(359) Access to Endoscopic Retrograde Cholangiopancreatography in Children and Adolescents with Cystic Fibrosis

Background: Cystic Fibrosis (CF)-related pancreatic and biliary disease contribute to morbidity and impair quality of life. Endoscopic retrograde cholangiopancreatography (ERCP) is used to diagnose and treat pancreatic and biliary disease related to CF or other causes. This study aimed to determine access to, and utilization of, ERCP in pediatric CF patients in the United States (US).

Methods: The Pediatric Health Information System Database (PHIS) was used to identify pediatric (age 1-21 years) healthcare encounters for pancreatic or biliary disease that were potential indications for ERCP. We evaluated patient and hospital characteristics associated with access to ERCP and with undergoing ERCP from 2009-2019. International Classification of Diseases (9th/10th Revision) billing codes were used to identify diagnostic indications for ERCP. Children were excluded after liver transplant.

Results: Among children with a CF diagnosis, 237 children in 1,413 hospital encounters had a potential diagnostic indication for ERCP; 125 ERCPs were performed (8.9% of all encounters). Children with an encounter diagnosis of pancreatic or biliary disease that was a potential ERCP indication were commonly female (57.5%), White race (79.9%), from urban areas (80.0 %), and had a biliary (vs. pancreatic) indication (55.2%). Mean age at encounter was 12.8±5.2 (SD) years. Most common diagnoses with potential ERCP indication were biliary calculus (22.5%), chronic pancreatitis (21.7%), and idiopathic acute pancreatitis (19.8%). Of all encounters, 15.8% did not have access to ERCP, defined as a hospital with 2 consecutive years during the study period with no recorded ERCP. Children with CF who had a potential indication but did not undergo ERCP were more likely to be treated in hospital with no access, have biliary diagnosis, and live in rural areas (Table 1). Variability was found in ERCP performed based on census region (Table 1), but no differences existed in gender, age, race, and ethnicity between those that did or did not undergo ERCP (Table 1).

Compared to children without CF who had a pancreatic or biliary potential indication for ERCP, children with CF were more likely to have a pancreatic indication (44.8% vs 21.5%, p< 0.001), live in rural areas (20% vs 13.7%, p< 0.001), be older (12.8(5.2) vs 10.7(5.8) years, p< 0.001), and be of White race (79.9% vs 59.1%, p < 0.001). Access to ERCP was not different in those with vs without CF (15.8% vs 15.6%, p=0.89, Chi-squared). In multivariate logistic regression, CF diagnosis was not associated with undergoing ERCP (OR 1.06, p=0.55) after adjusting for statistically significant univariate predictors (diagnosis category, age, race, and rural/urban code).

Conclusions: These data indicate that 1 in 6 children with CF nationwide have limitations accessing ERCP. Despite being diagnosed with a potential indication, CF patients with rural commuting code, biliary indication, and treatment at a center without access to ERCP were less likely to receive an ERCP. Utilization of ERCP in pediatric pancreatic and biliary disease varies by US region. Substantial differences in indication for and utilization of ERCP exists between those with and without CF diagnosis.

Acknowledgements: This work was supported in part by the CF Foundation (#PATHAK20BO) and the National Institutes of Health (T32 DK007762).

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