A new study is raising concerns about the radiation dose received when a pregnant woman presents with symptoms of cholangitis, gallstone pancreatitis, or other conditions requiring endoscopic retrograde cholangiopancreatography (ERCP).
Researchers from Greece found that the radiation risks associated with ERCP procedures are not trivial, but that radiation dose can be accurately estimated regardless of imaging parameters, equipment used, or gestational stage of the fetus. The study and the dose estimation guidelines appear in Gastrointestinal Endoscopy (April 2009, Vol. 69:4, pp. 824-831).
Dr. Eleni Samara and colleagues examined 24 consecutive male and female patients who received therapeutic ERCP for conditions including cholangitis, choledocholithiasis, pancreatitis, stent extraction, and pancreatic and bile duct tumors. No patients were pregnant or suspected of being pregnant. Doses were estimated using a Monte Carlo N-particle transport code.
The radiation doses estimated for a theoretical fetus in the 24 ERCP procedures ranged from 3.4 mGy to 55.9 mGy. Tabulated data included in the article allow clinicians to calculate the fetal radiation dose.
Fetal dose from ERCP procedures may occasionally exceed 10 mGy, a considerably greater value than previously reported, they concluded. In cases with pregnant patients, special efforts should be made to minimize the fetal radiation burden.
An accompanying editorial by Dr. Todd Baron and Beth Schueler, Ph.D., from the Mayo clinic in Rochester, MN, offers guidelines for the safe and effective use of fluoroscopy for minimizing dose during ERCP in pregnant women.
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