Endoscopy 2019; 51(04): S121-S122
DOI: 10.1055/s-0039-1681528
ESGE Days 2019 oral presentations
Saturday, April 6, 2019 14:30 – 16:00: ERCP cannulation 2 South Hall 1A
Georg Thieme Verlag KG Stuttgart · New York

PATIENT RADIATION EXPOSURE DURING ENTEROSCOPY-ASSISTED ERCP IN SURGICALLY ALTERED ANATOMY

T Moreels
1   Gastroenterology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
,
O De Ronde
1   Gastroenterology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
,
P Deprez
1   Gastroenterology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
,
H Piessevaux
1   Gastroenterology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

Also available at
 

Aims:

To provide data on radiation exposure in patients with surgically altered anatomy undergoing enteroscopy-assisted ERCP (EA-ERCP) during a 3-months registration period in comparison with conventional ERCP (C-ERCP) data.

Methods:

20 EA-ERCP procedures were compared with 53 C-ERCP procedures. Data on patient and procedure characteristics were collected as well as radiation data: fluoroscopy time, total radiation dose and dose-area product (DAP).

Results:

Mean age in the EA-ERCP group was 58 ± 5 years vs. 66 ± 2 years in the C-ERCP group (p = 0.105) with a general M/F ratio of 67/33%. Surgical reconstructions were Roux-en-Y hepaticojejunostomy, total gastrectomy, gastric bypass and Whipple's resection. EA-ERCP procedures were restricted to biliary indications, whereas C-ERCP indications were both biliary and pancreatic. Mean fluoroscopy time was comparable in both groups (358 ± 28 s vs. 350 ± 40 s, p = 0.815), as was total mean radiation dose with a tendency to be lower in the EA-ERCP group (83 ± 9 mGy) as compared to the C-ERCP group (97 ± 10 mGy, p = 0.449). However, DAP was significantly higher in the EA-ERCP group (2104 ± 187µGy*m2 vs. 1464 ± 117µGy*m2, p = 0.006), as is the total procedure time (82 ± 7 min vs. 41 ± 3 min, p < 0.001). These results indicate that C-ERCP procedures are more complex needing magnified fluoroscopy, whereas EA-ERCP procedures take more time for enteroscope insertion under wide field fluoroscopic guidance (as shown by increased DAP) with less complex ERCP manipulation (as shown by lower total dose).

Conclusions:

ESGE guidelines provide data on patient radiation exposure during conventional ERCP. However, no data are currently available on patient radiation exposure during enteroscopy-assisted ERCP in patients with surgically altered anatomy. Radiation exposure in EA-ERCP is different as compared to C-ERCP: EA-ERCP takes longer with a higher DAP, but with a lower total radiation dose. This is explained by the need of fluoroscopy during enteroscope insertion (higher DAP) to perform less complex ERCP procedures (lower total dose).