Fluoroscopy Time during ERCP Differs According to Anatomical Site of Treatment: A Multicenter Retrospective Study

Abstract

Purpose: Fluoroscopy time (FT) correlates with the utilization of fluoroscopy during ERCP. Practical and easy to follow predictors of prolonged FT during ERCP are poorly defined. We hypothesize that FT varies based on the type of ERCP (intrahepatic vs. extrahepatic vs. pancreatic). 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, ERCP cases were classifi ed into three groups, according to the anatomical location of pathology requiring treatment: intrahepatic cases when the managed pathology was located at or above the bifurcation of the biliary tree, extrahepatic cases when the treated pathology was located in the common hepatic duct or biliary duct or ampulla and pancreatic cases when the approached pathology was located in one of the pancreatic ducts. Then, we compared the mean FT for each category using one factor ANOVA. Results: 414 ERCP cases were reviewed. A total of six cases were excluded due to unsuccessful ERCP (n=4), a case that involved placement of duodenal stent (n=1) and a rendezvous procedure (n=1). Average age of the patients was 60.2 years; 57.7% of the patients were males. Six endoscopists performed the procedures. Experience of endoscopists ranged from 1-20 years. 49.2% of the procedures were performed without trainees. 50.7% of the cases involved native papillae. There were 283 extrahepatic cases with mean FT of 298 seconds (95% confidence interval [CI] 267-329 seconds), 104 intrahepatic cases with mean FT of 775 seconds (95% CI 665-885 seconds) and 21 pancreatic cases with mean FT of 405 seconds (95% CI 205-605 seconds). The average FT for all cases was 425 seconds (95% CI 8-3,516 seconds). The mean FT of the extrahepatic cases, pancreatic cases, and intrahepatic cases were 298 seconds, 405 seconds, and 775 seconds, respectively, with P<0.05. Conclusion: Fluoroscopy utilization is significantly higher in intrahepatic cases followed by pancreatic cases. Extrahepatic cases are associated with least fluoroscopy utilization. These findings have clinical implications for patient and staff radiation exposure, and would need to be accounted for if fluoroscopy time is adopted as a quality measure.Table: Table. ERCP cases as Extrahepatic, Pancreatic and Intrahepatic with mean and median fluoroscopy time (FT)