrograde cholangiopancreatography (ERCP) remains an important intervention in managing biliary and pancreatic disorders. Understanding shifts in indications, utilization patterns, and patient characteristics is essential to optimize care delivery and healthcare planning. Methods: We used the National Inpatient Sample 2018 to 2021 to identify ERCP hospitalizations using ICD-10-PCS codes, and associated common principle diagnosis using ICD-10-CM codes. Non-codable indications included cases where none of these primary diagnoses were present. Trends in patient demographics, hospital characteristics, and ERCP indications were evaluated. Survey-weighted analyses assessed changes over time, with adjusted analysis comparing outcomes such as length of stay and total hospital charges. Results: A total of 631,245 weighted ERCP cases were analyzed (155,990 in 2018 vs 159,465 in 2021). Patient age remained stable (mean 61 years), while the proportion of female patients declined slightly (56.4% to 54.9%, P < 0.001). Racial, insurance, and income distributions showed minimal variation. The proportion of admissions over weekends rose modestly (23.9% to 24.1%, P = 0.020). Patients with Charlson Comorbidity Index ≥3 increased from 30.9% to 34.7% (P < 0.001), indicating rising complexity. Most ERCPs occurred at urban teaching hospitals (78.9% in 2018 to 82.3% in 2021, P = 0.048), with large hospitals accounting for most cases. The median length of stay remained unchanged at 6 days (P = 0.27), while mean total hospital charges increased from $87,710 to $105,080—an adjusted difference of $16,087 (95% CI: $10,519–$21,654, P < 0.01). Clinical indications shifted notably. Cases for choledocholithiasis and biliary pancreatitis declined (–1.2% and –1.3%, respectively), while ascending cholangitis saw the most pronounced drop (16.6% to 9.9%, –6.7%). Conversely, unspecified obstruction and pancreatic head mass indications rose modestly (+1.5% and +0.4%, respectively). Proportion of non-codable ERCP indications increased from 40.8% to 43.6% (+2.8%). Conclusion: ERCP utilization remained steady from 2018 to 2021, but patient complexity and hospital charges increased. The significant decline in classic indications, particularly cholangitis, alongside a rise in non-codable indications, may reflect evolving diagnostic strategies or documentation practices. These findings highlight the need for improved coding precision and targeted quality measures to ensure appropriate ERCP use. Disclosure: AI was used to refine language.