A Randomized Controlled Trial of Patient Positioning During Endoscopic Retrograde Cholangiopancreatography (ERCP) Procedures: A Comparison Between Semi-Prone- and Prone-Positioned Patients.

Abstract

The prone "swimmers" position is preferable for endoscopic retrograde cholangiopancreatography (ERCP) as it provides the best visualization for selective bile duct cannulation. However, "swimmers" position does not comply with best-practice patient positioning guidelines. Our objective was to determine whether the semi-prone patient position was suitable for ERCP without negatively influencing the outcomes of the procedure. We conducted a randomized controlled trial, 50 patients in prone and 50 patients in semi-prone patient position, measuring the number of attempts and time to successfully cannulate the bile duct. Safety outcomes measured were airway access, pharyngeal endoscope passage, and complications. Between the two groups, there were no statistical differences in demographic variables, selective bile duct cannulation attempts, or cannulation time. Airway access scored significantly better in the semi-prone position. There was a significant positive correlation between the total number of cannulation attempts and papilla type. No intra- or post-procedural significant complications occurred. The semi-prone position was comparable to the "swimmers" position regarding the number of attempts and time required for selective bile duct cannulation but scored significantly better in airway access by anesthetists. A semi-prone patient position is advisable for ERCP procedures as it complies with best-practice patient positioning guidelines.