Fluoroscopy Time During Endoscopic Retrograde Cholangiopancreatography

Abstract

Fluoroscopy Time During Endoscopic Retrograde Cholangiopancreatography Kamil Obideen, Maarouf Hoteit, John Affronti, Qiang Cai Background: Endoscopic Retrograde Cholangiopancreatography (ERCP) is a gastrointestinal endoscopic procedure that requires fluoroscopy. The radiation dose of fluoroscopy is much higher than that of routine X-ray examinations, such as a chest X-ray. A few studies regarding radiation exposure of patients and ERCP staff during ERCP have been published in recent years. However, information about radiation exposure during each step of the procedure is not well known.AIMS: This study aimed to provide data regarding radiation exposure during specific components of ERCP, such as during the deep cannulation of the common bile duct (CBD). Methods: In the last several months, patients referred to us for their first ERCP were enrolled in this study. The fluoroscopy time before, during and post deep cannulation of the CBD in each ERCP were recorded. Results: We analyzed 46 successful ERCP procedures during the study period. Those procedures can be divided into two groups: 18 were diagnostic ERCPs and 28 were therapeutic ERCPs. The latter included obtaining cytology, performing sphincterotomy, balloon extraction, and stent insertion, etc. The mean FT before deep cannulation of the CBD was minimal, less than 0.1 minutes for each procedure in both groups. The mean FTs during the deep cannulation of the CBD were 4.5G4.1 minutes and 6.4G7.9 minutes for the diagnostic group and the therapeutic group respectively. The mean FTs for the whole procedure were 6.1G5.0 minutes and 16.2G11.0 minutes for the diagnostic group and the therapeutic groups respectively. The FT during deep cannulation of the CBD accounted for a significant portion of the whole FT in both the diagnostic group (4.5/6.1, about 74%) and the therapeutic group (6.4/16.2, about 40%). Conclusions: The radiation dose of one-minute FT is approximately 15 mGy at skin entrance which is equal to almost 100 routine chest X-rays. If the cannulation time can be reduced thereby shortening the FT during deep cannulation of the CBD, it will significantly reduce the radiation exposure during ERCP.