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CC BY-NC-ND 4.0 · Endosc Int Open 2024; 12(11): E1315-E1325
DOI: 10.1055/a-2427-3893
Original article

Defining standards for fluoroscopy in gastrointestinal endoscopy using Delphi methodology

Kareem Khalaf  ‡
1   Division of Gastroenterology, St Michael's Hospital, University of Toronto, Toronto, ON, Canada (Ringgold ID: RIN10071)
,
Katarzyna M. Pawlak  ‡
1   Division of Gastroenterology, St Michael's Hospital, University of Toronto, Toronto, ON, Canada (Ringgold ID: RIN10071)
,
Douglas G. Adler
2   Center for Advanced Therapeutic Endoscopy, Porter Adventist Hospital, Denver, USA (Ringgold ID: RIN14313)
,
Asma A. Alkandari
3   Thanyan Alghanim Center for Gastroenterology and Hepatology, Alamiri Hospital, Kuwait, Kuwait (Ringgold ID: RIN430617)
,
Alan N. Barkun 
4   Division of Gastroenterology and Hepatology, McGill University Health Centre, Montréal, QC, Canada
,
Todd H. Baron
5   Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina, United States
,
Robert Bechara 
6   Division of Gastroenterology, Queen's School of Medicine, Hotel Dieu Hospital, Kingston, ON, Canada
,
Tyler M. Berzin
7   Center for Advanced Endoscopy, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
,
Cecilia Binda 
8   Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Italy (Ringgold ID: RIN18568)
,
Ming-Yan Cai
9   Endoscopy Center and Endoscopy Research Instituter, Zhongshan Hospital, Fudan University, 180 FengLin Road, Shanghai, 200032, China (Ringgold ID: RIN92323)
,
Silvia Carrara
10   Department of Gastroenterology, Endoscopic Unit, IRCCS Humanitas Research Hospital, Milan, Italy (Ringgold ID: RIN9268)
,
Yen-I Chen
4   Division of Gastroenterology and Hepatology, McGill University Health Centre, Montréal, QC, Canada
,
Eduardo Guimarães Hourneaux de Moura 
11   Serviço de Endoscopia Gastrointestinal, Departamento de Gastroenterologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil (Ringgold ID: RIN117265)
,
Nauzer Forbes
12   Department of Medicine; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
,
Alessandro Fugazza
10   Department of Gastroenterology, Endoscopic Unit, IRCCS Humanitas Research Hospital, Milan, Italy (Ringgold ID: RIN9268)
,
Cesare Hassan 
10   Department of Gastroenterology, Endoscopic Unit, IRCCS Humanitas Research Hospital, Milan, Italy (Ringgold ID: RIN9268)
,
Paul D. James
13   Division of Gastroenterology, University Health Network, Toronto, Canada
,
Michel Kahaleh 
14   Gastroenterology, Rutgers Robert Wood Johnson Medical School New Brunswick, New Brunswick, United States (Ringgold ID: RIN43982)
,
Harry Martin
15   Pancreatobiliary Medicine, University College London Hospitals, London, UK (Ringgold ID: RIN8964)
,
Roberta Maselli
10   Department of Gastroenterology, Endoscopic Unit, IRCCS Humanitas Research Hospital, Milan, Italy (Ringgold ID: RIN9268)
,
Gary R. May
1   Division of Gastroenterology, St Michael's Hospital, University of Toronto, Toronto, ON, Canada (Ringgold ID: RIN10071)
,
Jeffrey D. Mosko
1   Division of Gastroenterology, St Michael's Hospital, University of Toronto, Toronto, ON, Canada (Ringgold ID: RIN10071)
,
Ganiyat Kikelomo Oyeleke
16   Department of Medicine, College of Medicine, Lagos University Teaching Hospital, Lagos, Nigeria (Ringgold ID: RIN291389)
,
Bret T. Petersen
17   Gastroenterology and Hepatology, Mayo Clinic, Rochester, USA
,
Alessandro Repici
10   Department of Gastroenterology, Endoscopic Unit, IRCCS Humanitas Research Hospital, Milan, Italy (Ringgold ID: RIN9268)
,
Payal Saxena
18   AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Chris O’Brien Lifehouse, Sydney, New South Wales, Australia (Ringgold ID: RIN2205)
,
Amrita Sethi
19   Endoscopy Center, Zhongshan Hospital, Fudan University, Shanghai, China (Ringgold ID: RIN21611)
,
Reem Z. Sharaiha 
20   Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, New York, United States
,
Marco Spadaccini
10   Department of Gastroenterology, Endoscopic Unit, IRCCS Humanitas Research Hospital, Milan, Italy (Ringgold ID: RIN9268)
,
Raymond Shing-Yan Tang
21   Department of Medicine and Therapeutics and Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong
,
Christopher W. Teshima
1   Division of Gastroenterology, St Michael's Hospital, University of Toronto, Toronto, ON, Canada (Ringgold ID: RIN10071)
,
Mariano Villarroel 
22   Department of Gastroenterology, Endoscopy Unit, Hospital Británico, Buenos Aires, Argentina (Ringgold ID: RIN62870)
,
Jeanin E. van Hooft 
23   Department of Gastroenterology & Hepatology, Leiden University Medical Center, Leiden, The Netherlands (Ringgold ID: RIN4501)
,
Rogier P. Voermans 
24   Department of Gastroenterology & Hepatology, Amsterdam University Medical Centres, Location AMC, University of Amsterdam, Amsterdam, The Netherlands (Ringgold ID: RIN522567)
,
Daniel von Renteln 
25   Division of Gastroenterology, Montreal University Hospital Center (CHUM), Montreal, Canada
,
Catharine M. Walsh 
26   Division of Gastroenterology, Hepatology and Nutrition, and the SickKids Research Institute, The Hospital for Sick Children, Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada (Ringgold ID: RIN7979)
,
Tricia Aberin
1   Division of Gastroenterology, St Michael's Hospital, University of Toronto, Toronto, ON, Canada (Ringgold ID: RIN10071)
,
Dawn Banavage
1   Division of Gastroenterology, St Michael's Hospital, University of Toronto, Toronto, ON, Canada (Ringgold ID: RIN10071)
,
Jowell A. Chen
1   Division of Gastroenterology, St Michael's Hospital, University of Toronto, Toronto, ON, Canada (Ringgold ID: RIN10071)
,
James Clancy
1   Division of Gastroenterology, St Michael's Hospital, University of Toronto, Toronto, ON, Canada (Ringgold ID: RIN10071)
,
Heather Drake
1   Division of Gastroenterology, St Michael's Hospital, University of Toronto, Toronto, ON, Canada (Ringgold ID: RIN10071)
,
Melanie Im
1   Division of Gastroenterology, St Michael's Hospital, University of Toronto, Toronto, ON, Canada (Ringgold ID: RIN10071)
,
Chooi Peng Low
1   Division of Gastroenterology, St Michael's Hospital, University of Toronto, Toronto, ON, Canada (Ringgold ID: RIN10071)
,
Alexandra Myszko
1   Division of Gastroenterology, St Michael's Hospital, University of Toronto, Toronto, ON, Canada (Ringgold ID: RIN10071)
,
Krista Navarro
1   Division of Gastroenterology, St Michael's Hospital, University of Toronto, Toronto, ON, Canada (Ringgold ID: RIN10071)
,
Jessica Redman
27   Division of Gastroenterology and Hepatology, Ottawa Hospital, Ottawa, Ontario, Canada (Ringgold ID: RIN27337)
,
Wayne Reyes
1   Division of Gastroenterology, St Michael's Hospital, University of Toronto, Toronto, ON, Canada (Ringgold ID: RIN10071)
,
Faina Weinstein
1   Division of Gastroenterology, St Michael's Hospital, University of Toronto, Toronto, ON, Canada (Ringgold ID: RIN10071)
,
Sunil Gupta 
1   Division of Gastroenterology, St Michael's Hospital, University of Toronto, Toronto, ON, Canada (Ringgold ID: RIN10071)
,
Ahmed H. Mokhtar
1   Division of Gastroenterology, St Michael's Hospital, University of Toronto, Toronto, ON, Canada (Ringgold ID: RIN10071)
,
Caleb Na
1   Division of Gastroenterology, St Michael's Hospital, University of Toronto, Toronto, ON, Canada (Ringgold ID: RIN10071)
,
Daniel Tham
1   Division of Gastroenterology, St Michael's Hospital, University of Toronto, Toronto, ON, Canada (Ringgold ID: RIN10071)
,
Yusuke Fujiyoshi 
1   Division of Gastroenterology, St Michael's Hospital, University of Toronto, Toronto, ON, Canada (Ringgold ID: RIN10071)
,
Tony He
1   Division of Gastroenterology, St Michael's Hospital, University of Toronto, Toronto, ON, Canada (Ringgold ID: RIN10071)
,
Sharan B. Malipatil
1   Division of Gastroenterology, St Michael's Hospital, University of Toronto, Toronto, ON, Canada (Ringgold ID: RIN10071)
,
Reza Gholami
1   Division of Gastroenterology, St Michael's Hospital, University of Toronto, Toronto, ON, Canada (Ringgold ID: RIN10071)
,
Nikko Gimpaya
1   Division of Gastroenterology, St Michael's Hospital, University of Toronto, Toronto, ON, Canada (Ringgold ID: RIN10071)
,
Arjun Kundra
28   Department of Gastroenterology and Hepatology, University of Virginia Medical Center, University of Virginia School of Medicine, Charlottesville, Virginia, USA (Ringgold ID: RIN21673)
,
Samir C. Grover 
1   Division of Gastroenterology, St Michael's Hospital, University of Toronto, Toronto, ON, Canada (Ringgold ID: RIN10071)
,
Natalia S. Causada Calo 
1   Division of Gastroenterology, St Michael's Hospital, University of Toronto, Toronto, ON, Canada (Ringgold ID: RIN10071)
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Abstract

Background and study aims Use of fluoroscopy in gastrointestinal endoscopy is an essential aid in advanced endoscopic interventions. However, it also raises concerns about radiation exposure. This study aimed to develop consensus-based statements for safe and effective use of fluoroscopy in gastrointestinal endoscopy, prioritizing the safety and well-being of healthcare workers and patients.

Methods A modified Delphi approach was employed to achieve consensus over three rounds of surveys. Proposed statements were generated in Round 1. In the second round, panelists rated potential statements on a 5-point scale, with consensus defined as ≥80% agreement. Statements were subsequently prioritized in Round 3, using a 1 (lowest priority) to 10 (highest priority) scale.

Results Forty-six experts participated, consisting of 34 therapeutic endoscopists and 12 endoscopy nurses from six continents, with an overall 45.6% female representation (n = 21). Forty-three item statements were generated in the first round. Of these, 31 statements achieved consensus after the second round. These statements were categorized into General Considerations (n = 6), Education (n = 10), Pregnancy (n = 4), Family Planning (n = 2), Patient Safety (n = 4), and Staff Safety (n = 5). In the third round, accepted statements received mean priority scores ranging from 7.28 to 9.36, with 87.2% of statements rated as very high priority (mean score ≥ 9).

Conclusions This study presents consensus-based statements for safe and effective use of fluoroscopy in gastrointestinal endoscopy, addressing the well-being of healthcare workers and patients. These consensus-based statements aim to mitigate risks associated with radiation exposure while maintaining benefits of fluoroscopy, ultimately promoting a culture of safety in healthcare settings.

Keywords

Pancreatobiliary (ERCP/PTCD) - Cholangioscopy - Quality and logistical aspects - Delphi technique - Fluoroscopy - Radiation - Gastrointestinal endoscopy

Supplementary Material



Publication History

Received: 07 May 2024

Accepted after revision: 30 September 2024

Accepted Manuscript online:
07 October 2024

Article published online:
18 November 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

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