A Survey of the Radiation Exposure Protection of Health Care Providers during Endoscopic Retrograde Cholangiopancreatography in Korea

BACKGROUND/AIMS: During endoscopic retrograde cholangiopancreatography (ERCP), all efforts should be made to be aware of radiation hazards and to reduce radiation exposure. The aim of this study was to investigate the status of radiation protective equipment and the awareness of radiation exposure in health care providers performing ERCP in Korean hospitals. METHODS: A survey with a total of 42 questions was sent to each respondent via mail or e-mail between October 2010 and March 2011. The survey targeted nurses and radiation technicians who participated in ERCP in secondary or tertiary referral centers. RESULTS: A total of 78 providers from 38 hospitals responded to the surveys (response rate, 52%). The preparation and actual utilization rates of protective equipment were 55.3% and 61.9% for lead shields, 100% and 98.7% for lead aprons, 47.4% and 37.8% for lead glasses, 97.4% and 94.7% for thyroid shields, and 57.7% and 68.9% for radiation dosimeters, respectively. The common reason for not wearing protective equipment was that the equipment was bothersome, according to 45.7% of the respondents. CONCLUSIONS: More protective equipment, such as lead shields and lead glasses, should be provided to health care providers involved in ERCP. In particular, the actual utilization rate for lead glasses was very low.

Endoscopic Treatment Strategy for Large Laterally Spreading Tumor: Endoscopic Piecemeal Mucosal Resection or Endoscopic Submucosal Dissection

BACKGROUND/AIMS: The therapeutic strategy between endoscopic piecemeal mucosal resection (EPMR) and endoscopic submucosal dissection (ESD) for large laterally spreading tumors (LSTs) has not been clearly defined. The aim of this study was to compare the clinical outcomes between EPMR and ESD in patients with large LST. METHODS: From July 2006 to September 2010, 106 patients who underwent endoscopic resection for large (>20 mm) LSTs were included in our retrospective analysis. RESULTS: Baseline characteristics of the patients and tumors were not different between two groups except for location (EPMR-right colon, ESD-rectum). The en bloc resection rate and complete resection rate were significantly higher in the ESD group than those in the EPMR group (EPMR vs. ESD, 53.5% vs. 88.6, P<0.01, 45.1% vs. 71.4%, P=0.01, respectively). However, total procedure time was significantly shorter in the EPMR group (21.3 min vs. 44.4 min, P<0.01). Furthermore, the rates of complication including perforation and bleeding were significantly lower in the EPMR group than those in the ESD group (perforation, 1.4% vs. 11.4%, P=0.02; bleeding, 4.2% vs. 17.1%, P=0.03, respectively). During 19.9 months of follow-up, no significant difference was observed in terms of recurrence (1.5% vs. 3.2%). Non-granular, pseudo-depressed type (LST-PD) showed a significantly higher presence of adenocarcinoma and deeper submucosal invasion than other types of LSTs. CONCLUSIONS: The therapeutic strategy for choosing between EPMR and ESD for large LST lesions should be determined based on the macroscopic findings of their subtype. En bloc resection with ESD should be applied to LST-PDs due to their higher rate of submucosal invasion.