Mrinal Garg

Ocular Radiation Threshold Projection Based off of Fluoroscopy Time During ERCP

OBJECTIVES:Current international guidelines for ocular radiation exposure suggest a threshold of 20 millisieverts (mSv)/year. Although endoscopists wear lead aprons, use of protective eye wear is optional. This study was conducted to analyze the lens radiation exposure during endoscopic retrograde cholangiopancreatography (ERCP) for endoscopists to determine the time of fluoroscopy needed to warrant using lens protection during ERCP.METHODS:ERCP patients were prospectively enrolled. Indications, interventions, fluoroscopy time, dose, and attending ± fellow involvement were recorded. Radiation exposure was collected from body dosimeters and dosimeters placed between the eyes. Cumulative radiation doses were obtained at study completion and averaged over the total fluoroscopy time to determine the mSv/hour exposure.RESULTS:A total of 187 cases were included. Attendings and fellows wore lens dosimeters in 178 and 126 cases, respectively, and body dosimeters in 174 and 128 cases, respectively. Attendings and fellows wore lens dosimeters throughout 15.89 and 11.24 h of fluoroscopy, respectively. The cumulative radiation dose absorbed per lens dosimeters was 5.35 mSv for attendings and 2.55 mSv for fellows. The projected lens absorption by the body dosimeters was 19.03 mSv for attendings and 5.21 mSv for fellows. The hourly fluoroscopy lens exposure was 0.34 mSv/hour for attendings and 0.23 mSv/hour for fellows.CONCLUSIONS:The amount of fluoroscopy hours needed to reach the currently suggested lens threshold limit (20 mSv/year) was 59.41 h for attendings and 88.17 h for fellows. Radioprotective eye wear should be worn by physicians with yearly fluoroscopy times in similarly structured practices that meet or exceed these thresholds.

Argon Plasma Coagulation for Extraction of an Impacted Trapezoid Basket in the Pancreatic Duct

We performed endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy for pancreatic stent placement on a 55-year-old woman with a dilated pancreatic duct, pancreatic duct stone, and chronic pancreatitis. During follow-up ERCP, the lithotripter traction wire fractured during electrohydraulic lithotripsy and mechanical lithotripsy. Multiple attempts using standard techniques to clear the lithotripter and stone failed. Argon plasma coagulation (APC) was used to ablate 2 of the lithotripter wires, and the lithotripter was disengaged from the stone and removed.

Argon plasma coagulation treatment of intraductal papillary neoplasm of biliary tract: an alternative approach

re 1. A, MRCP view showing dilated common bile and hepatic ducts. B, ERCP view showing mucobilia as a filling defect that was aggressively cleared . No mass lesion was seen on occlusion cholangiogram following clearance (right). C, Fluoroscopic image of adult gastroscope in the common bile D, Endoscopic view showing the common hepatic duct and bifurcations. E, Endoscopic view showing nodularities of the cystic duct (left) with w-band imaging (right). F, Staining of biopsy specimen showing intraductal papillary neoplasm of the bile duct, gastric type. Mucinous elium-forming papillary structures also seen here (left, H&E, orig. mag. 10; right, H&E, orig. mag. 20). G, Post-argon plasma coagulation treatt of nodularities.

Argon plasma coagulation treatment of biliary adenomas in a patient with familial adenomatous polyposis

Familial Adenomatous Polyposis (FAP) is a genetic condition characterized by extensive adenoma development throughout the gastrointestinal (GI) tract. GI neoplasias have been removed via endoscopic submucosal dissection in patients with FAP after total colectomy [1]. However, treatment modalities for biliary adenomas as a complication of FAP are not well described. We describe a case of a 70 year old male with attenuated FAP treated initially with total colon resection with ileorectal anastomosis. This article is protected by copyright. All rights reserved.