Post written by Anmol Singh, MBBS, and Venkata Akshintala, MD, from the Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.

Our study highlights the quantity of radiation exposure incurred during common and novel endoscopic procedures and elucidates the factors affecting it.

There has been an upward trend in the quantity and complexity of endoscopic procedures requiring fluoroscopy. Elevated levels of radiation exposure pose considerable risks; yet, precise monitoring and quantifying such exposure present persistent challenges.

Moreover, existing literature on radiation exposure inadequately accounts for variables such as procedural complexity and anatomical variations.

The median effective dose (ED) of radiation incurred during interventional EUS procedures was significantly higher than that observed during ERCP (4.3 vs 2.11 mSv, P = .002). Among patients undergoing ERCP-guided management of hilar stricture and EUS-guided enteroenterostomy, notable radiation doses of 94.6 mSv and 55.52 mSv were recorded.

A discernible rise in radiation exposure was noted with an increasing difficulty grading for biliary procedures (3.4 vs 1.56 mSv, P < .05), with a parallel trend toward heightened ED with increasing difficulty of pancreatic procedures (2.22 vs 4.08 mSv), although statistical significance was not attained, potentially constrained by a limited number of procedures in the analysis.

Patient-specific factors also exerted a significant impact on radiation exposure, with a higher median ED evident in patients with altered anatomy than those with nonaltered anatomy (2.34 vs 1.79 mSv, P = .03).

In addition, an upward trajectory in ED was observed with an increase in body mass index, with the group at 35 to 39.9 kg/m² receiving a greater ED than patients with a body mass index <30 kg/m² (3.14 vs 2.1 mSv).

Patients undergoing novel interventional EUS procedures exhibit significantly elevated radiation exposure compared with other endoscopy procedures. To mitigate the effects of increasing radiation dose, efforts should focus on quantifying and establishing standardized quality measures for acceptable radiation exposure in endoscopy. Optimizing x-ray tube positioning and fluoroscopy settings as well as implementing protective measures (eg, under-table shields, consistent dosimetry device usage) are crucial in reducing radiation exposure and should be standard practices.

Further studies are warranted to quantify dosimetry data for endoscopists and procedure staff.

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