Prospective analysis of fluoroscopy duration during ERCP: critical determinants

Area of Science:

• Gastroenterology
• Medical Imaging
• Radiation Safety

Background:

• Fluoroscopy use during Endoscopic Retrograde Cholangiopancreatography (ERCP) presents a direct relationship with radiation exposure, posing risks.
• Understanding factors influencing fluoroscopy time is crucial for radiation dose reduction strategies.

Purpose of the Study:

• To identify patient, physician, and procedural variables that significantly impact fluoroscopy duration during ERCP procedures.
• To provide data that can inform strategies for minimizing radiation exposure in ERCP.

Main Methods:

• A prospective analysis was conducted involving consecutive patients undergoing ERCP at two tertiary-care hospitals.
• Data on patient demographics, physician experience, and procedural details were collected and analyzed to determine associations with fluoroscopy time.

Main Results:

• No patient factors were found to significantly affect fluoroscopy duration. However, fluoroscopy time was significantly lower for two specific endoscopists.
• Procedural factors significantly increasing fluoroscopy duration included stent insertion, lithotripsy, needle-knife sphincterotomy, biopsies, and the use of guidewires and balloon catheters.
• Procedures involving a gastroenterology fellow were associated with longer fluoroscopy durations compared to those without fellow involvement.

Conclusions:

• Fluoroscopy duration during ERCP is primarily influenced by the specific interventions performed and the endoscopist, rather than patient-specific factors.
• The identified procedural variables can aid in predicting prolonged fluoroscopy times, enabling the implementation of targeted radiation safety precautions.
• Limitations include the study being conducted at only two centers and the lack of blinding, which could potentially influence physician behavior.