Kakodkar Samir, Haider Ali, Hoff Ryan T, Zamfirova Ina, Chi Kenneth
Department of Medicine, Division of Gastroenterology, Advocate Lutheran General Hospital, Park Ridge, USA.
Russell Research Institute, Advocate Lutheran General Hospital, Park Ridge, USA.
Cureus. 2021 Mar 8;13(3):e13771. doi: 10.7759/cureus.13771.
Background and objective Fluoroscopy during endoscopic retrograde cholangiopancreatography (ERCP) is associated with radiation exposure and related health risks. Either the physician or the radiology technologist can activate fluoroscopy during ERCP. The aim of this study was to determine if physician-controlled fluoroscopy is associated with decreased fluoroscopy time, which may correspond to less radiation exposure to patients and staff. Methods We conducted a single-center, retrospective study; data were collected on ERCP performed using physician-controlled and technologist-controlled fluoroscopy. Fluoroscopy time, procedure complexity level, and Stanford Fluoroscopy Score were compared between the two groups. Results The median fluoroscopy time significantly differed between the two groups with 108 seconds for physician-controlled and 146 seconds for technologist-controlled procedures (p=0.004). The ratio of median fluoroscopy time to procedure complexity level was significantly lower in the physician-controlled group at 73.0 seconds compared to 97.0 seconds in the technologist-controlled group (p=0.002). The ratio of median fluoroscopy time to Stanford Fluoroscopy Score was 25.5 seconds in the physician-controlled group compared to 39.3 seconds in the technologist-controlled group, which was also statistically significant (p<0.001). A subgroup analysis of physicians with advanced training in ERCP also showed a significantly reduced median fluoroscopy time to Stanford Fluoroscopy Complexity Score ratio: 25.5 seconds for physician-controlled versus 35.0 seconds for technologist-controlled (p=0.001). Conclusion The ERCP technique with physician-controlled fluoroscopy may be associated with shorter fluoroscopy time. This may correspond to decreased radiation exposure to patients compared to radiology technologist-controlled fluoroscopy. Further investigations with larger, prospective studies are warranted.
背景与目的 内镜逆行胰胆管造影术（ERCP）期间的荧光透视检查会带来辐射暴露及相关健康风险。在ERCP过程中，医生或放射技术人员均可启动荧光透视检查。本研究的目的是确定由医生控制荧光透视检查是否与荧光透视时间缩短相关，这可能意味着患者和工作人员所受辐射暴露减少。 方法 我们开展了一项单中心回顾性研究；收集了使用医生控制和技术人员控制的荧光透视检查进行ERCP的数据。比较了两组的荧光透视时间、操作复杂程度及斯坦福荧光透视评分。 结果 两组的中位荧光透视时间有显著差异，医生控制组为108秒，技术人员控制组为146秒（p = 0.004）。医生控制组中位荧光透视时间与操作复杂程度的比值显著低于技术人员控制组，分别为73.0秒和97.0秒（p = 0.002）。医生控制组中位荧光透视时间与斯坦福荧光透视评分的比值为25.5秒，技术人员控制组为39.3秒，同样具有统计学意义（p < 0.001）。对接受过ERCP高级培训的医生进行的亚组分析也显示，中位荧光透视时间与斯坦福荧光透视复杂程度评分的比值显著降低：医生控制组为25.5秒，技术人员控制组为35.0秒（p = 0.001）。 结论 采用医生控制荧光透视检查的ERCP技术可能与较短的荧光透视时间相关。与放射技术人员控制的荧光透视检查相比，这可能意味着患者所受辐射暴露减少。有必要开展更大规模的前瞻性研究作进一步调查。
