Time-limited fluoroscopy to reduce radiation exposure during ERCP: a prospective randomized trial

BackgroundMeasures should be used to limit radiation exposure of the staff and patients during ERCP.ObjectiveTo determine whether “time-limited fluoroscopy” reduces radiation exposure and fluoroscopy time (FT) compared with continuous fluoroscopy.DesignProspective randomized trial.SettingTertiary academic medical center.PatientsConsecutive adult patients presenting for ERCP.InterventionsSubjects were randomized into 2 fluoroscopy setting groups: (1) time-limited, where x-ray exposure is limited to 3 seconds each time the foot-operated switch is depressed; (2) continuous, where x-ray exposure continues for as long as the switch is depressed.Main Outcomes MeasurementsFT, patient, and procedure-related data were recorded. Radiation dosimetry badges were used to estimate cumulative exposure.ResultsNinety-nine procedures were performed in the time-limited group and 100 by using continuous fluoroscopy. The mean FT for time-limited fluoroscopy was 284.4 seconds (95% confidence interval [CI] 247.1-321.6) and for continuous fluoroscopy was 314 seconds (95% CI 265.6-362.4; P = .34). Longer FT was associated with moderate or difficult cannulation (P = .008), lithotripsy (P < .001), stent placement (P = .007), sphincterotomy (P < .001), and longer overall procedure length (P < 0.001). After controlling for confounding factors and interactions with a multiple linear regression model, time-limited fluoroscopy was associated with a 16.4% lower FT (P = .029). The average radiation dose was not amenable to multivariate analysis, and, therefore, no significant difference between groups was found.LimitationsEndoscopists were not blinded to the study group assignments.ConclusionsFT and radiation exposure are dependent upon numerous patient-, operator-, and procedure-related factors. This study found that, after controlling for the impact of confounding factors, time-limited fluoroscopy significantly decreases FTs.