Radio induced cancer risk during ERCP: Is it a real clinical problem?

Abstract

Background: in recent years many factors have been shown to influence dose received by the patient during ERCP. Therefore it is necessary to update radio induced cancer risk.Objectives: to calculate lifetime attributable risk of cancer during ERCP. To compare the risk with the most common X-ray examinations.Design: descriptive study with 393 consecutive ERCP performed at one center. Equipment used was Philips BV pulsera. In each exploration demographic and anthropometric variables of the patient were collected. Dosimetric quantities were calculated from exposure parameters. Effective dose was estimated using specific conversion factors. Organ doses and radio induced cancer incidence was estimated.Results: dose area product was 0.82 mGym 2 (IQR 0.4-1.5) with an average fluoroscopy time of 2 minutes and 45 seconds. Entrance surface dose was 30.7 mGy (IQR 15-60.8) and effective dose was 0.44 mSv (IQR 0.2-0.9). Multivariate analysis identified that difficult papillary cannulation (β0.4; p = 0.009), patient age (β-0.01; p = 0.001) and therapeutic applied (β= 0.89; p < 0.001) influenced dose-area product. The ERCP dose would be equivalent to the radiation received by twenty chest radiographs and would be about fourteen times smaller than a barium enema or twenty times less than that received during an abdominal CT. Lifetime attributable risk of cancer incidence was 4.08 and 16.81 per million procedures in diagnostic and therapeutic ERCP respectively.Conclusions: from the radiological point of view, ERCP is a safe technique that uses low exposure levels compared to other explorations commonly used in medicine. It implies a reasonably low risk of radio induced cancer.

Patient and Staff Radiation Exposure during Endoscopic Retrograde Cholangio-Pancreatography: Eight Years of Dose Monitoring

“…A summary of the results (median, mean and maximum values) is shown in Table 1 In Table 2 and Figures 5 and 6, the comparison of median values of the quantities T (min) and KAP (Gy.cm 2 ) is presented, between the results of this study and the corresponding results of similar published data. [3,5,6,10,11]. This is reflected in our results too, as it can be seen in Table 1 and Figure 1, although a single, well-experienced endoscopist, using the same X-ray imaging system, performed all 1632 ECRP procedures.…”

“…The American Society for Gastrointestinal Endoscopy (ASGE) and the American College of Gastroenterology (ACG) established a task force in 2006 to create quality metrics for endoscopy including ERCP [1]. Many studies have tried to estimate the radiation dose delivered to patients and medical staff during ERCP procedures, in hospital centers or even more, to establish local Dose Reference Levels (DRLs) [2][3][4][5][6][7][8][9][10][11][12]. Monitoring the doses reported from ERCP procedures is essential; not only in order to optimize the techniques and protocols in each center, but also to manage the probably increasing radiation dose delivered to patients.…”

Patient radiation dose and fluoroscopy time during ERCP: a single-center, retrospective study of influencing factors

“…The univariate and multivariate analysis with log-transformed data identified several factors as predictors for higher DAP (Table 4) and prolonged FT ( [38] an independent association was observed between younger patients and a higher DAP in ERCP, however, the authors did not identify any logical explanation for it. It is essential to pay a special attention to the radiation protection of young patient, but as life expectancy increases, highlighting the benefits of radiation protection in the elderly is also important [44].…”

Feasibility and safety of intraoperative bile duct clearance by antegrade transcystic balloon sphincteroplasty: A prospective observational pilot study

“…A reduced radiation exposure may be another benefit of the current intraoperative technique as the reported radiation exposure for an ERC with sphincterotomy and stone extraction is reported to range from 8.9 to 15 Gy•cm 2 . 34,35 In contrast to the bilirubin levels, gamma-glutamyltransferase levels were elevated in 23 patients (46%) 6 weeks after the intervention. Gamma-glutamyltransferase levels are known to slowly decrease after sphincterotomy or sphincteroplasty and successful bile duct clearance.…”