Original articleClinical endoscopyRadiation doses to ERCP patients are significantly lower with experienced endoscopists
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
References (23)
- et al.
Radiation doses to patients during ERCP
Gastrointest Endosc
(2001) - et al.
Radiation exposure to patients and personnel during interventional ERCP at a teaching institution
Gastrointest Endosc
(1996) - et al.
Time-limited fluoroscopy to reduce radiation exposure during ERCP: a prospective randomized trial
Gastrointest Endosc
(2007) - et al.
Therapeutic ERCP and pregnancy: is the radiation risk for the conceptus trivial?
Gastrointest Endosc
(2009) - et al.
Quality assessment of ERCPEndoscopic retrograde cholangiopancreatography
Gastrointest Endosc
(2002) - et al.
Effect of recent changes in atomic bomb survivor dosimetry on cancer mortality risk estimates
Radiat Res
(2004) - et al.
Studies of mortality of atomic bomb survivorsReport 13: solid cancer and noncancer disease mortality:1950-1997
Radiat Res
(2003) - et al.
Solid cancer incidence in atomic bomb survivors: 1958-1998
Radiat Res
(2007) - et al.
Computed tomography-an increasing source of radiation exposure
N Engl J Med
(2007) - et al.
Patient and staff exposure during endoscopic retrograde cholangiopancreatography
Br J Radiol
(2002)
Radiation doses to patients from endoscopic retrograde cholangiopancreatography examinations and image quality considerations
Radiat Prot Dosimetry
Cited by (72)
Radiation Safety and Standards for Women in Endoscopy: Summary of Concepts, Current Guidance, and Future Directions
2023, Clinical Gastroenterology and HepatologyAmerican Society for Gastrointestinal Endoscopy radiation and fluoroscopy safety in GI endoscopy
2021, Gastrointestinal EndoscopyA pilot single-center prospective randomized trial to assess the short-term effect of a flashing warning light on reducing fluoroscopy time and radiation exposure during ERCP
2018, Gastrointestinal EndoscopyCitation Excerpt :The factors found to significantly influence FT in univariable analysis were warning light (P = .043), trainee involvement (P = .009), cholangiography (P = .044), dilation (P < .001), lithotripsy (P < .001), stone extraction (P < .001), and stent placement (P = .041) (Table 3). Although some factors were not significant in univariable analysis (endoscopist, cannulation difficulty, sphincterotomy, and biliary sludge/debris clearance), based on previous studies10-12 and our clinical work, these variables were determined to be possible predictors and were also included in the multivariable analysis. The factors found to significantly influence FT in multivariable analysis (Table 4) were warning light (P = .042), endoscopist B (P = .007) and endoscopist C (P = .003; compared with endoscopist A), trainee involvement (P = .002), lithotripsy (P < .001), stone extraction (P < .001), and biliary sludge/debris clearance (P = .035).
Effects of a Brief Educational Program on Optimization of Fluoroscopy to Minimize Radiation Exposure During Endoscopic Retrograde Cholangiopancreatography
2018, Clinical Gastroenterology and HepatologyCitation Excerpt :HVEs appear able to circumvent this lack of formal radiation training. We and others have previously shown that high endoscopist ERCP volume is associated with lower patient radiation exposure.15,16 However, the majority of ERCPs in the United States are unfortunately performed by LVEs in smaller hospitals.22
Endoscopes, Guidewires, and Accessories
2018, ERCP, Third EditionERCP Training
2018, ERCP, Third Edition
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].