Radiation exposure to patients undergoing conventional and novel endoscopy procedures

The quantity and complexity of endoscopic procedures using fluoroscopy (ie, real-time ionizing radiation) have increased significantly. However, radiation exposure to patients during endoscopy procedures still needs to be better understood. In this study, we retrospectively quantified radiation exposure during endoscopic procedures under fluoroscopy and measured patients' effective radiation dose over 12 months.

A retrospective review of all patients aged ≥18 years who underwent GI endoscopic procedures under fluoroscopy at Johns Hopkins Hospital from June 30, 2019 to June 30, 2020 was conducted. The type of procedure, procedure duration, endoscopic submucosal dissection (ESD), fluoroscopy time (FT), American Society for Gastrointestinal Endoscopy ERCP procedural degree of difficulty grade, patient demographics, and patient anatomic variations were recorded. Median ESD, effective dose (ED), total FT, and the number of procedures were calculated.

Six hundred eighty-one patients (mean age, 59.8 ± 16.1 years; 51.8% women; mean body mass index, 26.8 ± 8.2 kg/m²) underwent 985 procedures. Of these, 681 index procedures were conducted: 539 ERCPs, 61 interventional EUSs (I-EUS), 72 EGDs, and 9 colonoscopies. I-EUS and ERCP had median EDs of 4.3 mSv (interquartile range [IQR], 1.3-9.58) and 2.11 mSv (IQR, .9-4.8) and FTs of 186 seconds (IQR, 78-358.9) and 121.8 seconds (IQR, 60.9-217.5), respectively. The median ED during I-EUS was significantly higher than during ERCP (4.3 vs 2.11 mSv, P = .002). Among all procedures, EUS-guided biliary interventions had the highest median ED (9 mSv [IQR, 4.35-15.5]).

Novel interventional endoscopic procedures have higher radiation exposures to the patient than conventional endoscopic procedures. Endoscopists must remain cognizant of the significant radiation exposure patients may experience, especially during complex therapeutic procedures. Best-care practices should be adopted to reduce potentially harmful exposure.