Assessing Patient Radiation Exposure in Endoscopic Retrograde Cholangiopancreatography: A Multicenter Retrospective Analysis of Procedural Complexity and Clinical Factors

Touko Kaasalainen; Ekaterina Saukko; Outi Lindström; Marianne Udd; Sara Regnér; Arto Saarela; Ervin Toth; Gabriele Wurm Johansson; Anna-Leena Manninen; Juha Grönroos; Leena Kylänpää

doi:10.3390/diagnostics14060656

Assessing Patient Radiation Exposure in Endoscopic Retrograde Cholangiopancreatography: A Multicenter Retrospective Analysis of Procedural Complexity and Clinical Factors

Diagnostics (Basel). 2024 Mar 21;14(6):656. doi: 10.3390/diagnostics14060656.

Authors

Touko Kaasalainen¹, Ekaterina Saukko², Outi Lindström³, Marianne Udd³, Sara Regnér^{4

5}, Arto Saarela⁶, Ervin Toth^{4

5}, Gabriele Wurm Johansson^{4

5}, Anna-Leena Manninen⁷, Juha Grönroos⁸, Leena Kylänpää³

Affiliations

¹ HUS Diagnostic Center, Radiology, University of Helsinki and Helsinki University Hospital, 00290 Helsinki, Finland.
² Department of Radiology, Turku University Hospital and University of Turku, 20521 Turku, Finland.
³ HUS Abdominal Center, Endoscopy Department, University of Helsinki and Helsinki University Hospital, 00290 Helsinki, Finland.
⁴ Department of Clinical Sciences Malmö, Lund University, 22100 Malmö, Sweden.
⁵ Department of Surgery and Gastroenterology, Skåne University Hospital, 20502 Malmö, Sweden.
⁶ Department of Gastrointestinal Surgery, Oulu University Hospital, 90220 Oulu, Finland.
⁷ Department of Radiology, Oulu University Hospital, 90220 Oulu, Finland.
⁸ Division of Digestive Surgery and Urology, Turku University Hospital and University of Turku, 20521 Turku, Finland.

Abstract

Background and aims: Endoscopic retrograde cholangiopancreatography (ERCP) procedures can result in significant patient radiation exposure. This retrospective multicenter study aimed to assess the influence of procedural complexity and other clinical factors on radiation exposure in ERCP.

Methods: Data on kerma-area product (KAP), air-kerma at the reference point (K_a,r), fluoroscopy time, and the number of exposures, and relevant patient, procedure, and operator factors were collected from 2641 ERCP procedures performed at four university hospitals. The influence of procedural complexity, assessed using the American Society for Gastrointestinal Endoscopy (ASGE) and HOUSE complexity grading scales, on radiation exposure quantities was analyzed within each center. The procedures were categorized into two groups based on ERCP indications: primary sclerosing cholangitis (PSC) and other ERCPs.

Results: Both the ASGE and HOUSE complexity grading scales had a significant impact on radiation exposure quantities. Remarkably, there was up to a 50-fold difference in dose quantities observed across the participating centers. For non-PSC ERCP procedures, the median KAP ranged from 0.9 to 64.4 Gy·cm² among the centers. The individual endoscopist also had a substantial influence on radiation dose.

Conclusions: Procedural complexity grading in ERCP significantly affects radiation exposure. Higher procedural complexity is typically associated with increased patient radiation dose. The ASGE complexity grading scale demonstrated greater sensitivity to changes in radiation exposure compared to the HOUSE grading scale. Additionally, significant variations in dose indices, fluoroscopy times, and number of exposures were observed across the participating centers.

Keywords: ERCP; PSC; fluoroscopy; procedural complexity; radiation exposure.

Grants and funding

This research was funded by the State Research Funding for University Hospitals in Finland, grant number TYH2020220.