Changing trends in tissue acquisition in malignant pancreatic neoplasms

Background and Aim To compare the frequency of use, hospital costs, and resource availability between endoscopic ultrasound‐guided fine needle aspiration (EUS‐FNA), percutaneous, and surgical techniques for tissue acquisition in malignant pancreatic neoplasms. Methods This is a retrospective claims analysis of Medicare patients undergoing biopsy of malignant pancreatic neoplasms over 5 years (2006–2010). The primary outcome measure was to compare the utilization of EUS, percutaneous techniques, and surgery for performing pancreatic biopsies. The secondary outcome measures were to compare treatment costs and variations in availability of resources between the three techniques over a 1‐year period (2010). Results Over 5 years, the use of EUS‐FNA increased by 69.3% (7100 to 12 020) and the use of percutaneous biopsy by 1.8% (4480 to 4560) compared to decrease in surgical biopsy (720 to 420) by 41.7% ( P  < 0.0001). When compared to percutaneous and surgical biopsies ($9639 and $21 947, respectively) the median hospital cost/claim for EUS‐FNA ($1794) was significantly lower ( P  < 0.0001). More EUS‐FNA procedures were performed in urban and teaching hospitals compared to rural and non‐teaching hospitals ( P  < 0.001). Conclusions Although EUS‐FNA is increasingly performed and is less costly, and the rate of surgical biopsies has declined precipitously, the utilization of percutaneous techniques remains prevalent. Training and education are required to disseminate the use of EUS‐FNA outside major teaching institutions or foster referral of patients to EUS centers because of implications for patient care and resource use.