Background and aims: Endoscopic retrograde cholangiopancreatography (ERCP) is usually performed with the
patient prone or in the left lateral position. The supine position could be more comfortable
and may facilitate airway management. On the other hand, technical difficulties and
a greater risk of adverse cardiorespiratory events have been shown when ERCP is performed
in a supine patient. Our aim was to assess, in a tertiary referral center, the differences
between performing ERCP with the patient supine or prone, in terms of technical features
and complications both during and after the procedure.
Patients and methods: Between December 2005 and May 2006, 120 patients (66 female, mean age 62 years) who
had an intact papilla and were candidates for therapeutic ERCP were prospectively
randomized to undergo ERCP under conscious sedation with midazolam, in the prone (n
= 60) or supine (n = 60) position, by an expert endoscopist (tutor) or a trainee.
The following parameters were recorded: difficulty of cannulation and difficulty of
ECRP procedure, time needed to visualize the papilla, time needed to achieve opacification
and cannulation, exam duration, episodes of tachy/bradycardia and desaturation, episodes
of duodenoscope displacement into the stomach, and complications.
Results: Ninety-eight patients underwent ERCP for benign disease and 22 for malignant biliary
strictures. The ERCP success rate was 98.3 % in the tutor group and 43.3 % in the
trainee group. No significant differences were found between the two groups of operators
(tutors and trainees) in the recorded parameters and complication rates encountered
in prone versus supine patients.
Conclusion: Our results show that ERCP success rates and complications (intraoperative and postoperative)
are similar whether ERCP is performed with the patient prone or supine, even when
operators are of differing skill levels. Training, technique, and a proper learning
phase are recommended in order to perform ERCP with no differences whether the patient
is prone or supine.
References
- 1 Taylor A J, Bohorfoush III (eds) A G. Interpretation of ERCP. Philadelphia; Lippincott-Raven
1997
- 2 Yakshe P N, Vennes J A.
Technique of endoscopic retrograde cholangiopancreatography. In: Sivak MV Jr (ed). Gastroenterologic endoscopy. 2nd edn., chap 57. Philadelphia;
Saunders 2000: 845-862
- 3 Leung J.
Fundamentals of ERCP. In: Leung J, Cotton PB (eds). ERCP Advanced Endoscopy E-book/Annual. 2004 http://www.gastrohep.com/advancedendo/book3.asp
- 4
Terruzzi V, Radaelli F, Meucci G, Minoli G.
Is the supine position as safe and effective as the prone position for endoscopic
retrograde cholangiopancreatography? A prospective randomized study.
Endoscopy.
2005;
37
1211-1214
- 5
Owens W D, Felts J A, Spitznagel E L.
ASA physical status classification: a study of consistency of ratings.
Anesthesiology.
1978;
43
239-243
- 6
Freeman M L, Nelson D B, Sherman S. et al .
Complications of endoscopic biliary sphincterotomy.
N Engl J Med.
1996;
335
909-919
- 7
Schutz S M, Abbott R M.
Grading ERCPs by degree of difficulty: a new concept to produce more meaningful outcome
data.
Gastrointest Endosc.
2000;
51
535-539
- 8
Cotton P B, Lehman G, Vennes J. et al .
Endoscopic sphincterotomy complications and their management: an attempt at consensus.
Gastrointest Endosc.
1991;
37
383-393
- 9
Froehlich F.
Patient position during ERCP: prone versus supine. What about the left lateral throughout?.
Endoscopy.
2006;
38
755
G. Costamagna, MD
Digestive Endoscopy Unit
Università Cattolica del Sacro Cuore
“A. Gemelli” University Hospital
Largo A. Gemelli 8
00168 Rome
Italy
Fax: +39-06-30156581
Email: gcostamagna@rm.unicatt.it
