Abstracts

total costs for the whole initial treatment, including hospitalization, were notdifferent between the two stent types (plastic €4,120 vs. SEMS €4,592; pZ0.29). Totalcosts for all endoscopic procedures, initial placement and reinterventions, werelower for plastic stents vs. SEMS (2,434 vs. €2,078; pZ0.04), whereas total costs forhospitalization were slightly higher in de plastic stent group (€5,336 vs. €4,536;pZ0.23). As a result, total costs per patient were not significantly different betweenplastic stents and SEMS (7,320 vs. €6,932, pZ0.61). In patients with a short survival(% 3 months), total costs per patient were also not different between plastic stentsand SEMS (€6,796 vs. €6,538; pZ0.81). No differences in costs were found betweenpcSEMS and uSEMS placement. Conclusion: Although initial costs of stent place-ment are higher for SEMS than for plastic stents, total costs are not different be-tween both stent types, also in patients with a short survival (% 3 months). Since theclinical outcome for SEMS is favorable and total costs are not different, SEMSplacement is recommended for palliation in all patients with CBD obstruction.

607Delivery of Monthly Patient Radiation Exposure Report Cards toEndoscopists Significantly Reduces Patient Radiation ExposureDuring ERCP: a Prospective Quality Improvement StudyNirav C. Thosani*, Shai Friedland, Ann M. Chen, Shivangi Kothari,Rajan Kochar, Charles Liao, Subhas BanerjeeGastroenterology & Hepatology, Stanford University, Stanford, CABackground: Patients exposure to radiation during ERCP may increase their lifetimerisk of developing cancer. In prior studies we demonstrated that low volume en-doscopists (LVE) exposed patients to significantly higher amounts of radiationcompared to high volume endoscopists (HVE) and that educating endoscopists influoroscopy best practices significantly reduced patient radiation exposure duringERCP for both LVE and HVE. Aim: To prospectively evaluate the impact of monthlyradiation exposure report cards to endoscopists, on radiation exposure to patientsduring ERCP. Methods: All endoscopists performing ERCP at a tertiary care centerreceived individualized monthly Patient Radiation Exposure Report Cards high-lighting radiation parameters including Fluoroscopy Time, Effective Radiation Doseand Dose Area Product (DAP) for their procedures, along with patient radiationexposure data for the best performing endoscopist (anonymous) as a comparator.The report card reinforced education on fluoroscopy best practices to minimizepatient radiation exposure, including minimizing fluoroscopy time, image collima-tion, use of lower magnification images, reducing frame rates & spot films. Radiationparameters were prospectively collected over a 3 month period for 2 HVE and 7 LVE(endoscopists performing!200 ERCPs/yr) and compared with data on ERCPs per-formed by the same endoscopists over a 12-month period prior to the educationalprogram, obtained from a prospectively maintained database. Results: Radiation dataon 811 ERCPs was analyzed: Pre-education (nZ331), Post-education (nZ252), Lagperiod (nZ232) was compared with that of 92 patients undergoing ERCP followingdelivery of a monthly report card (Table 1). Overall, monthly report cards resulted insignificant decline in median DAP and median Effective Radiation Dose for both HVEand LVE. A significant decline in Fluoroscopy Time was noted for HVE, while a trendtowards lower Fluoroscopy Time was noted for LVE. Significant increases werenoted in the use of collimation and in the proportion of lower magnification imagesfor both HVE and LVE. Compared to the lag period before delivery of report cards,reduction in median DAP was greater for HVE (37%), compared to LVE (21%)(Figure 1). HVE performed significantly better than LVE for all radiation parametersafter receiving the report card. None of the endoscopists reported any compromisein their ability to interpret and perform ERCP despite incorporating fluoroscopy bestpractices. Conclusion: 1. Delivery of a monthly Radiation Exposure Report Cardsignificantly reduces patient radiation exposure during ERCP. 2. All endoscopists(HVE & LVE) benefited from a monthly report card highlighting their radiationutilization, allowing for significant reductions in patient radiation exposure, withoutcompromising their ability to perform & interpret ERCP.

Table 1. Radiation Exposure parameters Pre and Post education,during the Lag period and following a Monthly Report Card

Parameter

AB158 GASTROINT

PreEducation

ESTINAL E

PostEducation

NDOSCO

LagPeriod

PY Vo

MonthlyReport Card

lume 79, No

p value(Trend)

Overall

Fluoroscopy Time (minutes) 5.6 3.3 3.05 1.95 !0.001 Total Effective Dose

(mGy)(Median)

80.1 51.9 50.42 31.85 !0.001

Dose Area Product (DAP)(Gycm2)

9.6

6.19 3.02 2.99 !0.001

No. of images/procedure

6 5 4 4 !0.001 Collimation of any image

(%)

16% 80% 77% 90% !0.001

% of images that are lowmagnification

10%

19% 34% 72% !0.001

Low Volume Endoscopist (!200ERCP/Year)

Fluoroscopy Time (minutes) 4 3.75 3.5 2.2 0.395 Total Effective Dose (mGy) 98.3 46.89 60.92 41.1 0.012 Dose Area Product

(DAP)(Gycm2)

13.98 7.21 7.95 6.25 !0.001

. 5S : 2014

Parameter

Pre

Education

Post

Education

Lag

Period

Monthly

Report Card

www.giejo

p value(Trend)

No. of images/procedure

6 4 5 5 0.154 Collimation of any image

(%)

22% 54% 54% 71% !0.001

% of images that are lowmagnification

42%

56% 40% 49% 0.991

High Volume Endoscopist (O200ERCP/Year)

Fluoroscopy Time (minutes) 6 3.3 2.6 1.9 !0.001 Total Effective Dose (mGy) 74.13 53.14 48.22 31.51 !0.001 Dose Area Product

(DAP)(Gycm̂2)

8.8 5.71 4.35 2.75 !0.001

No. of images/procedure

6 5 4 4 !0.001 Collimation of any image

(%)

10% 85% 84% 95% !0.001

% of images that are lowmagnification

1%

14% 32% 79% !0.001

608A Nationwide Quality Registry - Endoscopist-Related Predictors ofProcedural Outcome in ERCPVivian E. Ekkelenkamp*1, Frank Ter Borg2, Pieter Ter Borg3,Marco J. Bruno1, Marcel Groenen4, Robert a. De Man1, Erik Rauws5,Antonie J. P. Van Tilburg6, Arjun D. Koch11Department of Gastroenterology and Hepatology, Erasmus UniversityMedical Center, Rotterdam, Netherlands; 2Department ofGastroenterology and Hepatology, Deventer Hospital, Deventer,Netherlands; 3Department of Gastroenterology and Hepatology, IkaziaHospital, Rotterdam, Netherlands; 4Department of Gastroenterology andHepatology, Rijnstate Hospital, Arnhem, Netherlands; 5Department ofGastroenterology and Hepatology, Academic Medical Center,Amsterdam, Netherlands; 6Department of Gastroenterology andHepatology, Sint Franciscus Gasthuis, Rotterdam, NetherlandsIntroduction: The interest in quality of outcome of ERCPs is increasing. However,real-life data on procedural outcome and quality of ERCP are sparse. The Rotter-dam Assessment Form for ERCP (RAF-E) is an easy-to-use web-based ERCP registrytool. The aim of this study was to evaluate ERCPs in the Netherlands and to relateendoscopist-dependent factors to procedural outcome. Methods: All ERCP-per-forming endoscopists in the Netherlands were invited to participate and wereenabled to register their ERCPs over a one-year period using the RAF-E. The primaryoutcome was procedural success. The a priori difficulty level of the procedure wasclassified according to Schutz’s grade. Baseline characteristics of the endoscopist, forinstance previous experience, were recorded at entry. Difficulty degree level 1procedures with the intention to perform complete stone extraction or stentplacement in patients with native papillary anatomy were included in this analysis tocompare procedural outcome. This type of ERCP was chosen because it is consid-ered to be one of the routine indications to perform ERCPs and carried out by all

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