Defining standards for fluoroscopy in gastrointestinal endoscopy using Delphi methodology
Endoscopy International Open, vol. 12, pp. E1315–E1325
Abstract
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.
Authors 56
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St. Michael's Hospital · University of Toronto · IRCCS Humanitas Research Hospital
Affiliation as printed
Division of Gastroenterology, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
Department of Gastroenterology, IRCCS Humanitas Research Hospital Department of Gastroenterology, Rozzano, Italy
Division of Gastroenterology, St Michael's Hospital, Toronto, Canada
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St. Michael's Hospital · University of Toronto
Affiliation as printed
Division of Gastroenterology, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
The Centre for Therapeutic Endoscopy and Endoscopic Oncology and Division of Gastroenterology, St Michael's Hospital, Toronto, Canada
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Affiliation as printed
Center for Advanced Therapeutic Endoscopy, Porter Adventist Hospital, Denver, USA
Center for Advanced Therapeutic Endoscopy, Centura Health, Englewood, United States
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Jahra Hospital · Portsmouth Hospitals NHS Trust
Affiliation as printed
Thanyan Alghanim Center for Gastroenterology and Hepatology, Alamiri Hospital, Kuwait, Kuwait
Endoscopy, Portsmouth Hospitals NHS trust, Portsmouth, United Kingdom of Great Britain and Northern Ireland
internal medicine, Al Jahra Hospital, Al Jahra, Kuwait
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Montreal General Hospital · McGill University Health Centre
Affiliation as printed
Division of Gastroenterology and Hepatology, McGill University Health Centre, Montréal, QC, Canada
Division of Gastroenterology, Rm D7 148, Montreal General Hospital, Montreal, Canada
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University of North Carolina at Chapel Hill
Affiliation as printed
Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina, United States
Gastroenterology & Hepatology, University of North Carolina, Chapel Hill, United States
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Hotel Dieu Hospital · Kingston Health Sciences Centre
Affiliation as printed
Division of Gastroenterology, Queen's School of Medicine, Hotel Dieu Hospital, Kingston, ON, Canada
Gastroenterology, Kingston Health Sciences Center, Kingston, Canada
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Beth Israel Deaconess Medical Center · Harvard University
Affiliation as printed
Center for Advanced Endoscopy, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, United States
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Azienda Unità Sanitaria Locale Della Romagna · Ospedale “M. Bufalini” di Cesena · Ospedale G.B. Morgagni - L.Pierantoni
Affiliation as printed
Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Italy
Unit of Gastroenterology and Digestive Endoscopy, Maurizio Bufalini Hospital, Cesena, Italy
Unit of Gastroenterology and Digestive Endoscopy, Morgagni-Pierantoni Hospital, Forli, Italy
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Fudan University · Zhongshan Hospital
Affiliation as printed
Endoscopy Center and Endoscopy Research Instituter, Zhongshan Hospital, Fudan University, 180 FengLin Road, Shanghai, 200032, China
Endoscopy Center, Zhongshan Hospital Fudan University, Shanghai, China
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IRCCS Humanitas Research Hospital
Affiliation as printed
Department of Gastroenterology, Endoscopic Unit, IRCCS Humanitas Research Hospital, Milan, Italy
Digestive Endoscopy, Istituto Clinico Humanitas, Rozzano, Italy
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McGill University Health Centre · McGill University
Affiliation as printed
Division of Gastroenterology and Hepatology, McGill University Health Centre, Montréal, QC, Canada
Medicine, McGill University, Montreal, Canada
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Universidade de São Paulo · Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo
Affiliation as printed
Serviço de Endoscopia Gastrointestinal, Departamento de Gastroenterologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
Gastrointestinal Endoscopy Department, Universidade de Sao Paulo Hospital das Clinicas, Sao Paulo, Brazil
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Affiliation as printed
Department of Medicine; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
Medicine, University of Calgary, Calgary, Canada
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Fondazione Humanitas per la Ricerca · IRCCS Humanitas Research Hospital
Affiliation as printed
Department of Gastroenterology, Endoscopic Unit, IRCCS Humanitas Research Hospital, Milan, Italy
Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Rozzano, Italy
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Humanitas University · IRCCS Humanitas Research Hospital
Affiliation as printed
Department of Gastroenterology, Endoscopic Unit, IRCCS Humanitas Research Hospital, Milan, Italy
Department of Biomedical Sciences, Humanitas University, Milan, Italy
Endoscopy Unit, IRCCS Humanitas Clinical and Research Center, Milan, Italy
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Rutgers, The State University of New Jersey
Affiliation as printed
Gastroenterology, Rutgers Robert Wood Johnson Medical School New Brunswick, New Brunswick, United States
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University College Hospital · University College London Hospitals NHS Foundation Trust · University College London
Affiliation as printed
Pancreatobiliary Medicine, University College London Hospitals, London, UK
Gastroenterology, University College London Hospitals NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland
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Humanitas University · IRCCS Humanitas Research Hospital
Affiliation as printed
Department of Gastroenterology, Endoscopic Unit, IRCCS Humanitas Research Hospital, Milan, Italy
Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
Endoscopic Unit, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
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St. Michael's Hospital · University of Toronto
Affiliation as printed
Division of Gastroenterology, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
Division of Gastroenterology, St Michael's Hospital, Toronto, Canada
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St. Michael's Hospital · University of Toronto
Affiliation as printed
Division of Gastroenterology, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
Gastroenterology, St Michael's Hospital, Toronto, Canada
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Lagos University Teaching Hospital
Affiliation as printed
Department of Medicine, College of Medicine, Lagos University Teaching Hospital, Lagos, Nigeria
Department of Medicine, Lagos University Teaching Hospital, Surulere, Nigeria
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Affiliation as printed
Gastroenterology and Hepatology, Mayo Clinic, Rochester, USA
Gastroenterology and Hepatology, Mayo Clinic, Rochester, United States
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Humanitas University · IRCCS Humanitas Research Hospital
Affiliation as printed
Department of Gastroenterology, Endoscopic Unit, IRCCS Humanitas Research Hospital, Milan, Italy
Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
Digestive Endoscopy Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy
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Royal Prince Alfred Hospital · Chris O’Brien Lifehouse
Affiliation as printed
AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Chris O’Brien Lifehouse, Sydney, New South Wales, Australia
AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Camperdown, Australia
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Fudan University · Columbia University Irving Medical Center · Zhongshan Hospital
Affiliation as printed
Endoscopy Center, Zhongshan Hospital, Fudan University, Shanghai, China
Gastroenterology and Hepatology, Columbia University Medical Center, New York, United States
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Affiliation as printed
Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, New York, United States
Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, United States
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IRCCS Humanitas Research Hospital
Affiliation as printed
Department of Gastroenterology, Endoscopic Unit, IRCCS Humanitas Research Hospital, Milan, Italy
Division of Gastroenterology and Digestive Endoscopy, IRCCS Humanitas Research Hospital, Rozzano, Italy
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Chinese University of Hong Kong
Affiliation as printed
Department of Medicine and Therapeutics and Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong
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St. Michael's Hospital · University of Toronto
Affiliation as printed
Division of Gastroenterology, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
Division of Gastroenterology, St Michael's Hospital, Toronto, Canada
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Hospital Británico de Buenos Aires
Affiliation as printed
Department of Gastroenterology, Endoscopy Unit, Hospital Británico, Buenos Aires, Argentina
Gastroenterology, Hospital Britanico de Buenos Aires, Buenos Aires, Argentina
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Jeanin Elise van Hooft Aachen Department of Gastroenterology and Hepatology Gastroenterology and Hepatology LUMC
Leiden University Medical Center
Affiliation as printed
Department of Gastroenterology & Hepatology, Leiden University Medical Center, Leiden, The Netherlands
Gastroenterology and Hepatology LUMC, Leiden University Medical Center, Leiden, Netherlands
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Amsterdam UMC Location University of Amsterdam · Amsterdam University Medical Centers · University of Amsterdam
Affiliation as printed
Department of Gastroenterology & Hepatology, Amsterdam University Medical Centres, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
Gastroenterology and Hepatology, Amsterdam University Medical Centres, Amsterdam, Netherlands
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Centre Hospitalier de l’Université de Montréal
Affiliation as printed
Division of Gastroenterology, Montreal University Hospital Center (CHUM), Montreal, Canada
Gastroenterology, Centre hospitalier de l'université de Montréal, Montreal, Canada
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University of Toronto · Hospital for Sick Children · The Wilson Centre · Sickkids Research Institute
Affiliation as printed
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
Department of Pediatrics, University of Toronto Faculty of Medicine, Toronto, Canada
Division of Gastroenterology, Hepatology, and Nutrition and the Research and Learning Institutes, The Hospital for Sick Children, Toronto, Canada
The Wilson Centre, University of Toronto, Toronto, Canada
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St. Michael's Hospital · University of Toronto
Affiliation as printed
Division of Gastroenterology, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
Division of Gastroenterology, University of Toronto, St Michael's Hospital, Toronto, Canada
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St. Michael's Hospital · University of Toronto
Affiliation as printed
Division of Gastroenterology, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
Division of Gastroenterology, University of Toronto, St Michael's Hospital, Toronto, Canada
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St. Michael's Hospital · University of Toronto
Affiliation as printed
Division of Gastroenterology, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
Division of Gastroenterology, University of Toronto, St Michael's Hospital, Toronto, Canada
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St. Michael's Hospital · University of Toronto
Affiliation as printed
Division of Gastroenterology, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
Division of Gastroenterology, University of Toronto, St Michael's Hospital, Toronto, Canada
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St. Michael's Hospital · University of Toronto
Affiliation as printed
Division of Gastroenterology, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
Division of Gastroenterology, University of Toronto, St Michael's Hospital, Toronto, Canada
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St. Michael's Hospital · University of Toronto
Affiliation as printed
Division of Gastroenterology, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
Division of Gastroenterology, University of Toronto, St Michael's Hospital, Toronto, Canada
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St. Michael's Hospital · University of Toronto
Affiliation as printed
Division of Gastroenterology, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
Division of Gastroenterology, University of Toronto, St Michael's Hospital, Toronto, Canada
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St. Michael's Hospital · University of Toronto · Ottawa Hospital
Affiliation as printed
Division of Gastroenterology, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
Division of Gastroenterology and Hepatology, Ottawa Hospital, Ottawa, Canada
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St. Michael's Hospital · University of Toronto · Ottawa Hospital
Affiliation as printed
Division of Gastroenterology and Hepatology, Ottawa Hospital, Ottawa, Ontario, Canada
Division of Gastroenterology, University of Toronto, St Michael's Hospital, Toronto, Canada
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The University of Sydney · St. Michael's Hospital · University of Toronto · Westmead Hospital
Affiliation as printed
Division of Gastroenterology, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
Gastroenterology and Hepatology, Westmead Hospital, Westmead, Australia
Medicine, The University of Sydney Westmead Clinical School, Westmead, Australia
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St. Michael's Hospital · University of Toronto
Affiliation as printed
Division of Gastroenterology, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
Division of Gastroenterology, University of Toronto, St Michael's Hospital, Toronto, Canada
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Caleb Na corresponding
St. Michael's Hospital · University of Toronto
Affiliation as printed
Division of Gastroenterology, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
Division of Gastroenterology, University of Toronto, St Michael's Hospital, Thornhill, Canada
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St. Michael's Hospital · University of Toronto · SHOWA Medical University Koto Toyosu Hospital
Affiliation as printed
Division of Gastroenterology, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
Digestive Disease Center, Showa University Koto Toyosu Hospital, Koto-ku, Japan
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St. Michael's Hospital · University of Toronto · St Vincent's Hospital Melbourne
Affiliation as printed
Division of Gastroenterology, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
Gastroenterology, St Vincent's Hospital Melbourne Pty Ltd, Fitzroy, Australia
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St. Michael's Hospital · University of Toronto
Affiliation as printed
Division of Gastroenterology, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
Division of Gastroenterology, University of Toronto, St Michael's Hospital, Toronto, Canada
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St. Michael's Hospital · University of Toronto
Affiliation as printed
Division of Gastroenterology, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
Division of Gastroenterology, University of Toronto, St Michael's Hospital, Toronto, Canada
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St. Michael's Hospital · University of Toronto
Affiliation as printed
Division of Gastroenterology, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
Department of Medicine, St Michael's Hospital, Toronto, Canada
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St. Michael's Hospital · University of Toronto · University of Virginia Medical Center
Affiliation as printed
Division of Gastroenterology, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
Department of Gastroenterology, University of Virginia Medical Center, Charlottesville, United States
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St. Michael's Hospital · University of Toronto · University of Virginia Medical Center · University of Virginia
Affiliation as printed
Department of Gastroenterology and Hepatology, University of Virginia Medical Center, University of Virginia School of Medicine, Charlottesville, Virginia, USA
Department of Medicine, University of Toronto, Toronto, Canada
Division of Gastroenterology, St. Michael's Hospital, Toronto, Canada
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St. Michael's Hospital · University of Ottawa · University of Toronto
Affiliation as printed
Division of Gastroenterology, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
Medicine, Division of Gastroenterology, University of Ottawa, Ottawa, Canada
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Natalia Causada Calo corresponding
St. Michael's Hospital · University of Toronto
Affiliation as printed
Division of Gastroenterology, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
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