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RADIATION EXPOSURE DURING ERCP: CRITICAL DETERMINANTS
E Kim3, M McLoughlin1,2, E Lam1, J Amar1, M Byrne2, J Telford2, R Enns1
1St Paul’s Hospital, Division of Gastroenterology, 2Vancouver General Hospital, Division of Gastroenterology, 3UBC Dept of Internal Medicine, Vancouver, BC
BACKGROUND: Fluoroscopy during ERCP carries a known risk of radiation exposure to patients and staff. The radiation dose has been shown to have a direct linear relationship with fluoroscopy time. Many factors including diagnosis, complexity of the case, physician training, and the number and type of interventions interact to determine the total duration of fluoroscopy during ERCP.
OBJECTIVE: To determine if there were specific patient/ physician factors which correlated with fluoroscopy duration.
METHODS: We performed a retrospective analysis of 1069 ERCPs at 2 tertiary referral hospitals over an 18 month period. Information including fluoroscopy time, patient demographics, indication for ERCP, procedures performed, endoscopist and diagnosis was collected from proformas which had been completed at the time of the procedure. Where these proformas were incomplete an electronic chart review was performed.
RESULTS: Of the 1069 procedures 72 were excluded due to missing data. Therefore, fluoroscopy time was analysed for 997 procedures. Mean fluoroscopy times (in minutes) with 95% confidence intervals for different diagnoses were as follows: CBD stones (n=443) 5.12 (3.05-4.07), benign biliary strictures (n=135) 3.94 (3.26-4.63), malignant biliary strictures (n=124) 5.82 (4.80-6.85) , chronic pancreatitis (n=49) 4.53 (3.44-5.63), bile leak (n=26) 3.67 (2.23-5.09), ampullary mass (n=11) 3.88 (1.28-6.48). When no pathology was seen (n=195) the mean fluoroscopy time was 3.56 minutes (3.05-4.07).
CONCLUSIONS: In this preliminary analysis of ERCP fluoroscopy time, the final diagnoses of CBD stones and malignant biliary strictures are associated with longer fluoroscopy times compared to final diagnoses where benign stricture or a passed stone was encountered. The factors associated with longer fluoroscopy time warrant further investigation.