Abstract
Background. ERCP is customarily performed with the patient in prone position. For patients intolerant of prone positioning, ERCP in left lateral decubitus (LLD) position offers a potential alternative. Aims. To compare efficacy and safety of ERCP in the LLD position versus prone position. Methods. Consecutive ERCP reports from August 2009 to October 2010 at Mayo Clinic Arizona were reviewed. Inclusion criteria. Age > 18 years, native papilla, and biliary indication. Primary outcome measure. Bile duct cannulation rate. Secondary outcomes. Times to ampullary localization and bile duct cannulation and complication rate. Results. ERCPs reviewed from 59 patients in two positions: 39 prone and 20 LLD. Cannulation Rate. 100% prone versus 90% in LLD (P=0.11). Median (IRQ) times. (1) Ampullary localization: 90 sec (70–110) prone versus 100 sec (80–118) (P=0.16); (2) bile duct cannulation: 140 sec (45–350) prone versus 165 sec (55–418) LLD (P=0.54). Complications. No periprocedure; postprocedure 4 (10%) prone versus 3 (15%) LLD (P=0.65). Conclusion. ERCP performed in LLD position allowed deep bile duct cannulation in 90% of patients without significantly increased procedural times or rate of complications as compared to prone position.
Highlights
Endoscopic retrograde cholangiopancreatography (ERCP) is conventionally performed in the prone position; this allows for easier passage of scope through the pharynx and low risk of aspiration for the patient and provides an effective and comfortable approach for the endoscopist [1]
ERCP performed in lateral decubitus (LLD) position allowed deep bile duct cannulation in 90% of patients without significantly increased procedural times or rate of complications as compared to prone position
Patients undergoing ERCP in prone and LLD positions were compared with respect to indication for ERCP, American Society of Anesthesiology (ASA) classification, and degree of difficulty of ERCP
Summary
Endoscopic retrograde cholangiopancreatography (ERCP) is conventionally performed in the prone position; this allows for easier passage of scope through the pharynx and low risk of aspiration for the patient and provides an effective and comfortable approach for the endoscopist [1]. Ferreira and Baron concluded that an ERCP with the patient in the supine position can be safely and effectively performed if necessitated by clinical circumstances [4], though the supine position can be less comfortable for the endoscopist. This conclusion was different from that reached by the Terruzzi and colleagues who reported that difficult cannulation was markedly increased in the supine position, and cardiopulmonary adverse events were more frequent in this group [5]. ERCP performed in LLD position allowed deep bile duct cannulation in 90% of patients without significantly increased procedural times or rate of complications as compared to prone position
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