Katsinelos Panagiotis, Gatopoulou Anthi, Gkagkalis Stergios, Fasoulas Kostas, Beltsis Athanasios, Zavos Christos, Terzoudis Sotiris, Lazaraki Georgia, Chatzimavroudis Grigoris, Vasiliadis Ioannis, Kountouras Jannis
Department of Endoscopy and Motility Unit, G. Gennimatas General Hospital, Aristotle University of Thessaloniki (Panagiotis Katsinelos, Anthi Gatopoulou, Stergios Gkagkalis, Kostas Fasoulas, Athanasios Beltsis, Sotiris Terzoudis, Georgia Lazaraki, Grigoris Chatzimavroudis, Ioannis Vasiliadis.
Department of Medicine, Second Medical Clinic, Aristotle University of Thessaloniki, Ippokration Hospital (Christos Zavos, Jannis Kountouras).
Ann Gastroenterol. 2012;25(4):338-344.
Fluoroscopy time (FT) in endoscopic retrograde cholangiopancreatography (ERCP) has a linear relationship with radiation exposure to endoscopist, personnel and patients. The aim of this prospective study was to investigate the factors influencing the FT during ERCP.
Between January 2010 and August 2011, patients with naïve papilla undergoing therapeutic ERCP were included in the study. Patient and procedural factors affecting fluoroscopy duration were investigated.
During the study period 549 ERCP records were included in the final analysis. The mean procedural time and FT were 19.53±7.61 min and 48.82±26.43 sec, respectively. There was no effect of age or gender on FT. Univariate analysis showed choledocholithiasis (+17.92 sec; 95%CI: 12.73-23.11, p<0.001), multiple stones (+21.21 sec; 95%CI: 14.31-30.35, p<0.001), stone size >10 mm (+27.514 sec; 95%CI: 16.62-35.71; p<0.001), precut technique (+12.46 sec; 95%CI: 6.32-18.60; p<0.001), periampullary diverticulum (+33.36 sec; 95%CI: 28.49-38.23; p<0.001), mechanical lithotripsy (+31.14 sec; 95%CI: 24.67-37.61; p<0.001) and mechanical lithotripsy plus stent placement (+42.41 sec; 95%CI: 31.93-52.89; p<0.001) to be associated with longer FT. Multivariate analysis identified choledocholithiasis (+13.24 sec; 95%CI: 4.44-22.04; p=0.003), multiple stones (+19.51 sec; 95%CI: 11.72-26.78; p<0.001), stone size >10 mm (+23.95 sec; 95%CI: 14.35-29.45; p<0.001), needle-knife papillotomy (+17.26 sec; 95%CI: 7.77-26.75; p<0.001), periampullary diverticulum (+21.99 sec; 95%CI: 17.81-26.16; p<0.001) and mechanical lithotripsy plus stent placement (+20.39 sec; 95%CI: 7.38-33.40; p=0.002) to prolong FT.
The identified factors influencing the FT may help endoscopists take appropriate precautions during ERCP to significantly decrease FTs.
内镜逆行胰胆管造影术（ERCP）中的透视时间（FT）与内镜医师、工作人员及患者所接受的辐射暴露呈线性关系。这项前瞻性研究的目的是调查影响ERCP术中FT的因素。
2010年1月至2011年8月期间，纳入接受治疗性ERCP的初发乳头患者进行研究。调查影响透视持续时间的患者及操作因素。
研究期间，549份ERCP记录纳入最终分析。平均操作时间和FT分别为19.53±7.61分钟和48.82±26.43秒。年龄和性别对FT无影响。单因素分析显示，胆总管结石（+17.92秒；95%置信区间：12.73 - 23.11，p<0.001）、多发结石（+21.21秒；95%置信区间：14.31 - 30.35，p<0.001）、结石大小>10毫米（+27.514秒；95%置信区间：16.62 - 35.71；p<0.001）、预切开技术（+12.46秒；95%置信区间：6.32 - 18.60；p<0.001）、壶腹周围憩室（+33.36秒；95%置信区间：28.49 - 38.23；p<0.001）、机械碎石术（+31.14秒；95%置信区间：24.67 - 37.61；p<0.001）以及机械碎石术加支架置入（+42.41秒；95%置信区间：31.93 - 52.89；p<0.001）与较长的FT相关。多因素分析确定胆总管结石（+13.24秒；9%置信区间：4.44 - 22.04；p = 0.003）、多发结石（+19.51秒；95%置信区间：11.72 - 26.78；p<0.001）、结石大小>10毫米（+23.95秒；95%置信区间：14.35 - 29.45；p<0.001）、针刀乳头切开术（+17.26秒；95%置信区间：7.77 - 26.75；p<0.001）、壶腹周围憩室（+21.99秒；95%置信区间：17.81 - 26.16；p<0.001）以及机械碎石术加支架置入（+20.39秒；95%置信区间：7.3B - 33.40；p = 0.002）会延长FT。
所确定的影响FT的因素可能有助于内镜医师在ERCP术中采取适当的预防措施，以显著缩短FT。
