title: Effect of physician training on fluoroscopy time during ERCP.
abstract: Our purpose was to compare fluoroscopy time during endoscopic retrograde cholangiopancreatography (ERCP) between endoscopists with different levels of experience. We performed a cross-sectional analysis of 269 consecutive ERCPs at an academic hospital during 1 year. Median fluoroscopy time was significantly longer in more complex cases, such as in therapeutic (406.5 s [IQR, 235.5-685]) compared to diagnostic (202 s [IQR, 141-481]; P = 0.002) procedures. The experience (number of prior ERCPs) of gastroenterology fellows involved in procedures was an independent predictor of shorter fluoroscopy time when controlling for patient and procedure characteristics (P < 0.0001). Median fluoroscopy time was 2.73 min shorter after at least 50 procedures had been performed (P = 0.039). Time for ERCPs involving fellows was not significantly longer than cases by attending physicians alone (P = 0.23). Increased experience is associated with lower radiation exposure during ERCP training. Radiation reduction methods should be prospectively investigated and integrated into training programs.
authors.affiliation: Division of Gastroenterology and Hepatology, University of Maryland Medical Center, Baltimore, Maryland 21201, USA. luradomo@medicine.umaryland.edu
authors.forename: Lance T
authors.initials: LT
authors.lastname: Uradomo
authors.forename: Mark E
authors.initials: ME
authors.lastname: Lustberg
authors.forename: Peter E
authors.initials: PE
authors.lastname: Darwin
mesh_terms: D002760:Cholangiopancreatography, Endoscopic Retrograde; D002983:Clinical Competence; D003430:Cross-Sectional Studies; D005257:Fellowships and Scholarships; D005260:Female; D005471:Fluoroscopy; D005762:Gastroenterology / Q000193:education*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013996:Time and Motion Studies