Radiation exposure during image-guided endoscopic procedures: The next quality indicator for endoscopic retrograde cholangiopancreatography

Abstract

Endoscopic retrograde cholangiopancreatography (ERCP) is one of the most frequently used image-guided procedures in gastrointestinal endoscopy. Post-ERCP pancreatitis is an important concern, and prophylaxis, cannulation and other related technical procedures have been well documented by endoscopists. In addition, medical radiation exposure is of great concern in the general population because of its rapidly increasing frequency and its potential carcinogenic effects. International organizations and radiological societies have established diagnostic reference levels, which guide proper radiation use and serve as global standards for all procedures that use ionizing radiation. However, data on gastrointestinal fluoroscopic procedures are still lacking because the demand for these procedures has recently increased. In this review, we present the current status of quality indicators for ERCP and the methods for measuring radiation exposure in the clinical setting as the next quality indicator for ERCP. To reduce radiation exposure, knowledge of its adverse effects and the procedures for proper measurement and protection are essential. Additionally, further studies on the factors that affect radiation exposure, exposure management and diagnostic reference levels are necessary. Then, we can discuss how to manage medical radiation use in these complex fluoroscopic procedures. This knowledge will help us to protect not only patients but also endoscopists and medical staff in the fluoroscopy unit.

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

“…Almost all diagnostic procedures have previously set DRLs that have been updated for several years, but not enough interventional procedures have yet received DRLs. Nationwide DRLs for endoscopic procedures performed under fluoroscopy are still not well established [27,28]. Currently, there is still not enough available data on RE from endoscopic FGPs, although the European Commission, UK, and German DRL set a single value for ERCP [29-31. The present report of third quartile values of FGPs, which is the first of its kind, will serve as a useful reference (▶ Table 1).…”

Multicentre prospective observational study protocol for radiation exposure from gastrointestinal fluoroscopic procedures (REX-GI study)

“…The introduction of DRLs in the UK achieved a reduction of approximately 50% in the radiation dose in typical X-ray examinations over 15 years 13. However, there is still not enough available data on RE for gastrointestinal fluoroscopic procedures, such as endoscopic retrograde cholangiopancreatography (ERCP), interventional endoscopic ultrasonography (EUS), small bowel endoscopy and enteral stent placement; these techniques are still being developed and have recently been used with increasing frequency 14 15…”

A Comparison of Radiation Exposure During Endoscopic Retrograde Cholangiopancreatography (ERCP) by Different Fluoroscope Techniques

“…[1] The American Society for Gastrointestinal Endoscopy (ASGE) refers to quality indicators in the following three categories: (1) preprocedure quality indicators: indication, sedation, and informed consent; (2) intraprocedural quality indicators: cannulation, procedure success rate, radiation dose, and fluoroscopy time (FT); and (3) postprocedure quality indicators: reporting and adverse events. [1,2] The use of fluoroscopy presents the inherent risk of radiation exposure to both staff and patients. The increased use of ERCP as a therapeutic modality has often led to increased ERCP duration, with a subsequent increase in the radiation dose administered.…”

“…The increased use of ERCP as a therapeutic modality has often led to increased ERCP duration, with a subsequent increase in the radiation dose administered. [2,3] Such exposure is not well documented, and little data on this topic have been collected to date. [4] However, radiation exposure is of great concern for patients and medical staff because of its rapidly increasing frequency and potential carcinogenic effects.…”

“…[4] However, radiation exposure is of great concern for patients and medical staff because of its rapidly increasing frequency and potential carcinogenic effects. [2,4,5] The radiation dose from fluoroscopy varies with different variables. [6][7][8] Fluoroscopy time is a quantitative measure that adds to duration as the patient undergoes fluoroscopy during ERCP.…”