A prospective analysis of factors influencing fluoroscopy time during therapeutic ERCP

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Abstract

Background

Fluoroscopy time (FT) in endoscopic retrograde cholangiopancreatography (ERCP) has a linear relationship with radiation exposure to endoscopist, personnel and patients. The aim of this prospective study was to investigate the factors influencing the FT during ERCP.

Patients and Methods

Between January 2010 and August 2011, patients with naïve papilla undergoing therapeutic ERCP were included in the study. Patient and procedural factors affecting fluoroscopy duration were investigated.

Results

During the study period 549 ERCP records were included in the final analysis. The mean procedural time and FT were 19.53±7.61 min and 48.82±26.43 sec, respectively. There was no effect of age or gender on FT. Univariate analysis showed choledocholithiasis (+17.92 sec; 95%CI: 12.73-23.11, p<0.001), multiple stones (+21.21 sec; 95%CI: 14.31-30.35, p<0.001), stone size >10 mm (+27.514 sec; 95%CI: 16.62-35.71; p<0.001), precut technique (+12.46 sec; 95%CI: 6.32-18.60; p<0.001), periampullary diverticulum (+33.36 sec; 95%CI: 28.49-38.23; p<0.001), mechanical lithotripsy (+31.14 sec; 95%CI: 24.67-37.61; p<0.001) and mechanical lithotripsy plus stent placement (+42.41 sec; 95%CI: 31.93-52.89; p<0.001) to be associated with longer FT. Multivariate analysis identified choledocholithiasis (+13.24 sec; 95%CI: 4.44-22.04; p=0.003), multiple stones (+19.51 sec; 95%CI: 11.72-26.78; p<0.001), stone size >10 mm (+23.95 sec; 95%CI: 14.35-29.45; p<0.001), needle-knife papillotomy (+17.26 sec; 95%CI: 7.77-26.75; p<0.001), periampullary diverticulum (+21.99 sec; 95%CI: 17.81-26.16; p<0.001) and mechanical lithotripsy plus stent placement (+20.39 sec; 95%CI: 7.38-33.40; p=0.002) to prolong FT.

Conclusions

The identified factors influencing the FT may help endoscopists take appropriate precautions during ERCP to significantly decrease FTs.

Related collections

Most cited references 16

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Endoscopic sphincterotomy complications and their management: an attempt at consensus.

P Cotton, G Lehman, J. Vennes … (1991)

Despite its relative safety (in comparison with surgery), and undoubted role in many clinical circumstances, biliary sphincterotomy is the most dangerous procedure routinely performed by endoscopists. Complications occur in about 10% of patients; 2 to 3% have a prolonged hospital stay, with a risk of dying. This document is an attempt to provide guidelines for prevention and management of complications, based on a workshop of selected experts, and a comprehensive review of the literature. We emphasize particularly the importance of specialist training, disinfection, drainage, and collaboration with surgical colleagues.

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Risk of cancer from diagnostic X-rays: estimates for the UK and 14 other countries.

Amy Berrington de Gonzalez, Sarah Darby (2004)

Diagnostic X-rays are the largest man-made source of radiation exposure to the general population, contributing about 14% of the total annual exposure worldwide from all sources. Although diagnostic X-rays provide great benefits, that their use involves some small risk of developing cancer is generally accepted. Our aim was to estimate the extent of this risk on the basis of the annual number of diagnostic X-rays undertaken in the UK and in 14 other developed countries. We combined data on the frequency of diagnostic X-ray use, estimated radiation doses from X-rays to individual body organs, and risk models, based mainly on the Japanese atomic bomb survivors, with population-based cancer incidence rates and mortality rates for all causes of death, using life table methods. Our results indicate that in the UK about 0.6% of the cumulative risk of cancer to age 75 years could be attributable to diagnostic X-rays. This percentage is equivalent to about 700 cases of cancer per year. In 13 other developed countries, estimates of the attributable risk ranged from 0.6% to 1.8%, whereas in Japan, which had the highest estimated annual exposure frequency in the world, it was more than 3%. We provide detailed estimates of the cancer risk from diagnostic X-rays. The calculations involved a number of assumptions and so are inevitably subject to considerable uncertainty. The possibility that we have overestimated the risks cannot be ruled out, but that we have underestimated them substantially seems unlikely.

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Patient and staff exposure during endoscopic retrograde cholangiopancreatography.

J M Pages, M Osteaux, N Buls … (2002)

Despite a number of efforts being put into the radiological protection of both patient and staff during interventional radiological (IR) procedures during recent years, information about radiation exposure during endoscopic retrograde cholangiopancreatography (ERCP) procedures remains scarce. The purpose of this study was to estimate both patient and staff radiation doses during therapeutic ERCP procedures by direct measurement and to compare these results with data from other IR procedures. For 54 patients, effective dose and skin dose were estimated by measuring the dose-area product. For staff, entrance surface doses to the lens of the eye, thyroid and hands were estimated by thermoluminescent dosemeters. A median effective dose of 7.3 mSv and a median entrance surface dose of 271 mGy per procedure were estimated for patients. The gastroenterologist received a median dose of 0.34 mGy to the lens of the eye, 0.30 mGy to the skin at the level of the thyroid and 0.44 mGy to the skin of the hands, per procedure. When comparing the dosimetric quantities presented in this study with data from other IR procedures, it is clear that patient skin doses and doses to staff are high owing to the use of inappropriate X-ray equipment. ERCP requires the same radiation protection practice as all IR procedures. It should be consistently included in future multicentre IR patient and staff dose survey studies at national or international level.

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Author and article information

Journal

Journal ID (nlm-ta): Ann Gastroenterol

Journal ID (iso-abbrev): Ann Gastroenterol

Journal ID (publisher-id): AnnGastroenterol

Title: Annals of Gastroenterology

Publisher: Hellenic Society of Gastroenterology (Greece )

ISSN (Print): 1108-7471

ISSN (Electronic): 1792-7463

Publication date (Print): 2012

Volume: 25

Issue: 4

Pages: 338-344

Affiliations

[a ]Department of Endoscopy and Motility Unit, G. Gennimatas General Hospital, Aristotle University of Thessaloniki (Panagiotis Katsinelos, Anthi Gatopoulou, Stergios Gkagkalis, Kostas Fasoulas, Athanasios Beltsis, Sotiris Terzoudis, Georgia Lazaraki, Grigoris Chatzimavroudis, Ioannis Vasiliadis

[b ]Department of Medicine, Second Medical Clinic, Aristotle University of Thessaloniki, Ippokration Hospital (Christos Zavos, Jannis Kountouras)

Author notes

Correspondence to: Panagiotis Katsinelos, MD, PhD, Ass. Prof. of Gastroenterology, Head, Department of Endoscopy and Motility Unit, G. Gennimatas General Hospital, Medical School, Aristotle University of Thessaloniki, Ethnikis Aminis 41, 54635 Thessaloniki, Greece, Tel: +30 2310 963341, Fax: +30 2310 210401, e-mail: gchatzimav@ 123456yahoo.gr

Article

Publisher ID: AnnGastroenterol-25-338

PMC ID: 3959413

PubMed ID: 24714062

SO-VID: 9bd98870-50e3-4829-9b2f-f5c96eaef0dd

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

A prospective analysis of factors influencing fluoroscopy time during therapeutic ERCP

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Abstract

Background

Patients and Methods

Results

Conclusions

Related collections

Software for SAXS correction and analysis

Most cited references 16

Endoscopic sphincterotomy complications and their management: an attempt at consensus.

Risk of cancer from diagnostic X-rays: estimates for the UK and 14 other countries.

Patient and staff exposure during endoscopic retrograde cholangiopancreatography.

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