Predictors of Fluoroscopy Exposure During Endoscopic Retrograde Cholangiopancreatography
Bibliographic record
Abstract
Aims Endoscopic retrograde cholangiopancreatography (ERCP) is a well-established procedure for treating pancreaticobiliary conditions. However, it relies on fluoroscopy use, exposing both the patient and the medical team to ionizing radiation. Understanding the factors associated with prolonged fluoroscopy time—used as an indicator of radiation dose—may improve safety practices and inform patient care. This study aims to identify patient, endoscopist, and institutional factors that predict prolonged fluoroscopy time during ERCP. Methods Data was obtained from a prospective, multi-center, high-fidelity ERCP registry. Patients undergoing ERCP at participating centers provided consent for voluntary enrollment. For each procedure, we documented patient, endoscopist, institutional, and peri-procedural variables. We defined prolonged fluoroscopy time to be≥2 minutes[NF1]. To identify predictors of prolonged fluoroscopy time, we employed stepwise multivariable logistic regression modeling. Statistical significance was set at a p-value of<0.05. Results 4,808 ERCPs were included in our multivariable logistic regression model. Following backwardsselection of variables, our final regression model included a total of 36 variables.Variables associated with increased odds of fluoroscopy time≥2 minutes include the following;trainee involvement (odds ratio, OR, 2.55, 95% confidence interval, CI, 2.20 – 2.97), stricturedilation performed (OR 2.15, 95% CI 1.57 – 2.97), biliary stent placement (OR 2.10, 95% CI1.77 – 2.49), use of double guidewire technique (OR 1.88, 95% CI 1.41 – 2.52), cytologybrushings performed (OR 1.88, 95% CI 1.47 – 2.40), prior sphincterotomy (OR 1.87, 95% CI1.54 – 2.27), presence of a proximal stricture (OR 1.87, 95% CI 1.50 – 2.33), 3-5 CBDcannulation attempts (OR 1.87, 95% CI 1.58 – 2.22), 6-10 CBD cannulation attempts (OR 3.11,95% CI 2.44 – 3.99), >10 CBD cannulation attempts (OR 6.81, 95% CI 4.99 – 9.40),cholangioscpoy performed (OR 1.75, 95% CI 1.08 – 2.92), outpatient setting (OR 1.26, 95% CI1.08 – 1.46), age (OR 1.01, 95% CI 1.01 – 1.01). Conversely, variables associated with lowerodds of fluoroscopy time≥2 minutes include; ERCP performed by female endoscopists (OR0.51, 95% CI 0.40 – 0.65), presence of institutional fluoroscopy training (OR 0.62, 95% CI 0.48– 0.80), presence of a distal stricture (OR 0.66, 95% CI 0.54 – 0.82), fluoroscopy controlled by aradiology technician (OR 0.73, 95% CI 0.59 – 0.90), cholodecholithiasis as the indication (OR0.77, 95% CI 0.64-0.92), Stent-related indications (OR 0.77, 95% CI 0.62 – 0.95), andendoscopist experience (OR 0.99, 95% CI 0.96 – 1.00). Conclusions Fluoroscopy duration during ERCP appears to be reduced in cases performed by female endoscopists and in endoscopists with more experience. Additionally, implementing formal fluoroscopy training and utilizing radiology technicians may reduce fluoroscopy exposure during ERCP. Publication History Article published online: 27 March 2025 © 2025. European Society of Gastrointestinal Endoscopy. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.016 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".