Ocular Radiation Threshold Projection Based off of Fluoroscopy Time During ERCP

Garg, Mrinal; Patel, Pikul; Blackwood, Margaret; Munigala, Satish; Thakkar, Payal; Field, James L.; Wallace, Dustin; Agarwal, Satty; Aoun, Elie; Kulkarni, Abhijit; Dhawan, Manish; Farah, Katie; Thakkar, Shyam

doi:10.1038/ajg.2016.540

Cited by 21 publications

(26 citation statements)

References 17 publications

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“…The populationbased cannulation information will help carry out further research into quality and speed of cannulation, in addition to complications, on a population-based scale. 4,[11][12][13][14][15][16] From another perspective, prolonged fluoroscopy duration should create an awareness of the risk of radiation injury to both the patient and to staff and physicians. [11][12][13] Our data showed a relatively long duration compared with data from abroad.…”

Section: Discussionmentioning

confidence: 99%

Multicenter database registry for endoscopic retrograde cholangiopancreatography: Japan Endoscopic Database Project

Kato

Tanaka

Kida

et al. 2019

Digestive Endoscopy

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Background and Aim Few studies have reported on a national, population‐based endoscopic retrograde cholangiopancreatography (ERCP) database. Hence, in 2015, we established a multicenter ERCP database registry, the Japan Endoscopic Database (JED) Project in preparation for a nationwide endoscopic database. The objective the present study was to evaluate this registry before the establishment of a nationwide endoscopic database. Methods From 1 January 2015 to 31 March 2017, we collected and analyzed the ERCP data of all patients who underwent ERCP in four participating centers in the JED Project based on the JED protocol. Results Four centers carried out 4104 ERCP on 2173 patients. Data entry of ERCP information (age, 100%; gender, 100%; American Society of Anesthesiologists Physical Status Classification System, 74.5%; scope, 92.7%; time to ERCP, 100%; antithrombotic drug information, 55.0%; primary selective common bile duct [CBD] cannulation methods, 73.0%; number of attempts at primary selective CBD cannulation, 67.6%; overall selective CBD cannulation methods, 68.9%; ERCP procedure time, 66.3%; fluoroscopy time, 65.1%; adverse events, 74.9%; serum amylase levels 1 day post‐ERCP, 36.5%) was accurately extracted from the four centers. Success rate of CBD cannulation by level of ERCP difficulty was 98.5%, 99.0%, and 96.4% in grades 1, 2, and 3, respectively. Complication rate by overall selective CBD cannulation method was 5.6%, 7.6%, and 10.5% in the contrast‐assisted technique, guidewire‐assisted technique, and cross‐over method, respectively. Conclusion Data from this evaluation of the JED Project, a multicenter ERCP database registry, suggest the feasibility of establishing a nationwide ERCP database and its challenges.

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Section: Discussionmentioning

confidence: 99%

Multicenter database registry for endoscopic retrograde cholangiopancreatography: Japan Endoscopic Database Project

Kato

Tanaka

Kida

et al. 2019

Digestive Endoscopy

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“…The same study by Buls et al reported a median ocular dose of 0.34 mSv per procedure [ 52 ]. A similar study by Garg et al measured optic radiation exposure in attendings and fellows after 187 ERCP cases [ 53 ]. The cumulative radiation dose absorbed per lens dosimeter was 5.35mSv for attendings and 2.55mSv for fellows.…”

Section: Ercp Radiationmentioning

confidence: 99%

“…The cumulative radiation dose absorbed per lens dosimeter was 5.35mSv for attendings and 2.55mSv for fellows. The findings project that procedure times of 59.41h for attendings and 88.17h for fellows are needed to reach the lens threshold limit (20 mSv/year) [ 53 ]. Zagorska et al evaluated 15 ERCP cases and reported ocular exposure between 19.4 and 25.6 mSv, values above or around the annual dose limit [ 54 ].…”

Section: Ercp Radiationmentioning

confidence: 99%

“…While it is not a universal requirement, thyroid shields or guards have been shown to reduce the total body effective dose by 46% per year [ 83 ]. To avoid ocular damage, recent studies by Garg et al recommend the use of radioprotective eyewear by physicians and fellows exposed to radiation for more than 59.4h and 88.2h, respectively [ 53 ]. More robust precautions should be taken in centers that utilize more advanced imaging or endoscopic procedures.…”

Section: Concluding Remarks and Future Directionsmentioning

confidence: 99%

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Occupation-associated health hazards for the gastroenterologist/ endoscopist

Ofori

Ramai

John

et al. 2018

aog

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Advances in the field of endoscopy have allowed gastroenterologists to obtain detailed imaging of anatomical structures and to treat gastrointestinal diseases with endoscopic therapies. However, these technological developments have exposed endoscopists and staff to hazards such as musculoskeletal injuries, exposure to infectious agents, and ionizing radiation. We aimed to review the occupational hazards for the gastroenterologist and endoscopist. Using PubMed, Medline, Medscape, and Google Scholar, we identified peer-reviewed articles with the keywords “occupational hazards,” “health hazards,” “occupational health hazards,” “endoscopy,” “gastroenterologist,” “infectious agents,” “musculoskeletal injuries,” and “radiation.” Strategies for reducing exposure to infectious agents, radiation, and the risk of musculoskeletal injuries related to gastroenterology include compliance with established standard measures, the use of thyroid shields and radioprotective eyewear, and ergonomic practices. We conclude that educating endoscopic personnel and trainees in these practices, in addition to further research in these areas, will likely lead to the development of more efficient and user-friendly workspaces that are safer for patients and personnel.

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“…Despite of application of low-dose radiation X-ray system in ERCP, the use of uoroscopy places patients and endoscopists at risk of radiation-induced injury [2]. Although radiation time and dosage can be minimized by experienced ERCP endoscopists [3], how to reduce radiation exposure during conventional ERCP procedures has gained great attention [4]. According to the ALARA (As Low as Reasonably Achievable) principle, precautions should be taken to reduce radiation exposure to patients and staff.…”

Section: Introductionmentioning

confidence: 99%

Application of digital cholangioscopy assisted non-radiation endoscopic retrieval of common bile duct stones

Feng¹,

Xu²,

Liu³

et al. 2020

Preprint

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Background Few studies have evaluated digital cholangioscopy (DCS) assisted non-radiation endoscopic retrograde cholangiopancreatography (NR-ERCP) for choledocholithiasis. Here, we evaluated the application of DCS assisted NR-ERCP for endoscopic retrieval of common bile duct (CBD) stones.Methods Patients who underwent ERCP for choledocholithiasis and without prior ERCP were included. Data related to technical success and outcomes of DCS-assisted NR-ERCP and conventional ERCP were retrieved and compared. Procedure and technical details of DCS assisted NR-ERCP were collated and reviewed.Results In total, 304 and 53 patients who underwent conventional and DCS-assisted ERCP were recruited. Relatively larger stones (p < 0.001) was present in DCS assisted NR-ERCP. No statistical difference was present in biliary access, lithotripsy, stone removal and total complications. A higher proportion of larger balloon for EPBD (p < 0.001) and more ERCP sessions for stone clearance (p < 0.001) were present in conventional ERCP. In DCS-assisted ERCP, technical success was achieved in 52 (98.1%) patients and DCS-guided laser lithotripsy was applied in 9 (17%) patients. DCS guided laser lithotripsy was superior to mechanical lithotripsy for stone clearance (p < 0.001) in large stones. Mean length of biliary exploration and whole NR-ERCP were 8.60 ± 1.96 (6–19) and 32.96 ± 16.29 (13–82) minutes, respectively. One delayed bile-leakage, one moderate pancreatitis, two mild pancreatitis and five cases of hyperamylasemia occurred. Technical details and complications were not statistically differed between patients with a dilated and a non-dilated CBD.Conclusions DCS-based NR-ERCP is technically feasible and safe for retrieval of CBD stones. It provides an alternative to conventional ERCP for endoscopic treatment of simple choledocholithiasis.

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Ocular Radiation Threshold Projection Based off of Fluoroscopy Time During ERCP

Cited by 21 publications

References 17 publications

Multicenter database registry for endoscopic retrograde cholangiopancreatography: Japan Endoscopic Database Project

Multicenter database registry for endoscopic retrograde cholangiopancreatography: Japan Endoscopic Database Project

Occupation-associated health hazards for the gastroenterologist/ endoscopist

Application of digital cholangioscopy assisted non-radiation endoscopic retrieval of common bile duct stones

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