Radiation exposure dose of fluoroscopy-guided gastrointestinal procedures: A single-center retrospective study

Abstract

Background and study aims Fluoroscopy-guided gastrointestinal procedures (FGPs) are increasingly common. However, the radiation exposure (RE) to patients undergoing FGPs is still unclear. We examined the actual RE of FGPs. Patients and methods This retrospective, single-center cohort study included consecutive FGPs, including endoscopic retrograde cholangiopancreatography (ERCP), interventional endoscopic ultrasound (EUS), enteral stenting, balloon-assisted enteroscopy, tube placement, endoscopic injection sclerotherapy (EIS), esophageal balloon dilatation and repositioning for sigmoid volvulus, from September 2012 to June 2019. We measured the air kerma (AK, mGy), dose area product (DAP, Gycm2), and fluoroscopy time (FT, min) for each procedure. Results In total, 3831 patients were enrolled. Overall, 2778 ERCPs were performed. The median AK, DAP, and FT were as follows: ERCP: 109 mGy, 13.3 Gycm2 and 10.0 min; self-expandable enteral stenting (SEMS): 62 mGy, 12.4 Gycm2 and 10.4 min; tube placement: 40 mGy, 13.8 Gycm2 and 11.1 min; balloon-assisted enteroscopy: 43 mGy, 22.4 Gycm2 and 18.2 min; EUS cyst drainage (EUS-CD): 96 mGy, 18.3 Gycm2 and 10.4 min; EIS: 36 mGy, 8.1 Gycm2 and 4.4 min; esophageal balloon dilatation: 9 mGy, 2.2 Gycm2 and 1.8 min; and repositioning for sigmoid volvulus: 7 mGy, 4.7 Gycm2 and 1.6 min. Conclusion This large series reporting actual RE doses of various FGPs could serve as a reference for future prospective studies.

Diagnostic Reference Levels for Fluoroscopy-guided Gastrointestinal Procedures in Japan from the REX-GI Study: A Nationwide Multicentre Prospective Observational Study

“…We included consecutive patients receiving standard clinical care who underwent the following treatment and diagnostic procedures under fluoroscopic guidance: (1) ERCP; (2) interventional EUS; (3) balloon-assisted enteroscopy; (4) enteral metallic stent placement; and (5) enteral tube placement. In addition, we subcategorized ERCP, which had a larger number of registered cases than other procedures, into the following four disease sites according to previous reports 17 , 18 : 1) common bile duct stones, 2) proximal malignant biliary obstruction, 3) distal malignant biliary obstruction, and 4) pancreatic disease. There were no age restrictions.…”

Medical radiation exposure during gastrointestinal enteral metallic stent placement: Post hoc analysis of the REX‐GI study

“…In recent years, various endoscopic procedures for diagnostic and therapeutic intervention have rapidly increased in popularity in gastrointestinal endoscopy units. The ICRP recommends that DRLs should be used to manage patient doses during both diagnostic and therapeutic procedures 18–20 . The ICRP 135 publication recommends that all individuals involved in performing patient procedures with a risk of medical exposure be familiar with the DRL process as a tool for optimizing protection 21 .…”

Comparison of Radiation Exposure between Endoscopic Ultrasound-Guided Hepaticogastrostomy and Hepaticogastrostomy with Antegrade Stenting

“…The European Society of Gastrointestinal Endoscopy guidelines on radiation protection in digestive endoscopy recommend establishing a standard radiation dose for ERCP [ 26 ]. However, there are only a few reports on radiation exposure in ERCP, even fewer on EUS-BD [ 27 , 28 , 29 ], and, of course, none on EUS-HGAS and EUS-HGS. Therefore, the results of this study will have a significant impact on a gastroenterologist.…”