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Cholangioscopy-assisted ERCP reduces radiation exposure in treating choledocholithiasis: a retrospective
Junpu Wang1, Zifeng Huang1, Pengwei Zhang1
1Gallstone Disease Center, The Affiliated Puren Hospital of Wuhan University of Science and Technology, Wuhan, China.
Background:
Conventional ERCP for common bile duct stones relies on fluoroscopy, which raises concerns about radiation exposure and may not fully exclude residual stones. This study compared cholangioscopy-assisted ERCP with conventional fluoroscopy-guided ERCP in routine treatment of choledocholithiasis.
Methods:
This single-center retrospective study included 100 patients with bile duct stones treated between June 2024 and June 2025. The cholangioscopy-assisted group included patients who underwent electronic mother-baby cholangioscopy-assisted ERCP (n = 50), and the conventional group was selected from contemporaneous conventional fluoroscopy-guided ERCP cases using age-stratified random sampling (n = 50). The primary endpoint was the intra-procedural radiation-dose reading measured in mGy by an RG1000 radiation dose meter placed at the routine patient position. Secondary outcomes included procedure time, duct clearance, adverse events, length of stay, and hospitalization cost. Confounding was addressed using stabilized inverse probability of treatment weighting (IPTW).
Results:
Median radiation-dose reading was lower in the cholangioscopy-assisted group than in the conventional group (9.93 vs. 14.64 mGy, p < 0.001). After IPTW, cholangioscopy assistance remained associated with a reduced radiation-dose reading (geometric mean ratio [GMR] 0.687, 95% CI 0.610-0.774; p < 0.001) and a lower risk of high radiation exposure (risk ratio 0.301, 95% CI 0.095-0.955; p = 0.042). Procedure time and hospitalization cost were higher, whereas length of stay was shorter. Complete clearance in one session was 88.0% versus 94.0%, and all patients requiring second-session ERCP achieved final duct clearance. All post-ERCP pancreatitis cases were mild, and no statistically significant difference in short-term adverse events was observed between groups.
Conclusion:
Cholangioscopy-assisted ERCP was associated with lower intra-procedural radiation-dose reading and fewer high-dose procedures in patients treated for choledocholithiasis. No statistically significant difference in short-term adverse events was observed, but longer procedure duration and higher cost were noted. These findings should be confirmed in prospective studies using standardized radiation metrics and longer follow-up.
