Prospective analysis of fluoroscopy duration during ERCP: critical determinants.
BACKGROUND
Fluoroscopy during ERCP has a linear relationship with radiation, carrying risk of exposure.


OBJECTIVE
To determine patient, physician, and procedural factors affecting fluoroscopy duration.


METHODS
Prospective analysis of ERCPs with evaluation of patient, physician, and procedural variables.


METHODS
Two tertiary-care hospitals.


METHODS
Consecutive patients undergoing ERCP.


METHODS
ERCP.


METHODS
Variables associated with prolonged fluoroscopy duration.


RESULTS
Mean fluoroscopy time (388 ERCPs) was 6.77 minutes (95% CI, 6.15-7.39). No patient factors were found to significantly affect fluoroscopy duration. Fluoroscopy duration was significantly lower for 2 endoscopists compared with the reference endoscopist (average of 4.16 minutes less; 95% CI, -5.48 to -2.48). Multivariable analysis identified variables associated with longer fluoroscopy duration; stent insertion (+3.11 minutes; 95% CI, 1.91-4.30), lithotripsy (+5.74 minutes; 95% CI, 0.931-10.5), needle-knife sphincterotomy (+4.44 minutes; 95% CI, 2.20-6.67), biopsies (+2.11 minutes; 95% CI, 0.025-4.18), use of a guidewire (+1.55 minutes; 95% CI, 0.025-3.07), additional guidewires (+5.61 minutes; 95% CI, 2.69-8.51), and balloon catheter (+4.27 minutes; 95% CI, 3.00-5.53). Mean fluoroscopy duration when a gastroenterology fellow was involved (n = 318) was 7.05 minutes (95% CI, 6.35-7.76) compared with 5.44 minutes (95% CI, 4.26-6.63) when no fellow present (n = 70) (P < .0451).


CONCLUSIONS
Only 2 centers; others may have different results. Not blinded; investigators may change their practice because fluoroscopy was duration studied. Irrelevance of measuring fluoroscopy duration because endoscopists using protection may not have increased radiation exposure.


CONCLUSIONS
In this prospective analysis, factors associated with fluoroscopy duration included endoscopists; stent insertion; lithotripsy; biopsies; use of a needle-knife, guidewire, and balloon catheter; and involvement of a gastroenterology fellow. These identified variables may help endoscopists predict which procedures are associated with prolonged fluoroscopy duration and may lead to appropriate precautions.
Kim
Edward
E
St. Paul's Hospital, Vancouver, British Columbia, Canada.
McLoughlin
Mark
M
Lam
Eric C
EC
Amar
Jack
J
Byrne
Michael
M
Telford
Jennifer
J
Enns
Rob
R
D001706:Biopsy / Q000706:statistics & numerical data; D002404:Catheterization / Q000706:statistics & numerical data; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000706:statistics & numerical data*; D003138:Common Bile Duct Neoplasms / Q000628:therapy; D004867:Equipment Design; D005257:Fellowships and Scholarships; D005260:Female; D005471:Fluoroscopy / Q000706:statistics & numerical data*; D042882:Gallstones / Q000628:therapy; D005762:Gastroenterology / Q000193:education; D006801:Humans; D008096:Lithotripsy / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016717:Sphincterotomy, Endoscopic / Q000706:statistics & numerical data; D015607:Stents / Q000706:statistics & numerical data; D013996:Time and Motion Studies