Endoscopy 2008; 40(2): 93-97
DOI: 10.1055/s-2007-995317
Original article

© Georg Thieme Verlag KG Stuttgart · New York

No difference between supine and prone position for ERCP in conscious sedated patients: a prospective randomized study

A.  Tringali1 , M.  Mutignani1 , A.  Milano2 , V.  Perri1 , G.  Costamagna1
  • 1Digestive Endoscopy Unit, Catholic University, Rome, Italy
  • 2Department of Internal Medicine and Aging Science, Unit of Gastroenterology, Chieti, Italy
Further Information

Publication History

submitted 24 January 2007

accepted after revision 2 September 2007

Publication Date:
05 December 2007 (online)

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