Patient Irradiation During Endoscopic Retrograde Cholangiopancreatography (ERCP)

Abstract

Background: ERCP is an important therapeutic tool in biliary/pancreatic disorders and relies heavily on the use of fluoroscopy. The aim of this study was to assess the amount of irradiation during ERCPs in relation with procedure difficulty and operator experience. Methods: Data were prospectively collected from consecutive ERCPs performed during a 3 months period. For each exam, the following data were collected: patient's characteristics (age, sex, weight), fluoroscopy time, dose area-product (DAP), procedure difficulty (easy, normal or difficult) and the operator experience. The ERCPs were carried out by two seniors(>2000 ERCPs) and one junior(<250 ERCPs) operators. The statistical analysis was performed with the non-parametric Mann-Whitney test and the analysis of variance with ANOVA test. Results: 92 patients (49M,43F), mean age 65 years(range 29-94 years) were included. During ERCPs, the following interventions were performed: 59 biliary sphincterotomy, 46 biliary stone extraction, 7 biliary duct dilation, 15 biliary duct cytology, 20 biliary stents, 13 other. Overall, the mean fluoroscopy time was 8.6min(range: 0.8-48min,75th percentile: 11.6min) and the mean DAP value was 20.6 Gy/cm2(range: 2.2-147Gy/cm2,75th percentile: 26Gy/cm2). A good correlation was observed between the fluoroscopy time and the DAP value, as described by the formula: DAP(Gy/cm2)=2.5 Gy/cm2xmin-1xT(min)(determination coefficient r2=0.8216)and between the complexity of the procedure and the two fluoroscopic parameters (Table 1). The DAP value and the fluoroscopy time were poorly correlated with patient's weight(r2 =0.069). There was no correlation between DAP or fluoroscopy time and both the procedure difficulty and the operator experience (p=0.91, respectively 0.58, ANOVA test, detailed values not shown). The mean fluoroscopy time and DAP values were 7.6±1.3min and 16.1±3.4Gy/cm2 for junior(32 ERCPs: 3 easy,19 normal,10 difficult)and respectively 8.7±1.0min and 22.3±3.2Gy/cm2(60 ERCPs: 12 easy, 25 normal, 23 difficult) for seniors. Conclusion: For the first time we show that DAP values and fluoroscopy time were dependent on the difficulty of the procedure and that the operator experience had no influence on these parameters. Tabel 1Mean fluoroscopy duration and mean DAP value for easy, normal and difficult ERCPs Difficulty # of exams Mean fluoroscopy duration (min) x Mean DAP (Gy/cm2)y Easy 15 2.8 ± 2.3 7.5 ± 1.0 Normal 44 6.6 ± 0.6 14.9 ± 1.8 Difficult 33 14.3 ± 1.7 34.9 ± 5.2 Open table in a new tab