How safe is ERCP to the endoscopist?

BACKGROUND: Interventional techniques in endoscopy such as endoscopic retrograde cholangiopancreatography (ERCP) have greatly increased since laparoscopic cholecystectomy has become widespread; mainly these techniques deal with common bile duct stones. Fluoroscopy is usually employed, and chronic exposure to X-ray, in spite of the relative low dose, can lead to potentially unhealthy conditions such as malignancies like bone marrow and other solid cancers. A median of 18 years of life is lost per fatal cancer, including the time of latency since exposure. Nor should one forget benign condition such as cataracts that can lead to partial or complete blindness and which surely impair life's quality. METHODS: Simulated examinations were carried at the University Hospital (São Paulo, Brazil) using an anthropomorphic phantom in place of the physician. Four sets of dosimeters were placed in the forehead, neck, torso, and lower abdomen (with and without a lead apron) and standard ERCP fluoroscopic techniques were employed. RESULTS: The dose equivalents were calculated and compared to the recommended exposure doses of national and international boards of radiation protection. CONCLUSIONS: Based on the results found and compared to standards, working safely means: (1) A lead (0.5 mm thickness) apron is fundamental. Without 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 hazardous to the eye, allowing only seven ERCPs monthly.

[Endoscopic treatment of colon vascular ectasia during bleeding with injection of adrenaline solution at 1:10,000 and monopolar electrocoagulation: an alternative approach. Case report]. / Tratamento endoscópico de ectasia vascular do cólon na vigência de sangramento com injeção de solução de adrenalina 1:10.000 e eletrocoagulação monopolar: uma abordagem alternativa. Relato de caso.

Gastrointestinal bleeding accounts for 2% of all adult hospital admissions each year. Vascular ectasia is one of the most frequently reported cause of lower gastrointestinal bleeding. In almost 80% of patients with bleeding vascular ectasia will stop spontaneously, but will often recur. Many treatments are proposed like superselective catheterization with infusion of vasoconstrictor by angiography, Laser photocoagulation, heater probe, bipolar electrocoagulation, hot biopsy forceps, have been used in colonoscopy, but some effects are short-lived others are so expensive and without an effective treatment. The authors present one case of bleeding vascular ectasia during colonoscopy submitted to a new, cheap and effective approach with injection a 1:10,000 solution of epinephrine following electrocoagulation by colonoscopy.

Experimental heterotopic bone transplant.

We studied the reaction in rats to implants of heterotopic bone in the paravertebral region, using three types of material: bone preserved in alcohol, homologous bone preserved in alcohol associated with autogenous cancellous bone obtained from the iliac crest of the same animal, and isolated autogenous cancellous bone. Thirty rats were operated on, ten in each group. Some were sacrificed after 6, 14 and 21 days. The excised grafts were histologically studied. Animals in the third group showed new bone formation even in the first days, those in the second group presented less intense bone formation and those in the first group showed only traces of new bone tissue in the third week.