Predictors of Fluoroscopy Exposure During Endoscopic Retrograde Cholangiopancreatography

Aims Endoscopic retrograde cholangiopancreatography (ERCP) is a well-established procedure for treating pancreaticobiliary conditions. However, it relies on fluoroscopy use, exposing both the patient and the medical team to ionizing radiation. Understanding the factors associated with prolonged fluoroscopy time—used as an indicator of radiation dose—may improve safety practices and inform patient care. This study aims to identify patient, endoscopist, and institutional factors that predict prolonged fluoroscopy time during ERCP.

Methods Data was obtained from a prospective, multi-center, high-fidelity ERCP registry. Patients undergoing ERCP at participating centers provided consent for voluntary enrollment. For each procedure, we documented patient, endoscopist, institutional, and peri-procedural variables. We defined prolonged fluoroscopy time to be≥2 minutes[NF1]. To identify predictors of prolonged fluoroscopy time, we employed stepwise multivariable logistic regression modeling. Statistical significance was set at a p-value of<0.05.

Results 4,808 ERCPs were included in our multivariable logistic regression model. Following backwardsselection of variables, our final regression model included a total of 36 variables.Variables associated with increased odds of fluoroscopy time≥2 minutes include the following;trainee involvement (odds ratio, OR, 2.55, 95% confidence interval, CI, 2.20 – 2.97), stricturedilation performed (OR 2.15, 95% CI 1.57 – 2.97), biliary stent placement (OR 2.10, 95% CI1.77 – 2.49), use of double guidewire technique (OR 1.88, 95% CI 1.41 – 2.52), cytologybrushings performed (OR 1.88, 95% CI 1.47 – 2.40), prior sphincterotomy (OR 1.87, 95% CI1.54 – 2.27), presence of a proximal stricture (OR 1.87, 95% CI 1.50 – 2.33), 3-5 CBDcannulation attempts (OR 1.87, 95% CI 1.58 – 2.22), 6-10 CBD cannulation attempts (OR 3.11,95% CI 2.44 – 3.99), &gt;10 CBD cannulation attempts (OR 6.81, 95% CI 4.99 – 9.40),cholangioscpoy performed (OR 1.75, 95% CI 1.08 – 2.92), outpatient setting (OR 1.26, 95% CI1.08 – 1.46), age (OR 1.01, 95% CI 1.01 – 1.01). Conversely, variables associated with lowerodds of fluoroscopy time≥2 minutes include; ERCP performed by female endoscopists (OR0.51, 95% CI 0.40 – 0.65), presence of institutional fluoroscopy training (OR 0.62, 95% CI 0.48– 0.80), presence of a distal stricture (OR 0.66, 95% CI 0.54 – 0.82), fluoroscopy controlled by aradiology technician (OR 0.73, 95% CI 0.59 – 0.90), cholodecholithiasis as the indication (OR0.77, 95% CI 0.64-0.92), Stent-related indications (OR 0.77, 95% CI 0.62 – 0.95), andendoscopist experience (OR 0.99, 95% CI 0.96 – 1.00).

Conclusions Fluoroscopy duration during ERCP appears to be reduced in cases performed by female endoscopists and in endoscopists with more experience. Additionally, implementing formal fluoroscopy training and utilizing radiology technicians may reduce fluoroscopy exposure during ERCP.

Publikationsverlauf

Artikel online veröffentlicht:
27. März 2025