Radiation doses to ERCP patients are significantly lower with experienced endoscopists

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.