@article{70a4bf8912354f01819442f59967cafe,
title = "Predictors of Prolonged Fluoroscopy Exposure in Pediatric Endoscopic Retrograde Cholangiopancreatography: Results from the Large Pediatric Endoscopic Retrograde Cholangiopancreatography Database Initiative Multicenter Cohort",
abstract = "Background and Aims:Ionizing radiation exposure during endoscopic retrograde cholangiopancreatography (ERCP) is an important quality issue especially in children. We aim to identify factors associated with extended fluoroscopy time (FT) in children undergoing ERCP.Methods:ERCP on children <18 years from 15 centers were entered prospectively into a REDCap database from May 2014 until May 2018. Data were retrospectively evaluated for outcome and quality measures. A univariate and step-wise linear regression analysis was performed to identify factors associated with increased FT.Results:1073 ERCPs performed in 816 unique patients met inclusion criteria. Median age was 12.2 years (interquartile range [IQR] 9.3-15.8). 767 (71%) patients had native papillae. The median FT was 120 seconds (IQR 60-240). Factors associated with increased FT included procedures performed on patients with chronic pancreatitis, ERCPs with American Society of Gastrointestinal Endoscopy (ASGE) difficulty grade >3, ERCPs performed by pediatric gastroenterologist (GI) with adult GI supervision, and ERCPs performed at non-free standing children's hospitals. Hispanic ethnicity was the only factor associated with lower FT.Conclusion:Several factors were associated with prolonged FTs in pediatric ERCP that differed from adult studies. This underscores that adult quality indicators cannot always be translated to pediatric patients. This data can better identify children with higher risk for radiation exposure and improve quality outcomes during pediatric ERCP.",
keywords = "Endoscopic retrograde cholangiopancreatography difficulty grade, Pancreatic endoscopic retrograde cholangiopancreatography, Pediatric endoscopy quality indicator, Radiation exposure",
author = "Liu, {Quin Y.} and Wenly Ruan and Fishman, {Douglas S.} and Barth, {Bradley A.} and Tsai, {Cynthia Man Wai} and Giefer, {Matthew J.} and Kim, {Kyung Mo} and Mercedes Martinez and Luigi Dall'Oglio and {De Angelis}, Paola and Filippo Torroni and Simona Faraci and Sam Bitton and Michael Wilsey and Khalaf, {Racha T.} and Steven Werlin and Kulwinder Dua and Clifton Huang and Roberto Gugig and Petar Mamula and Fox, {Victor L.} and Grover, {Amit S.} and Quiros, {J. Antonio} and Yuhua Zheng and Troendle, {David M.}",
note = "Funding Information: This was a retrospective evaluation of prospectively collected data for the Pediatric ERCP Database Initiative (PEDI). Consecutive ERCP on children <18 years of age were collected from 15 centers over a 4-year period from May 2014 until May 2018. Institutional Review Board (IRB) approval was obtained from all participating centers. Consent for study participation was obtained at centers where it was required by their IRB. Pre-procedure, procedure and post-procedure forms were completed for all patients. Study data were collected and managed using REDCap (Research Electronic Data Capture) electronic data capture tools hosted at UT Southwestern Medical Center . REDCap is a secure, web-based application designed to support data capture for research studies, providing an intuitive interface for validated data entry; audit trails for tracking data manipulation and export procedures; automated export procedures for seamless data downloads to common statistical packages; and procedures for importing data from external sources. Pre-procedure forms included patient information such as demographics, procedure indications and pre-procedure laboratory results (Figure 1, Supplemental Digital Content, http://links.lww.com/MPG/C584 ) . Procedure forms included information such as procedure indication, ASGE difficulty grade , endoscopic maneuvers performed, procedure time, trainee participation, and FT. Post-procedure forms included information such as complications . Cases were excluded if an additional procedure requiring fluoroscopy exposure was performed during the same session. Univariate and stepwise linear regression was performed to identify factors associated with increased FT. This study was supported by the UT Southwestern Academic Information System (CTSA NIH Grant UL1-RR024982) and the REDCap project. Publisher Copyright: {\textcopyright} 2022 Lippincott Williams and Wilkins. All rights reserved.",
year = "2022",
month = mar,
day = "1",
doi = "10.1097/MPG.0000000000003347",
language = "English (US)",
volume = "74",
pages = "408--412",
journal = "Journal of Pediatric Gastroenterology and Nutrition",
issn = "0277-2116",
publisher = "Lippincott Williams and Wilkins",
number = "3",
}