To evaluate whether cholangioscopy-assisted ERCP is associated with reduced fluoroscopy exposure compared to conventional fluoroscopy-guided ERCP in patients with choledocholithiasis.
Approach:
Statistical Analysis: Confounding was addressed using stabilized inverse probability of treatment weighting (IPTW).
Key Findings:
Median radiation-dose reading was lower in the cholangioscopy-assisted group (9.93 mGy) compared to the conventional group (14.64 mGy, p < 0.001).
Cholangioscopy assistance was associated with a reduced radiation-dose reading (GMR 0.687, 95% CI 0.610–0.774; p < 0.001) and lower risk of high radiation exposure (risk ratio 0.301, 95% CI 0.095–0.955; p = 0.042).
Procedure time and hospitalization cost were higher in the cholangioscopy group, while length of stay was shorter.
Complete duct clearance in one session was 88.0% for cholangioscopy-assisted ERCP versus 94.0% for conventional ERCP.
All post-ERCP pancreatitis cases were mild, with no statistically significant difference in short-term adverse events between groups.
Interpretation:
Cholangioscopy-assisted ERCP was associated with lower intra-procedural radiation exposure without a significant increase in short-term adverse events, although it resulted in longer procedure duration and higher costs.
Limitations:
Single-center study may limit generalizability.
Retrospective design may introduce selection bias.
Short follow-up period may not capture long-term outcomes.
Conclusion:
Cholangioscopy-assisted ERCP may reduce radiation exposure in the management of choledocholithiasis, but further prospective studies are needed to confirm these findings.
