Defining standards for fluoroscopy in gastrointestinal endoscopy using Delphi methodology

Kareem Khalaf¹, Katarzyna M Pawlak¹, Douglas G Adler², Asma A Alkandari³, Alan N Barkun⁴, Todd H Baron⁵, Robert Bechara⁶, Tyler M Berzin⁷, Cecilia Binda⁸, Ming-Yan Cai⁹, Silvia Carrara¹⁰, Yen-I Chen⁴, Eduardo Guimarães Hourneaux de Moura¹¹, Nauzer Forbes¹², Alessandro Fugazza¹⁰, Cesare Hassan¹⁰, Paul D James¹³, Michel Kahaleh¹⁴, Harry Martin¹⁵, Roberta Maselli¹⁰, Gary R May¹, Jeffrey D Mosko¹, Ganiyat Kikelomo Oyeleke¹⁶, Bret T Petersen¹⁷, Alessandro Repici¹⁰, Payal Saxena¹⁸, Amrita Sethi¹⁹, Reem Z Sharaiha²⁰, Marco Spadaccini¹⁰, Raymond Shing-Yan Tang²¹, Christopher W Teshima¹, Mariano Villarroel²², Jeanin E van Hooft²³, Rogier P Voermans²⁴, Daniel von Renteln²⁵, Catharine M Walsh²⁶, Tricia Aberin¹, Dawn Banavage¹, Jowell A Chen¹, James Clancy¹, Heather Drake¹, Melanie Im¹, Chooi Peng Low¹, Alexandra Myszko¹, Krista Navarro¹, Jessica Redman²⁷, Wayne Reyes¹, Faina Weinstein¹, Sunil Gupta¹, Ahmed H Mokhtar¹, Caleb Na¹, Daniel Tham¹, Yusuke Fujiyoshi¹, Tony He¹, Sharan B Malipatil¹, Reza Gholami¹, Nikko Gimpaya¹, Arjun Kundra²⁸, Samir C Grover¹, Natalia S Causada Calo¹

Affiliations

¹ Division of Gastroenterology, St Michael's Hospital, University of Toronto, Toronto, ON, Canada.
² Center for Advanced Therapeutic Endoscopy, Porter Adventist Hospital, Denver, USA.
³ Thanyan Alghanim Center for Gastroenterology and Hepatology, Alamiri Hospital, Kuwait, Kuwait.
⁴ Division of Gastroenterology and Hepatology, McGill University Health Centre, Montréal, QC, Canada.
⁵ Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina, United States.
⁶ Division of Gastroenterology, Queen's School of Medicine, Hotel Dieu Hospital, Kingston, ON, Canada.
⁷ Center for Advanced Endoscopy, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
⁸ Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Italy.
⁹ Endoscopy Center and Endoscopy Research Instituter, Zhongshan Hospital, Fudan University, 180 FengLin Road, Shanghai, 200032, China.
¹⁰ Department of Gastroenterology, Endoscopic Unit, IRCCS Humanitas Research Hospital, Milan, Italy.
¹¹ Serviço de Endoscopia Gastrointestinal, Departamento de Gastroenterologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil.
¹² Department of Medicine; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
¹³ Division of Gastroenterology, University Health Network, Toronto, Canada.
¹⁴ Gastroenterology, Rutgers Robert Wood Johnson Medical School New Brunswick, New Brunswick, United States.
¹⁵ Pancreatobiliary Medicine, University College London Hospitals, London, UK.
¹⁶ Department of Medicine, College of Medicine, Lagos University Teaching Hospital, Lagos, Nigeria.
¹⁷ Gastroenterology and Hepatology, Mayo Clinic, Rochester, USA.
¹⁸ AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.
¹⁹ Endoscopy Center, Zhongshan Hospital, Fudan University, Shanghai, China.
²⁰ Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, New York, United States.
²¹ Department of Medicine and Therapeutics and Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong.
²² Department of Gastroenterology, Endoscopy Unit, Hospital Británico, Buenos Aires, Argentina.
²³ Department of Gastroenterology & Hepatology, Leiden University Medical Center, Leiden, The Netherlands.
²⁴ Department of Gastroenterology & Hepatology, Amsterdam University Medical Centres, Location AMC, University of Amsterdam, Amsterdam, The Netherlands.
²⁵ Division of Gastroenterology, Montreal University Hospital Center (CHUM), Montreal, Canada.
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.
²⁷ Division of Gastroenterology and Hepatology, Ottawa Hospital, Ottawa, Ontario, Canada.
²⁸ Department of Gastroenterology and Hepatology, University of Virginia Medical Center, University of Virginia School of Medicine, Charlottesville, Virginia, USA.

PMID: 39559412
PMCID: PMC11573466
DOI: 10.1055/a-2427-3893

Defining standards for fluoroscopy in gastrointestinal endoscopy using Delphi methodology

Kareem Khalaf et al. Endosc Int Open. 2024.

. 2024 Nov 18;12(11):E1315-E1325.

doi: 10.1055/a-2427-3893. eCollection 2024 Nov.

Authors

Affiliations

¹ Division of Gastroenterology, St Michael's Hospital, University of Toronto, Toronto, ON, Canada.
² Center for Advanced Therapeutic Endoscopy, Porter Adventist Hospital, Denver, USA.
³ Thanyan Alghanim Center for Gastroenterology and Hepatology, Alamiri Hospital, Kuwait, Kuwait.
⁴ Division of Gastroenterology and Hepatology, McGill University Health Centre, Montréal, QC, Canada.
⁵ Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina, United States.
⁶ Division of Gastroenterology, Queen's School of Medicine, Hotel Dieu Hospital, Kingston, ON, Canada.
⁷ Center for Advanced Endoscopy, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
⁸ Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Italy.
⁹ Endoscopy Center and Endoscopy Research Instituter, Zhongshan Hospital, Fudan University, 180 FengLin Road, Shanghai, 200032, China.
¹⁰ Department of Gastroenterology, Endoscopic Unit, IRCCS Humanitas Research Hospital, Milan, Italy.
¹¹ Serviço de Endoscopia Gastrointestinal, Departamento de Gastroenterologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil.
¹² Department of Medicine; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
¹³ Division of Gastroenterology, University Health Network, Toronto, Canada.
¹⁴ Gastroenterology, Rutgers Robert Wood Johnson Medical School New Brunswick, New Brunswick, United States.
¹⁵ Pancreatobiliary Medicine, University College London Hospitals, London, UK.
¹⁶ Department of Medicine, College of Medicine, Lagos University Teaching Hospital, Lagos, Nigeria.
¹⁷ Gastroenterology and Hepatology, Mayo Clinic, Rochester, USA.
¹⁸ AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.
¹⁹ Endoscopy Center, Zhongshan Hospital, Fudan University, Shanghai, China.
²⁰ Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, New York, United States.
²¹ Department of Medicine and Therapeutics and Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong.
²² Department of Gastroenterology, Endoscopy Unit, Hospital Británico, Buenos Aires, Argentina.
²³ Department of Gastroenterology & Hepatology, Leiden University Medical Center, Leiden, The Netherlands.
²⁴ Department of Gastroenterology & Hepatology, Amsterdam University Medical Centres, Location AMC, University of Amsterdam, Amsterdam, The Netherlands.
²⁵ Division of Gastroenterology, Montreal University Hospital Center (CHUM), Montreal, Canada.
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.
²⁷ Division of Gastroenterology and Hepatology, Ottawa Hospital, Ottawa, Ontario, Canada.
²⁸ Department of Gastroenterology and Hepatology, University of Virginia Medical Center, University of Virginia School of Medicine, Charlottesville, Virginia, USA.

PMID: 39559412
PMCID: PMC11573466
DOI: 10.1055/a-2427-3893

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

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/).

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Conflict of interest statement

Conflict of Interest Tyler Berzin - Consultant for: Medtronic, Boston Scientific, Wision AI, Microtech. Alan N. Barkun - Consultant for Olympus Inc and Medtronic Inc. Cecilia Binda – Lecturer for Steris, Fujifilm, Boston Scientific, Q3 Medical. Alessandro Fugazza – Consultant for Boston Scientific. Rogier P. Voermans - Consultancy and research grant for Boston Scientific, Research grant Prion Medical; Consultancy fee form from Cook Medical. Lecturer Viatris and Zambon. Nauzer Forbes – Speaker for Boston Scientific, Pentax Medical. Consultant for Boston Scientific, Pentax Medical and AstraZeneca. Mariano Villarroel – Consultant for Boston Scientific. Yen-I Chen – Consultant for Boston Scientific. President of Chess Medical. Robert Bechara – Consultant for Olympus, Pentax, Vantage, Medtronic, Pendopharm. Payal Saxena – Consultant for Boston Scientific, Ambu, Erbe. Amrita Sethi – Consultant for Boston Scientific, Interscope, Medtronic, Olympus; Research Support for Boston Scientific, Fujifilm and ERBE. Cesare Hassan: Fujifilm Co. (consultancy); Medtronic Co. (consultancy). Alessandro Repici: Fujifilm Co. (consultancy); Olympus Corp (consultancy); Medtronic Co. (consultancy). Bret Peterson – Consultant for Olympus, Pentax. Investigator for Boston Scientific and Ambu. Silvia Carrara – Consultant for Olympus and Aboca. Jeffrey D. Mosko – Speaker for Boston Scientific, Pendopharm, SCOPE rounds, Vantage, Medtronic. Medical Advisory Board for Pendopharm, Boston Scientific, Janssen, Pentax, Fuji. Grants and Research support from CAG. Christopher W. Teshima – Speaker for Medtronic and Boston Scientific, Consultant for Boston Scientific. Gary R. May – Consultant for Olympus. Speaker for Pentax, Fuji and Medtronic. Samir C Grover –Research grants and personal fees from AbbVie and Ferring Pharmaceuticals, personal fees from Takeda, Sanofi, and BioJAMP, education grants from Janssen, and has equity in Volo Healthcare. All the authors have no relevant financial disclosures or conflicts of interest to declare.

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Defining standards for fluoroscopy in gastrointestinal endoscopy using Delphi methodology

Affiliations

Defining standards for fluoroscopy in gastrointestinal endoscopy using Delphi methodology

Authors

Affiliations

Abstract

Conflict of interest statement

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References

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