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The following is a summary of “Location of endoscopic retrograde cholangiopancreatography impacts fluoroscopy time: a multi-institutional retrospective study at tertiary academic centers,” published in the April 2025 issue of the BMC Gastroenterology by Marino et al.

Endoscopic retrograde cholangiopancreatography (ERCP) plays a pivotal role in diagnosing and managing a range of pancreatobiliary conditions. As a fluoroscopy-guided procedure, ERCP inherently involves radiation exposure for both patients and medical personnel. The setting in which ERCP is performed—whether in an EU, radiology suite, or operating room, along with personnel operating the fluoroscopic equipment, may significantly influence the duration of radiation exposure. This study aimed to evaluate differences in fluoroscopy time, a proxy for radiation dosage, across various procedural environments and conditions.

A retrospective cohort study was conducted across multiple tertiary academic centers, analyzing 3,251 ERCP procedures performed between April 2015 and November 2021. After exclusion criteria were applied, a total of 3,228 cases were included in the final analysis. Fluoroscopy time was assessed across different procedural locations (EU, RS, OR), operator types (endoscopist-controlled vs. technician-controlled fluoroscopy), and timeframes (standard working hours vs. after-hours). Statistical comparisons were made to identify significant differences in mean FT among these subgroups.

Among the analyzed procedures, 54.8% (n = 1,768) were performed in the EU, 37.9% (n = 1,223) in the RS, and 7.3% (n = 237) in the OR. Mean FT varied significantly by location: procedures in the EU had an average FT of 6.0 minutes, compared to 3.5 minutes in the RS and 4.1 minutes in the OR. FT in the EU was significantly longer than in both the RS and OR individually, as well as when the RS and OR data were combined. Additionally, ERCPs performed in the OR demonstrated significantly shorter FT compared to those performed in non-OR settings (5.0 minutes vs. 5.7 minutes, respectively).

Operator involvement also played a role: ERCPs with fluoroscopy controlled by the endoscopist were associated with longer FT than those with dedicated fluoroscopy technicians. Furthermore, procedures conducted during standard working hours had significantly longer FT (5.0 minutes) compared to those performed after hours (3.3 minutes), suggesting a potential influence of staffing patterns, workflow efficiency, or case complexity.

This multicenter analysis reveals that ERCP fluoroscopy time significantly differs based on procedural setting, time of day, and the individual operating the fluoroscopic equipment. These findings highlight the importance of optimizing procedural workflows and personnel allocation to reduce radiation exposure without compromising procedural quality or outcomes.

Source: bmcgastroenterol.biomedcentral.com/articles/10.1186/s12876-024-03536-w