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CC BY-NC-ND 4.0 · Endosc Int Open 2022; 10(04): E403-E412
DOI: 10.1055/a-1749-5043
Original article

Does ERCP position matter? A randomized controlled trial comparing efficacy and complications of left lateral versus prone position (POSITION study)

Poornima Varma
1   Department of Gastroenterology & Hepatology, Austin Health, Heidelberg, Australia
,
Shara Ket
2   Department of Gastroenterology & Hepatology, Monash Medical Centre, Clayton, Australia
,
Eldho Paul
3   Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Monash Medical Centre, Clayton, Australia
,
Malcolm Barnes
2   Department of Gastroenterology & Hepatology, Monash Medical Centre, Clayton, Australia
,
David A. Devonshire
2   Department of Gastroenterology & Hepatology, Monash Medical Centre, Clayton, Australia
,
Daniel Croagh
4   Department of Upper GI Surgery, Monash Medical Centre, Clayton, Australia
5   Department of Surgery, Monash University, Clayton, Australia
,
Michael P. Swan
2   Department of Gastroenterology & Hepatology, Monash Medical Centre, Clayton, Australia
› Author AffiliationsTRIAL REGISTRATION: Single centre, prospective, randomized controlled trial. Conducted at Monash Health https://monashhealth.org/
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Abstract

Background and study aims Endoscopic retrograde cholangiopancreatography (ERCP) is traditionally performed with patients in the prone position (PP). However, this poses a potentially increased risk of anesthetic complications. An alternative is the left lateral (LL) decubitus position, which is commonly used for endoscopic procedures. Our aim was to compare cannulation rate, time, and outcomes in ERCP performed in LL versus PP.

Patients and methods We conducted a non-inferiority, prospective, randomized control trial with 1:1 randomization to either LL or PP position. Patients > 18 years of age with native papillae requiring a therapeutic ERCP were recruited between March 2017 and November 2018 in a single tertiary center.

Results A total of 253 patients were randomized; 132 to LL (52.2 %) and 121 to PP (47.8 %). Cannulation rates were 97.0 % in LL vs 99.2 % in PP (difference –2.2 % (one-sided 95 % CI: –5 % to 0.6 %). Median time to biliary cannulation was 03:50 minutes in LL vs 02:57 minutes in PP (P = 0.62). Pancreatitis rates were 2.3 % in LL vs 5.8 % in PP (P = 0.20). There were significantly lower radiation doses used in PP (0.23 mGy/m2 in LL vs 0.16 mGy/m2 in PP, P = 0.008) without a difference in fluoroscopy times.

Conclusions Our analysis comparing LL to PP during ERCP shows comparable procedural and anesthetic outcomes, with significantly lower radiation exposure when performed in PP. We conclude that ERCP undertaken in the LL position is not inferior to PP, except for higher radiation exposure, and should be considered as a safe alternate position for patients undergoing ERCP.

Supplementary material



Publication History

Received: 21 June 2021

Accepted after revision: 10 November 2021

Article published online:
14 April 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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