Radiation exposure to patients during ERCP is significantly higher with low-volume endoscopists

Background: Patients are exposed to radiation during ERCP, and this may increase their lifetime risk of the development of cancer and other deleterious radiation effects. Objective: To evaluate the association between the endoscopist's ERCP volume and the patient radiation dose during ERCP. Design: Single-center, retrospective study. Setting: Tertiary referral center. Patients and Interventions: A total of 197 patients undergoing 331 ERCPs. Main Outcome Measurements: Patient radiation exposure parameters including fluoroscopy time, total radiation dose, dose area product, and effective dose for all ERCPs performed at our academic medical center by 2 high-volume endoscopists (HVEs) (<= 200 ERCPs/year) and 7 low-volume endoscopists (LVEs). Radiation exposure for each ERCP was adjusted against a validated procedure complexity scale and the Stanford Fluoroscopy Complexity Score, which was created based on the numbers of interventions that would mandate additional radiation exposure. Results: ERCPs performed by LVEs were associated with a significantly higher median total radiation dose (98.30 mGy vs 74.13 mGy), dose area product (13.98 Gy-cm(2) vs 8.8 Gy-cm(2)), and effective dose (3.63 mSv vs 2.28 mSv), despite lower median Stanford Fluoroscopy Complexity Scores (3.0 vs 6.0) compared with HVEs. No significant difference was noted in median fluoroscopy time (4.0 minutes vs 3.30 minutes) between LVEs and HVEs. Limitations: Retrospective, single-center study at a tertiary referral center. Conclusion: ERCPs performed by LVEs are associated with significantly higher radiation exposure to patients compared with those performed by HVEs despite the fact that procedures performed by HVEs are of greater complexity.