Clinical Report: Cholangioscopy-Enhanced ERCP Minimizes Radiation Exposure

Overview

Cholangioscopy-assisted ERCP significantly reduces intra-procedural radiation exposure compared to conventional ERCP in managing choledocholithiasis.

Background

The management of common bile duct stones (CBDS) is critical due to their association with serious complications such as acute cholangitis and pancreatitis. Conventional ERCP, while effective, poses risks related to radiation exposure and may not always ensure complete duct clearance.

Data Highlights

Key Findings

• Cholangioscopy-assisted ERCP resulted in a median radiation dose of 9.93 mGy compared to 14.64 mGy for conventional ERCP (p < 0.001).
• After IPTW adjustment, cholangioscopy assistance was associated with a geometric mean ratio of 0.687 for radiation dose (95% CI 0.610–0.774; p < 0.001).
• The risk of high radiation exposure was significantly lower in the cholangioscopy group (risk ratio 0.301, 95% CI 0.095–0.955; p = 0.042).
• Procedure time and hospitalization costs were higher in the cholangioscopy group, while length of stay was shorter.
• Complete duct clearance in one session was achieved in 88.0% of cholangioscopy patients versus 94.0% in the conventional group.
• All post-ERCP pancreatitis cases were mild, with no significant difference in short-term adverse events between the two groups.

Clinical Implications

The findings suggest that cholangioscopy-assisted ERCP may be a safer alternative for managing choledocholithiasis by reducing radiation exposure. Clinicians should consider the balance between the benefits of reduced radiation and the increased procedure time and costs when selecting treatment options.

Conclusion

Cholangioscopy-assisted ERCP demonstrates a significant reduction in radiation exposure.

Related Resources & Content

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2. Surgical Endoscopy, 2025 -- Evaluating Diagnostic Approaches for Suspected Common Bile Duct Stones
3. Surgical Endoscopy, 2024 -- Evaluation of Intraoperative Versus Preoperative ERCP in Laparoscopic Cholecystectomy for Cholecystocholedocholithiasis: A Three-Year Analysis at Kepler University Hospital
4. Endoscopic management of common bile duct stones: European Society of Gastrointestinal Endoscopy (ESGE) guideline | ESGE
5. Peroral cholangioscopy for detecting residual stones missed by cholangiography: Systematic review and meta-analysis - PMC
6. A comparative study of extracorporeal shock wave lithotripsy and cholangioscopy-guided lithotripsy in the management of complex biliary stones: A randomized trial - PubMed
7. Surgical Endoscopy — Erratum: Nonradiation Endoscopist ERCP Shows Comparable Efficacy to Conventional ERCP
8. Endoscopic management of common bile duct stones: European Society of Gastrointestinal Endoscopy (ESGE) guideline | ESGE
9. Peroral cholangioscopy for detecting residual stones missed by cholangiography: Systematic review and meta-analysis - PMC
10. A comparative study of extracorporeal shock wave lithotripsy and cholangioscopy-guided lithotripsy in the management of complex biliary stones: A randomized trial - PubMed