TOPLINE:

Endoscopic retrograde cholangiopancreatographies (ERCPs) performed on patients in the left lateral or supine position had shorter procedure times, largely due to reduced endotracheal intubation rates, than those performed in the prone position and were not associated with increased post-procedure hospitalization rates.

METHODOLOGY:

• ERCP is traditionally performed in the prone position after endotracheal intubation, but it can also be done in left lateral and supine positions without necessarily requiring intubation. Research studies comparing outcomes across positions are limited and inconsistent.
• Researchers conducted a retrospective multicenter analysis involving 6510 patients (mean age, 60.28 years; 47% male) to compare procedural metrics and outcomes of ERCP performed in the supine, prone, and left lateral positions at 11 hospitals in Washington state.
• Patients were categorized by their initial position, with 999 in the prone group, 3362 in the supine group, and 2149 in the left lateral group. The most common indication for ERCP was biliary stone disease.
• The primary outcome was the duration of ERCP, calculated from the initial introduction of the duodenoscope into the mouth to its removal after completion of the procedure. Secondary outcomes included pre-procedure evaluation time, anesthesia induction time, and readmission rates.

TAKEAWAY:

• Endotracheal intubation rates were much higher in the supine (90%) and prone (94%) positions than in the left lateral position (27%; P < .01 for all).
• The mean duration of ERCP was shorter for left lateral and supine positions (31.71 and 36.49 minutes, respectively) than the prone position (40.99 minutes). ERCPs performed in the prone position required more time at every stage of the procedure.
• Endotracheal intubation was the most significant factor for increased anesthesia induction time (100%), anesthesia ready time (97%), and duration of ERCP (55%). The difference in the duration of ERCP between left lateral and supine vs prone positions, and between left lateral and supine positions, did not reach statistical significance.
• The likelihood of readmission at 7 days was lower in the supine position than in the prone position (adjusted odds ratio, 0.63; P = .01).

IN PRACTICE:

“This study suggests that ERCP in the left lateral or supine position is time efficient, reduces need for universal endotracheal intubation without increasing the risk of post-ERCP hospitalization,” the authors of the study wrote.

SOURCE:

The study, led by Divyanshoo R. Kohli, MD, Pancreas and Liver Clinic, Providence Sacred Heart Medical Center, Spokane, Washington, was published online in Digestive Diseases and Sciences.

LIMITATIONS:

The study is limited by its retrospective design and the absence of procedural information. Patient-specific variables, including clinical status, comorbid conditions, physical status classification, and anesthesia tolerance, were not assessed. Some centers had universal endotracheal intubation and prone positioning policies, while others were selective, potentially introducing bias despite statistical adjustments. Readmissions at out-of-network hospitals were not captured in the analysis.

DISCLOSURES:

One author disclosed receiving research support and an equipment loan from Fujifilm for an unrelated project. The authors declared having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.