Measures of patient radiation exposure during endoscopic retrograde cholangiography:Beyond fluoroscopy time

AIM:to determine whether fluoroscope time is a good predictor of patient radiation exposure during endoscopic retrograde cholangiopancreatography.METHODS:this is a prospective observational study of consecutive patients undergoing endoscopic retrograde cholangiopancreatography in a tertiary care setting.Data related to radiation exposure were collected.The following measures were obtained:Fluoroscopy time(FT),dose area product(DAP)and dose at reference point(DOSERP).Coefficients of determination were calculated to analyze the correlation between FT,DAP and DOSRP.Agreement between FT and DAP/DOSRP was assessed using Bland Altman plots.RESULTS:Four hundred sixty-three data sets were obtained.Fluoroscopy time average was 7.3 min.Fluoroscopy related radiation accounted for 86%of the total DAP while acquisition films related radiation accounted for 14%of the DAP.For any given FT there are wide ranges of DAP and DOSERP and the variability in both increases as fluoroscopy time increases.The coefficient of determination(R2)on the non transformed data for DAP and DOSERP versus FT were respectively 0.416 and0.554.While fluoroscopy use was the largest contributor to patient radiation exposure during endoscopic retrograde cholangiography(ERCP),there is a wide variability in DAP and DOSERP that is not accounted for by FT.DAP and DOSERP increase in variability as FT increases.This translates into poor accuracy of FT in predicting DAP and DOSERP at higher radiation doses.CONCLUSION:DAP and DOSERP in addition to FT should be adopted as new ERCP quality measures to estimate patient radiation exposure.

Organ and function preservation in gastrointestinal cancer: Current and future perspectives on endoscopic ablation

The escalating prevalence of gastrointestinal cancers underscores the urgency for transformative approaches.Current treatment costs amount to billions of dollars annually,combined with the risks and comorbidities associated with invasive surgery.This highlights the importance of less invasive alternatives with organ preservation being a central aspect of the treatment paradigm.The current standard of care typically involves neoadjuvant systemic therapy followed by surgical resection.There is a growing interest in organ preservation approaches by way of minimizing extensive surgical resections.Endoscopic ablation has proven to be useful in precursor lesions,as well as in palliative cases of unrese-ctable disease.More recently,there has been an increase in reports on the utility of adjunct endoscopic ablative techniques for downstaging disease as well as contributing to non-surgical complete clinical response.This expansive field within endoscopic oncology holds great potential for advancing patient care.By addressing challenges,fostering collaboration,and embracing technological advancements,the gastrointestinal cancer treatment paradigm can shift towards a more sustainable and patient-centric future emphasizing organ and function preservation.This editorial examines the evolving landscape of endoscopic ablation strategies,emphasizing their potential to improve patient outcomes.We briefly review current applications of endoscopic ablation in the esophagus,stomach,duodenum,pancreas,bile ducts,and colon.