# Sex disparities in diagnostic workup of benign pancreaticobiliary disease before endoscopic retrograde cholangiopancreatography

## TL;DR

The study found that women with benign pancreaticobiliary conditions were less likely to receive a complete initial diagnostic workup compared to men, though there were no significant delays in receiving ERCP.

## Contribution

This study reveals sex-based disparities in the initial diagnostic evaluation for benign pancreaticobiliary disease, highlighting inadequate workup for women despite similar ERCP timing.

## Key findings

- Male patients were more likely to have liver chemistry tests and imaging ordered at the first visit compared to female patients.
- Female patients were more likely to have an inadequate initial diagnostic workup for benign pancreaticobiliary conditions.
- There were no significant differences in the time from presentation to ERCP between male and female patients.

## Abstract

Women face diagnostic delays in the workup of many diseases. We investigated whether there are sex-based disparities in the diagnostic workup of patients with benign pancreaticobiliary pathologies requiring endoscopic retrograde cholangiopancreatography (ERCP).

We conducted a multicenter retrospective cohort study including patients undergoing ERCP from December 2017 to 2021 for benign pancreaticobiliary pathologies. We assessed differences between males and females in days from presentation to ERCP, number of healthcare visits before ERCP, symptoms, and diagnostic workup at first visit.

One hundred twenty-eight patients (68 female patients) were identified. Eighteen percent of male patients initially presented with fever or chills versus 6% of female patients (P = .03), but otherwise there were no differences in symptoms. There was no difference between sexes in number of encounters or days from presentation until ERCP (P = .5). Significant differences occurred in the initial diagnostic evaluation. Male patients had liver chemistry testing in 98% of initial visits versus 85% of female patients (P = .01), and 95% had imaging ordered at first visit versus 82% of female patients (P = .03). Excluding febrile patients, male patients remained more likely to have laboratory (P = .02) and imaging evaluations (P = .05) at the initial visit. Thirteen female patients (19%) had an inadequate workup at the first visit for benign pancreaticobiliary conditions compared with 3 male patients (5%, P = .02).

We did not observe sex-based delays in time from presentation to ERCP in our sample; however, women were less likely to have adequate workup for benign pancreaticobiliary conditions at the first visit.