Patient Position and ERCP Outcomes in Patients with Surgically Altered Foregut Anatomy

Aims Patients with surgically altered gastrointestinal anatomy undergoing endoscopicretrograde cholangiopancreatography (ERCP) pose challenges due to anatomicaldistortions. Factors such as patient positioning, endoscopist experience, andchoice of endoscope may influence procedural success. It is unclear how thesefactors may impact the technical success of ERCP among patients with alteredanatomy. We primarily aimed to determine the impact of patient positioning (proneversus left lateral decubitus [LLD]) on technical success of ERCP among patientswith surgically altered anatomy. We also considered the impact of endoscopistexperience and endoscope type, alongside patient positioning.

Methods We conducted a retrospective single-centre study using data from 2010 to 2020that included patients with hepaticojejunostomy, Roux-en-Y anastomosis, Billroth1, or Billroth-2 anatomy. The primary outcome was technical success of the ERCP,which we comprehensively defined as of successful navigation to the papilla orsurgical anastomosis, selective cannulation and cholangiography, and therealization of the intended therapeutic goals. The secondary outcomes were thepresence of immediate bleeding and procedural time. Statistical analysis involveddescriptive statistics using mean and standard deviation (SD) and Fisher exacttest with relative risk (RR) and 95% confidence interval (95% CI). All statisticaltests were two-tailed and considered significant at P<0.05.

Results Among 205 patients, 179 were in the LLD group, and 26 were in the prone group.Patient demographics did not significantly differ between groups. The choice ofendoscope (P=0.011) and endoscopist experience (P<0.001) were the onlyvariables with significant differences. There were no significant differencesbetween the two groups in terms of procedural success (RR 1.1, 95% CI: 0.8-1.5),immediate bleeding (RR 1.7, 95% CI: 0.2-14.8), and procedural time (P=0.808).Patients in the left lateral decubitus (LLD) position had a significantly higherlikelihood of technical success compared to those in the prone position (OR 2.59,95% CI 1.09-6.14, p=0.031). Additionally, non-Roux-en-Y reconstructions wereassociated with significantly higher technical success rates than Roux-en-Yreconstructions (OR 0.354, 95% CI 0.182-0.690, p=0.002).

Conclusions We found that patient positioning had a significant impact on technical success inERCP among patients with surgically altered anatomy. The choice of positioningshould be tailored optimizing outcomes in this complex patient subset.

Conflicts of interest

Declaration : All the authors have no relevant financial disclosures or conflicts of interest to declare. CWT – Speaker: Medtronic and Boston Scientific, Consultant: Boston Scientific. GRM – Consultant for Olympus. Speaker: Pentax, Fuji and Medtronic. JDM – Speaker: Boston Scientific, Pendopharm, Vantage, Medtronic. Medical Advisory Board: Pendopharm, Boston Scientific, Janssen, Pentax, Fuji. SCG –Research grants and personal fees from AbbVie and Ferring Pharmaceuticals, personal fees from Takeda, Pfizer, Abbvie, Sanofi, and BioJAMP, education grants from Janssen and Abbvie, and has equity in Volo Healthcare.

Publication History

Article published online:
15 April 2024