Oh Chi Hyuk, Dong Seok Ho, Kim Jung-Wook, Kim Gi-Ae, Lee Jae Min
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kyung Hee University College of Medicine.
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea.
Medicine (Baltimore). 2020 Mar;99(13):e19498. doi: 10.1097/MD.0000000000019498.
This study aimed to analyze the dose of radiation to which the physician is exposed during endoscopic retrograde cholangiopancreatography (ERCP) and to identify predictive factors of radiation exposure during the procedure. Furthermore, we evaluated the patient characteristics and procedural factors associated with prolonged fluoroscopy time (FT).A cross-sectional retrospective analysis of 780 ERCPs performed at a tertiary academic hospital over a 2-year period was conducted. The primary outcome was radiation exposure during ERCP as determined by FT; additionally, the association between variables and radiation exposure was determined. Moreover, we evaluated their correlations with age, sex, body mass index (BMI), diagnosis, duration of procedure, procedure name, and procedure complexity.According to the analysis of the 780 ERCPs performed in 2 years, the mean FT was 5.07 minutes (95% confidence interval [CI], 4.87-5.26). The mean radiation durations were as follows: cholelithiasis, 5.76 minutes (95% CI, 4.75-6.80); malignant biliary obstruction, 6.13 minutes (95% CI, 5.91-6.35); pancreatic disease, 5.28 minutes (95% CI, 4.45-6.28); and benign biliary stricture, 5.32 minutes (95% CI, 5.02-5.94). Significant differences affecting fluoroscopy duration between the 2 endoscopists were not observed in the present study. Multivariate analysis revealed that prolonged fluoroscopy duration was related to specific characteristics, including higher BMI (BMI >27.5 kg/m) (+4.1 minutes; 95% CI, 2.56-5.63), mechanical lithotripsy (+4.85 minutes; 95% CI, 0.45-9.25), needle-knife use (+4.5 minutes; 95% CI, 2.15-6.86), and malignant biliary obstruction (+2.34 minutes; 95% CI, 0.15-4.53).ERCPs are associated with significantly higher radiation exposure of patients on the specific procedure. Endoscopists should be aware of the determining factors, including patients with obesity, who underwent mechanical lithotripsy, who had malignant biliary obstruction, and who underwent a procedure using a needle knife, that affect FT during ERCP.
本研究旨在分析医生在内镜逆行胰胆管造影术（ERCP）过程中所受的辐射剂量，并确定该操作过程中辐射暴露的预测因素。此外，我们评估了与透视时间延长（FT）相关的患者特征和操作因素。
对一家三级学术医院在两年内进行的780例ERCP进行了横断面回顾性分析。主要结局是由FT确定的ERCP期间的辐射暴露；此外，还确定了变量与辐射暴露之间的关联。此外，我们评估了它们与年龄、性别、体重指数（BMI）、诊断、操作持续时间、操作名称和操作复杂性的相关性。
根据对两年内进行的780例ERCP的分析，平均FT为5.07分钟（95%置信区间[CI]，4.87 - 5.26）。平均辐射持续时间如下：胆结石，5.76分钟（95% CI，4.75 - 6.80）；恶性胆管梗阻，6.13分钟（95% CI，5.91 - 6.35）；胰腺疾病，5.28分钟（95% CI，4.45 - 6.28）；良性胆管狭窄，5.32分钟（95% CI，5.02 - 5.94）。在本研究中未观察到两位内镜医师之间影响透视持续时间的显著差异。多因素分析显示，透视持续时间延长与特定特征相关，包括较高的BMI（BMI>27.5 kg/m²）（+4.1分钟；95% CI，2.56 - 5.63）、机械碎石术（+4.85分钟；95% CI，0.45 - 9.25）、针刀使用（+4.5分钟；9% CI，2.15 - 6.86）和恶性胆管梗阻（+2.34分钟；95% CI，0.15 - 4.53）。
ERCP在特定操作中会使患者受到显著更高的辐射暴露。内镜医师应了解影响ERCP期间FT的决定因素，包括肥胖患者、接受机械碎石术的患者、患有恶性胆管梗阻的患者以及接受针刀操作的患者。
