The use of ionizing radiation in interventional gastroenterology is essential for performing complex procedures such as endoscopic retrograde cholangiopancreatography (ERCP), endoscopic placement of digestive stents via esophagogastroduodenoscopy (EGD), and biliodigestive anastomosis or cystogastrostomy performed under endoscopic ultrasound (EUS) guidance. However, prolonged exposure to X-rays represents a non-negligible risk for both patients and operators.This study aimed to assess patient exposure to ionizing radiation during these procedures and to identify factors influencing radiation dose.

We conducted a retrospective study of procedures requiring fluoroscopy—ERCP, digestive stent placement, EUS-guided biliodigestive anastomosis, and EUS-guided cystogastrostomy—performed between May 2023 and August 2024 in the Internal Medicine B Department. Collected data included demographic characteristics, indication for the procedure, procedure type, fluoroscopy time, reference-point air kerma (Ka,r, expressed in mGy), and clinical or technical variables potentially influencing radiation exposure.

Procedure complexity was assessed using an adapted scale inspired by classifications of the American Society for Gastrointestinal Endoscopy (ASGE). An analytical study was performed to evaluate risk factors using JAMOVI software.

A total of 146 procedures were analyzed: 129 ERCPs (88.4%), 7 EUS-guided biliodigestive anastomoses (4.4%), 6 digestive stent placements (4.1%), and 4 EUS-guided cystogastrostomies (3.1%).The cumulative radiation dose (Ka,r) ranged from 2.59 to 297 mGy, with a median of 64.5 mGy (36.9–124).

Median fluoroscopy time was 5 min 30 s (3 min 40 s – 9 min 17 s), and the median total procedure duration was 100 minutes (83–120).

ERCPs were associated with significantly higher radiation exposure compared to EUS- or EGD-related procedures, with median doses of: 65 mGy (37–123.74) for ERCP, 57.7 mGy (45.7–65) for EUS-guided procedures and 33.3 mGy (27.6–73.6) for digestive stent placement via EGD.

ERCPs classified as ASGE GRADE II showed slightly higher radiation doses, with a median of 69.7 mGy (37.6–123.1).

In our analysis, age was the only factor significantly influencing the total duration of ERCP procedures. Radiation exposure varied significantly according to ERCP indication (p = 0.023; p < 0.05). Patients undergoing biliary drainage for obstructive jaundice due to lithiasis or malignancy received higher radiation doses.

Assessment of ionizing radiation exposure in the interventional endoscopy suite demonstrates significant variation according to procedure type, indication, and technical factors. Procedure complexity plays a key role; however, more complex procedures did not result in significantly higher radiation exposure.A better understanding of risk factors for elevated radiation dose—such as body habitus or operator expertise—may help strengthen radiation-protection strategies and optimize patient safety.