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World J Clin Cases. Dec 26, 2018; 6(16): 1087-1093
Published online Dec 26, 2018. doi: 10.12998/wjcc.v6.i16.1087
Radiation exposure during image-guided endoscopic procedures: The next quality indicator for endoscopic retrograde cholangiopancreatography
Shiro Hayashi, Mamoru Takenaka, Makoto Hosono, Tsutomu Nishida
Shiro Hayashi, Department of Gastroenterology and Internal Medicine, Hayashi Clinic, Osaka, Suita 564-0018, Japan
Shiro Hayashi, Tsutomu Nishida, Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka, Toyonaka 560-8565, Japan
Mamoru Takenaka, Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Sayama 589-8511, Japan
Makoto Hosono, Department of Radiology, Kindai University Faculty of Medicine, Osaka, Sayama 589-8511, Japan
Author contributions: Hayashi S wrote the initial draft of the manuscript; Takenaka M, Hosono M and Nishida T critically reviewed the manuscript.
Conflict-of-interest statement: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this paper.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author to: Tsutomu Nishida, MD, PhD, Doctor, Department of Gastroenterology, Toyonaka Municipal Hospital, 4-14-1 Shibahara, Osaka, Toyonaka 560-8565, Japan. tnishida.gastro@gmail.com
Telephone: +81-6-68430101 Fax: +81-6-68583531
Received: September 25, 2018
Peer-review started: September 25, 2018
First decision: October 11, 2018
Revised: October 23, 2018
Accepted: October 31, 2018
Article in press: November 1, 2018
Published online: December 26, 2018
Processing time: 91 Days and 17.1 Hours
Abstract

Endoscopic retrograde cholangiopancreatography (ERCP) is one of the most frequently used image-guided procedures in gastrointestinal endoscopy. Post-ERCP pancreatitis is an important concern, and prophylaxis, cannulation and other related technical procedures have been well documented by endoscopists. In addition, medical radiation exposure is of great concern in the general population because of its rapidly increasing frequency and its potential carcinogenic effects. International organizations and radiological societies have established diagnostic reference levels, which guide proper radiation use and serve as global standards for all procedures that use ionizing radiation. However, data on gastrointestinal fluoroscopic procedures are still lacking because the demand for these procedures has recently increased. In this review, we present the current status of quality indicators for ERCP and the methods for measuring radiation exposure in the clinical setting as the next quality indicator for ERCP. To reduce radiation exposure, knowledge of its adverse effects and the procedures for proper measurement and protection are essential. Additionally, further studies on the factors that affect radiation exposure, exposure management and diagnostic reference levels are necessary. Then, we can discuss how to manage medical radiation use in these complex fluoroscopic procedures. This knowledge will help us to protect not only patients but also endoscopists and medical staff in the fluoroscopy unit.

Keywords: Quality indicator; Fluoroscopic procedures; Endoscopic retrograde cholangiopancreatography; Diagnostic reference levels; Radiation exposure

Core tip: Endoscopic retrograde cholangiopancreatography (ERCP) is one of the most frequently performed image-guided procedures in gastrointestinal endoscopy. Among several quality measures of endoscopic procedures, including ERCP, radiation exposure is still not well documented. In the general population, medical radiation exposure is of great concern because of its rapid increase and potential carcinogenesis. International organizations have established diagnostic reference levels for proper use, which are now global standards. Therefore, radiation exposure represents the next quality indicator for ERCP. We must understand the adverse effects, the requirements for protection and other influencing factors. This knowledge will help us to protect patients, medical staff and endoscopists.