Correlation of Fluoroscopy Utilization with ERCP Complexity Grade: A Multicenter Retrospective Study

Abstract

Purpose: Fluoroscopy time (FT) is a major determinant of fluoroscopy exposure during ERCP. It is a candidate to be one of the quality indicators for ERCP in the future. One determinant of FT may be the complexity of the procedure. ASGE recommended a new system to grade the ERCP complexity. Aim of this study is to measure the mean, median and 95% confidence interval of the FT for each ERCP complexity grade. Methods: This is a retrospective American multicenter study. The centers that participated are a tertiary center, a cancer center and a community hospital. After reviewing patients' charts, each ERCP case was assigned a complexity grade as defined by ASGE grading system. Then, we calculated the mean, the median and the 95% confidence interval of the FT for each ERCP complexity grade. Results: Four hundred fourteen ERCP cases were reviewed. A total of six cases were excluded due to unsuccessful ERCP (n=4), ERCP that involved placement of duodenal stent (n=1), and a rendezvous procedure (n=1). 57.7% of the patients were males. Average age of the patients was 60.2 years. Six endoscopists performed the procedures. Experience of endoscopists ranged from 1 year to 20 years. 49.2% of the procedures were performed without trainees. 50.7% of the cases involved native papillae. The average FT for all cases was 425 seconds (8 seconds to 3516 seconds). Procedures involving a trainee required longer FT (450 seconds vs. 399 seconds) but this did not reach statistical significance (P <0.23). Mean, median, mode and 95% confidence interval of the FT for each ERCP complexity grade are shown in table 1 and figure 1. Using one-way ANOVA, the FT time was significantly different between grades (P <0.05).Table 1: Mean, median, mode and 95% confidence interval of the Fluoroscopy Time (FT) for each ERCP complexity gradeFigure 1: Relationship between ERCP complexity grades and mean fluoroscopy time (FT) used during ERCP procedures.Conclusion: There is a significant increase in fluoroscopy time as ERCP complexity grade increases. This has clinical implications for patient and staff radiation exposure, and would need to be accounted for if fluoroscopy time is adopted as a quality measure.