Original article
Clinical endoscopy
Radiation doses to ERCP patients are significantly lower with experienced endoscopists

https://doi.org/10.1016/j.gie.2009.12.060Get rights and content

Background

Patients undergoing ERCP receive nontrivial doses of radiation, which may increase their risk of developing cancer, especially young patients. Radiation doses to patients during ERCP correlate closely with fluoroscopy time.

Objective

The aim of this study was to determine whether endoscopist experience is associated with fluoroscopy time.

Design

Retrospective analysis of a prospectively collected database.

Setting

Data from 69 providers from 6 countries.

Patients

9,052 entries of patients undergoing ERCP.

Main Outcome Measurements

Percent difference in fluoroscopy time associated with endoscopist experience and fellow involvement.

Results

For procedure types that require less fluoroscopy time, compared with endoscopists who performed > 200 ERCPs in the preceding year, endoscopists who performed <100 and 100 to 200 ERCPs had 104% (95% confidence interval [CI], 85%-124%) and 27% (95% CI, 20%-35%) increases in fluoroscopy time, respectively. Every 10 years of experience was associated with a 21% decrease in fluoroscopy time (95% CI, 19%-24%). For fluoroscopy-intense procedures, compared with endoscopists who performed >200 ERCPs in the preceding year, endoscopists who performed <100 and 100 to 200 ERCPs had 59% (95% CI, 39%-82%) and 11% (95% CI, 3%-20%) increases in fluoroscopy time, respectively. Every 10 years of experience was associated with a 20% decrease in fluoroscopy time (95% CI, 18%-24%).

Limitations

Database used is a voluntary reporting system, which may not be generalizable. Data is self-reported and was not verified for accuracy.

Conclusions

Fluoroscopy time is shorter when ERCP is performed by endoscopists with more years of performing ERCP and a greater number of ERCPs in the preceding year. These findings may have important ramifications for radiation-induced cancer risk.

Section snippets

Methods

The ERCP Quality Network, sponsored by Olympus America, is a voluntary reporting system that prospectively collects data pertaining to endoscopist demographics and experience, as well as procedure indication, type, duration, difficulty, and outcomes, including complications. Endoscopists worldwide have been encouraged to submit their ERCP information to the database for the purpose of developing individual report cards and benchmarking standards. All procedure and provider information is

Results

As of January 29, 2009, the ERCP Quality Network contained 9052 entries from 68 endoscopists practicing at 30 institutions in 6 countries. We excluded 397 entries that did not contain fluoroscopy time, for a total of 8655 entries. Eighty-one percent of providers were from the United States, and 10% were from the United Kingdom. A total of 4030 procedures (47% of all procedures) were completed by 34 academic endoscopists (52% of all endoscopists). The remaining 4625 (53%) procedures were

Discussion

Overall, our analysis showed that certain procedure types, less-experienced endoscopists, and procedures performed by fellows were associated with longer fluoroscopy times.

Both cumulative years of performing ERCP and ERCP volume in the preceding year were independently associated with shorter fluoroscopy exposure. At this time, there are insufficient data to support using fluoroscopy time as a surrogate end point for competency, but it is an easily measureable and comparable variable. The

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    DISCLOSURE: The following author received research support for this study from the Damon Runyon Cancer Research Foundation (CI-36-07) and the National Institutes of Health (K23 DK079291): J.H. Rubenstein. All other authors disclosed no financial relationships relevant to this publication

    See CME section; p. 177

    If you want to chat with an author of this article, you may contact Dr. Jorgensen at [email protected].

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