Time-limited fluoroscopy to reduce radiation exposure during ERCP: a prospective randomized trial

Area of Science:

• Gastroenterology
• Medical Imaging
• Radiation Safety

Background:

• Endoscopic retrograde cholangiopancreatography (ERCP) involves radiation exposure for staff and patients.
• Minimizing radiation exposure during ERCP is crucial for safety.

Purpose of the Study:

• To evaluate if time-limited fluoroscopy reduces radiation exposure and fluoroscopy time (FT) compared to continuous fluoroscopy during ERCP.
• To assess the impact of different fluoroscopy settings on radiation dose and procedure duration.

Main Methods:

• A prospective randomized trial was conducted at a tertiary academic medical center.
• Adult patients undergoing ERCP were randomized into two groups: time-limited (3-second x-ray bursts) and continuous fluoroscopy.
• Fluoroscopy time (FT), patient data, procedure details, and cumulative radiation exposure were recorded.

Main Results:

• No significant difference in mean FT was initially observed between time-limited (284.4s) and continuous (314s) fluoroscopy groups (P=.34).
• However, after controlling for confounding factors using multiple linear regression, time-limited fluoroscopy was associated with a significant 16.4% reduction in FT (P=.029).
• Factors like difficult cannulation, lithotripsy, stent placement, and sphincterotomy were associated with longer FTs. No significant difference in average radiation dose was found between groups.

Conclusions:

• Time-limited fluoroscopy significantly decreases fluoroscopy time (FT) during ERCP when confounding factors are accounted for.
• Fluoroscopy time and radiation exposure are influenced by patient, operator, and procedure-specific variables.
• Limitations include the lack of blinding for endoscopists to the assigned fluoroscopy group.