Patients with necrotizing pancreatitis are exposed to a considerable amount of radiation from both diagnostic imaging and therapeutic procedures, which can lead to an increase in lifetime cancer risk, according to study findings published in Clinical and Translational Gastroenterology.

Although step-up endoscopic or percutaneous techniques improve outcomes in patients with necrotizing pancreatitis, multiple radiographic exposures and fluoroscopic procedures using ionizing radiation are needed. The cumulative effects of these procedures are still not well known. A team of US-based investigators conducted a retrospective cohort study to assess risk factors associated with cumulative radiation exposure among patients with necrotizing pancreatitis who had undergone imaging studies and fluoroscopic and endoscopic procedures.

The primary study outcome was the cumulative effective dose (CED) that each patient received for the evaluation and treatment of necrotizing pancreatitis. High CED was defined as more than 500 mSv, as this threshold is linked to a 5% lifetime risk for cancer.


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Secondary outcomes included CED calculated during 4 periods over the disease course, which included the diagnostic phase, treatment phase, early sequelae after the resolution of necrotizing pancreatitis, and late sequelae of necrotizing pancreatitis.

A total of 171 patients with necrotizing pancreatitis who were admitted to University of California San Francisco Medical Center between January 2011 and June 2019 were included in the analysis. The average follow-up was 44 months, and 18.1% of patients were treated with a conservative approach that included enteral nutritional support and antibiotics as needed; 81.9% of patients underwent intervention for necrosis, which included drainage and/or necrosectomy. Over the course of the study, 18 patients died.

In assessing the frequency of diagnostic imaging and therapeutic procedures with fluoroscopy, patients underwent a median of 6 chest radiographs, 3 abdominal radiographs, 7 computer tomography scans, and 1 magnetic resonance imaging scan during treatment for necrotizing pancreatitis; 158 patients underwent 1 or more fluoroscopic procedures (median, 7 procedures), 46 patients underwent a median of 4 endoscopic procedures using fluoroscopy, and 95 patients underwent a median of 8 percutaneous catheter drainages.

No statistical differences were observed when comparing the rates of diagnostic imaging or therapeutic fluoroscopy by year in the median number of studies or CED per patient over time.

The median CED was 274 mSv and 30% of patients were exposed to a CED of more than 500 mSv; however, age, sex, and etiology of pancreatitis were not associated with high exposure upon multivariable analysis. Conversely, disease severity was strongly correlated with high exposure.

APACHE II score on hospital admission (adjusted odds ratio [aOR], 1.10; P =.001), intensive care unit admission (aOR, 5.64; P =.002), multiorgan failure (aOR, 3.46; P <.001), and infected necrosis (OR, 3.89; P <.001) were all associated with increased odds of high exposure in a step-up endoscopic approach as compared with a step-up percutaneous approach.

Researchers noted, “This highlights that although minimally invasive therapies reduce morbidity related to [necrotizing pancreatitis], they can be associated with a significant amount of ionizing radiation.” “This is particularly important in [necrotizing pancreatitis] because these patients often tend to be young, may have additional risk factors for malignancy such as smoking and alcohol, and can develop chronic pancreatitis, which increases the risk of pancreatic cancer,” wrote the researchers.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.

Reference

Thiruvengadam NR, Miranda J, Kim C, et al. Burden of ionizing radiation in the diagnosis and management of necrotizing pancreatitis. Clin Transl Gastroenterol. 2021;12(5):e00347. doi:10.14309/ctg.0000000000000347