Comparison of safety and efficacy of ERCP performed with the patient in supine and prone positions

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Gastrointestinal EndoscopyVolume 67, Issue 7, June 2008, Pages 1037-1043

doi:10.1016/j.gie.2007.10.029 Copyright © 2008 American Society for Gastrointestinal Endoscopy Published by Mosby, Inc.

Original article

Comparison of safety and efficacy of ERCP performed with the patient in supine and prone positions

Lincoln E.V.V.C. Ferreira MD, PhDa and Todd H. Baron MD, FASGE, a

aCurrent affiliations: Department of Medicine, Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA

Received 23 February 2007;

accepted 9 October 2007.

Rochester, Minnesota, USA.

Available online 18 January 2008.

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Background

ERCP is usually performed with the patient in the prone position. Little data exist on ERCP in the supine position, which is considered unsafe in nonintubated patients.

Objective

Our purpose was to compare outcomes of ERCP in the prone and supine positions.

Design

Retrospective study.

Setting

Tertiary care medical center.

Patients

All patients undergoing ERCP by one endoscopist over an 18-month period.

Main Outcome Measurements

American Society of Anesthesiologists (ASA) score, procedural degree of difficulty, procedural time, success rates, complication rates, effects on oxygen desaturation and hemodynamics, amount of sedation, need for precut sphincterotomy.

Results

A total of 649 patients were evaluated, of whom 506 patients were prone and 143 were supine. There were no differences between the groups with regard to sex, procedural time, ASA scores, need for precut sphincterotomy, adverse cardiovascular events, episodes of oxygen desaturation, dose of meperidine or midazolam, or oxygen supplementation. Complete success and complication rates were similar for both groups (90.2% and 11.2% for supine and 92.5% and 9.1% for prone, respectively). Procedural degree of difficulty was significantly higher in the supine group (P < .001). There were no episodes of aspiration in either group and no severe complications.

Limitations

Retrospective study, one endoscopist.

Conclusions

ERCP performed in nonintubated patients placed supine is often more difficult and may lead to more mild adverse respiratory events than when performed with the patient prone. Supine ERCP is appropriate in certain patients who cannot lie prone (abdominal pain, abdominal distention, ascites, recent abdominal or neck surgery, indwelling percutaneous tubes and need for access during the procedure to indwelling internal/external percutaneous biliary catheters, and in the morbidly obese) with more intensive monitoring in those who are not intubated.

Abbreviations: ASA, American Society of Anesthesiologists; GETA, general endotracheal anesthesia; LLD, left lateral decubitus