How safe is ERCP to the endoscopist ?

• Published in: Surgical endoscopy Vol. 11; no. 6; pp. 615 - 617
• Main Authors: COHEN, R. V, ALDRED, M. A, PAES, W. S, FAUSTO, A. M. F, NUCCI, J. R, YOSHIMURA, E. M, OKUNO, E, GARCIA, M. E, MARUTA, L. M, TOLOSA, E. M. C
• Format: Journal Article
• Language: English
• Published: New York, NY Springer 01.06.1997
• Subjects: Biological and medical sciences; Cholangiopancreatography, Endoscopic Retrograde - standards; Digestive system. Abdomen; Dose-Response Relationship, Radiation; Endoscopy; Fluoroscopy - standards; Gallstones - surgery; Humans; Investigative techniques, diagnostic techniques (general aspects); Maximum Allowable Concentration; Medical sciences; Occupational Exposure - standards; Phantoms, Imaging; Radiation Dosage; Radiation Protection - standards; Reference Standards; Safety; X-Rays - adverse effects; Human; Biliary tract; Cholangiopancreatography; Evaluation; Radiodiagnosis; Retrograde; Biliary tract disease; Experimental study; Prevention; Radiation dose; Combinatorial method; Public health organization; Irradiation; Lithiasis; Digestive diseases; Sphincterotomy; Endoscopy; Radiation protection; Comparative study
• ISSN: 0930-2794; 1432-2218
• DOI: 10.1007/s004649900405

Interventional techniques in endoscopy such as endoscopic retrograde cholangiopancreatography (ERCP) have greatly increased since laparoscopic cholecystectomy has become widespread; mainly these techniques deal with common bile duct stones. Fluoroscopy is usually employed, and chronic exposure to X-ray, in spite of the relative low dose, can lead to potentially unhealthy conditions such as malignancies like bone marrow and other solid cancers. A median of 18 years of life is lost per fatal cancer, including the time of latency since exposure. Nor should one forget benign condition such as cataracts that can lead to partial or complete blindness and which surely impair life's quality. Simulated examinations were carried at the University Hospital (São Paulo, Brazil) using an anthropomorphic phantom in place of the physician. Four sets of dosimeters were placed in the forehead, neck, torso, and lower abdomen (with and without a lead apron) and standard ERCP fluoroscopic techniques were employed. The dose equivalents were calculated and compared to the recommended exposure doses of national and international boards of radiation protection. Based on the results found and compared to standards, working safely means: (1) A lead (0.5 mm thickness) apron is fundamental. Without it less than one ERCP\month should be performed. (2) With an apron, 23 examinations/month are allowed. (3) No thyroid protection grants only 19 exams/month. (4) Performing ERCP without lead glasses is hazardous to the eye, allowing only seven ERCPs monthly.