Michelle Hughes, MD1, Harshit S. Khara, MD, FACG2, Nirav Thosani, MD3, Nicholas Bartell, MD1, Krystle Bittner, MPH1, Asad Ullah, MD1, Vikas Kumar, MD2, Ammara Khalid, MD2, David L. Diehl, MD4, Bradley Confer, DO2, Prithvi Patil, MD3, Alexandra Johnson, RN1, Truptesh Kothari, MD, MS5, Vivek Kaul, MD, FACG5, Shivangi Kothari, MD5
1University of Rochester Medical Center, Rochester, NY; 2Geisinger Medical Center, Danville, PA; 3University of Texas, Houston, TX; 4Geisinger Health System, Danville, PA; 5University of Rochester Medical Center, Strong Memorial Hospital, Rochester, NY
Introduction: Patients are exposed to radiation during endoscopic retrograde cholangiopancreatography (ERCP) which may increase the cumulative risk of the development of cancer and/or of other radiation-related adverse events. ERCP utilizes radiological guidance to direct diagnosis and therapy of biliary and pancreatic pathology. There is limited data available evaluating if the amount of radiation directed to the patient during ERCP is different by endoscopist-directed fluoroscopy versus when ERCP is assisted by radiology technician. Our aim was to assess the difference in the dose of radiation administered to the patient when fluoroscopy during ERCP is operated by the endoscopist versus the radiology technician.
Methods: This is an IRB-approved multi-center retrospective chart review of patients who underwent ERCP between 07/2017 and 11/2018 at three high-volume academic centers. Patient-specific data was collected including demographics, cholecystectomy status and indication for ERCP. Procedural and fluoroscopic data were also obtained. Descriptive and inferential analyses were performed utilizing SPSS software.
Results: During the study period, a sample of 100 patients that underwent ERCP performed with radiology technician (RT) assistance (two tech-driven institutions; n = 50 each) and a sample of 50 patients with endoscopist-led fluoroscopy (ELF) were compared. Patient characteristics are summarized in Table 1. The most common indication for ERCP was choledocholithiasis (n = 26 vs. 24, RT vs ELF, respectively). Mean procedure time (34.6 vs. 26.6 min, RT vs. ELF; p = 0.056) and mean fluoroscopy time (5.2 vs. 4.9 min, RT vs. ELF; p = 0.897) were similar in both groups. The ELF group obtained a significantly greater number of images during ERCP (RT 9.9 vs. ELF 14.6, p < 0.001). The mean dose of radiation (Gy/cm2) administered to the patient was significantly higher in the RT group (RT 40.6 vs. ELF 20.3; p = 0.016).
Discussion: Endoscopist-driven fluoroscopy during ERCP is associated with lower radiation dose compared to radiology technician assisted fluoroscopy at high volume ERCP centers. Endoscopists are also better at saving more images during an ERCP. Future education and training of radiation technicians may help reduce the radiation to the patients.
Citation: Michelle Hughes, MD; Harshit S. Khara, MD, FACG; Nirav Thosani, MD; Nicholas Bartell, MD; Krystle Bittner, MPH; Asad Ullah, MD; Vikas Kumar, MD; Ammara Khalid, MD; David L. Diehl, MD; Bradley Confer, DO; Prithvi Patil, MD; Alexandra Johnson, RN; Truptesh Kothari, MD, MS; Vivek Kaul, MD, FACG; Shivangi Kothari, MD. P0940 - A MULTI-CENTER COMPARISON OF PROCEDURALIST VERSUS RADIOLOGY TECHNICIAN-DRIVEN FLUOROSCOPY IN ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY: BEST WHEN YOU DO IT YOURSELF!. Program No. P0940. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.