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 17 January 2018

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News

ERCP with patients in the supine position less safe

ERCP performed with the patient in supine position is technically more demanding, and carries a greater risk of adverse cardiorespiratory events in nonintubated patients, reports the latest issue of Endoscopy.

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Endoscopic retrograde cholangiopancreatography is usually performed with the patient lying in the prone position.

The assumption is made that this position is optimal for cannulation of the papilla and for obtaining good-quality radiographic images.

The supine position, however, may be more comfortable for the patient and may facilitate airway management.

Dr Terruzzi and colleagues from Italy aimed to compare the 2 positions in terms of procedure outcome, safety, and patient tolerance.

Patients undergoing endoscopic retrograde cholangiopancreatography were randomized to start in either the prone position or the supine position.

There was at least 1 adverse cardiorepiratory event in 7 patients in the supine group
Endoscopy

The research team excluded patients under the age of 18 years, intubated patients, and those who had already undergone endoscopic sphincterotomy.

The team assessed the difficulty of cannulation using the Freeman score.

Total procedure time, patient tolerance, and willingness to undergo endoscopic retrograde cholangiopancreatography in the future were recorded.

The researchers also recorded procedure-related adverse cardiorespiratory events, including oxygen desaturation, tachycardia, bradycardia.

A total of 34 patients were evaluated, of which 21 were men, and 13 were women with a mean age 68.

There were 17 patients in each group.

The team noted that demographic and clinical features, and the indications for the procedure were similar for the 2 patient groups.

The median Freeman score was significantly lower in the prone group compared with the supine group.

The team observed that biliary cannulation was achieved in all patients in the prone group, but was not achieved in 5 patients in the supine group.

In 4 of these 5 patients, biliary cannulation was successfully achieved after turning the patient into the prone position.

The percentage of patients unwilling to repeat the endoscopic retrograde cholangiopancreatography procedure in the future was higher in the supine group.

The researchers found that the mean tolerance score and mean total procedure time were similar in the 2 groups.

In addition, the team noted at least 1 adverse cardiorepiratory event in 7 patients in the supine group, compared with only 1 patient in the prone group.

Dr Terruzzi's team commented, “Endoscopic retrograde cholangiopancreatography performed with the patient in the supine position is technically more demanding for operators used to working with patients in the prone position.”

“It also carries a greater risk of adverse cardiorespiratory events in nonintubated patients.”

Endosc 2005: 37: 1211-1214
09 December 2005

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