Carine Bou-Abboud Matta, MD1, Daniel B. Karb, MD1, Dina Ahmad, MD2, Amitabh Chak, MD3, Brooke Glessing, MD1, Ashley Faulx, MD3, John Dumot, DO1, Gerard Isenberg, MD, MBA4, Richard C. Wong, MD4, Zachary L. Smith, DO3
1University Hospitals of Cleveland, Cleveland, OH; 2Case Western Reserve University / University Hospitals, Cleveland, OH; 3University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH; 4University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH
Introduction: The necessary use of fluoroscopy during endoscopic retrograde cholangiopancreatography (ERCP) involves radiation exposure to the endoscopy staff and patients. Radiation technologists (RT) are formally trained to minimize exposure whereas endoscopists are not. The aim of this study was to primarily determine whether involvement of RT reduced fluoroscopy time and secondarily to identify independent predictors of increased fluoroscopy time during ERCP.
Methods: We conducted a retrospective review of ERCPs performed between August 2017-September 2018 within a single healthcare system. This system is unique in that it has 2 endoscopy units, both of which perform high-volume, high-level ERCPs. Four interventional endoscopists on faculty perform ERCPs at both centers. In one unit (site 1) the fluoroscopy units are controlled by the endoscopist and in the second (site 2) a RT controls it at the direction of the endoscopist. Procedure notes were reviewed for demographic and procedural data. Univariate analyses were used to assess differences among individual variables by site using Chi-squared and Mann-Whitney U test. Secondary comparisons included independent predictors of increased fluoroscopy time as assessed by multivariable linear regression. To minimize confounding, only ERCPs performed by endoscopists who work at both centers were analyzed.
Results: A total of 949 ERCPs were performed during the study period and 605 met inclusion criteria. Patient demographic and procedure characteristics are outlined in Table 1. There was no significant difference between fluoroscopy times in ERCPs that were RT-controlled (mean 372.7 seconds, st. dev. 391.5) versus endoscopist-controlled (334.2 seconds, st. dev 350.4). When controlling for confounding variables in the multivariable model, this difference remained statistically nonsignificant. Independent predictors of high fluoroscopy time in the multivariable model include trainee involvement, ERCP level 3 complexity, hilar biliary obstruction, technically unsuccessful ERCPs, stent placement, balloon or catheter dilation, mechanical and electrohydraulic lithotripsy, ductoscopy and outpatient procedures (Table 2).
Discussion: Involvement of a trained RT during ERCP does not decrease fluoroscopy time. Several other fixed and modifiable variables were independently associated with high fluoroscopy times, including trainee involvement. These results stress the importance of formal fluoroscopy education early in an interventional endoscopy fellowship.
Citation: Carine Bou-Abboud Matta, MD; Daniel B. Karb, MD; Dina Ahmad, MD; Amitabh Chak, MD; Brooke Glessing, MD; Ashley Faulx, MD; John Dumot, DO; Gerard Isenberg, MD, MBA; Richard C. Wong, MD; Zachary L. Smith, DO. P0926 - COMPARING RADIATION TIME IN RADIOLOGY TECHNOLOGIST-CONTROLLED VERSUS ENDOSCOPIST-CONTROLLED FLUOROSCOPY DURING ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY. Program No. P0926. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.