Comparative Analysis of ERCP and PTBD for Biliary Interventions for Readmission Rates and Patient Outcomes

Endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic biliary drainage (PTBD) are interventions used to relieve biliary obstruction. The utility of ERCP compared with PTBD is not fully understood from a utilization outcome standpoint. Our study compares readmission rates and hospitalization outcomes in ERCP and PTBD.

Using the National Readmission Database (NRD) 2016 to 2020, we identified all patients with an ERCP or PTBD completed during admission. The study cohort was first analyzed by 3 weighted study arms including those admitted with cholangitis, biliary/pancreatic malignancy, and choledocholithiasis. Second, we analyzed the cohort by a 1:1, unweighted propensity match. The primary outcome was 30 day, 90 day, and 6 month readmission. Secondary outcomes were readmission/overall mortality, cost, and length of stay. Outcomes were analyzed using multivariate analysis.

A total of 621,735 admissions were identified associated with 589,796 ERCP and 31,939 PTBD. In the propensity matched cohort, PTBD had a higher readmission rate at 30 days (20.38% vs. 13.71% P <0.0001), 90 days (14.63% vs. 13.14%, P <0.0001) but lower rate at 6 months (8.50% vs. 9.67%, P =0.0003). Secondary outcomes included increased PTBD-associated hospital length of stay (9.01 d vs. 6.74 d, P <0.0001), hospitalization cost ($106,947.97 vs. $97,602.25, P <0.0001), and overall mortality (6.86% vs. 4.35%, P <0.0001). No major differences were found for mortality among readmissions at 30 days (7.19% vs. 6.88%, P =0.5382), 90 day (6.82% vs. 6.51%, P =0.5612), and 6 months (5.08% vs. 5.91%, P =0.1744).

ERCP demonstrated superior results compared with PTBD for readmission rates, length of stay and overall mortality. For failed ERCP cases, emerging data for Endoscopic ultrasound guided-biliary drainage (EUS-BD) offers potential over PTBD and may provide additional options for the future in tertiary referral centers with experience.