HOW SAFE IS ERCP TO THE ENDOSCOPIST

Background: Interventional techniques in endoscopy such as endoscopic retrograde cholangiopancreatography (ERCP) have greatly increased sinc e laparoscopic cholecystectomy has become widespread; mainly these tec hniques deal with common bile duct stones. Fluoroscopy is usually empl oyed, and chronic exposure to X-ray, in spite of the relative low dose , can lead to potentially unhealthy conditions such as malignancies li ke bone marrow and other solid cancers. A median of Is years of life i s lost per fatal cancer, including the time of latency since exposure. Nor should one forget benign condition such as cataracts that can lea d to partial or complete blindness and which surely impair life's qual ity. Methods: Simulated examinations were carried at the University Ho spital (Sao Paulo, Brazil) using an anthropomorphic phantom in place o f the physician. Four sets of dosimeters were placed in the forehead, neck, torso, and lower abdomen (with and without a lead apron) and sta ndard ERCP fluoroscopic techniques were employed. Results: The dose eq uivalents were calculated and compared to the recommended exposure dos es of national and international boards of radiation protection. Concl usions: Based on the results found and compared to standards, working safely means: (1) A lead (0.5 mm thickness) apron is fundamental. With out it less than one ERCP\month should be performed. (2) With an apron , 23 examinations/month are allowed. (3) No thyroid protection grants only 19 exams/month. (4) Performing ERCP without lead glasses is hazar dous to the eye, allowing only seven ERCPs monthly.