Reply to Dr. Froehlich

We are grateful to Dr. Froehlich for his comments [1] and his interest in our article [2]. Dr. Froehlich considers that the left lateral patient position during endoscopic retrograde cholangiopancreatography (ERCP) is a valid alternative to the prone position, since it is probably more comfortable for the patient and carries a lower risk of aspiration. Unfortunately, we cannot provide any comments on this opinion, as we have no experience with the position (the local endoscopy suite is not equipped with a mobile radiology system, which is essential for working with the patient on the left side).

However, the experience described by Dr. Froehlich provides an opportunity to point out once again that the best patient position for ERCP probably mainly depends on the way in which the operator is accustomed to performing the procedure. Consequently, having the patient in the supine position does not necessarily influence the difficulty of the procedure for an endoscopist who routinely works with intubated patients. The three endoscopists directly involved in the trial [2] routinely carry out ERCP with moderate sedation and analgesia and are all accustomed to working with the patient in the prone position. This might be an important bias of the study that could limit the generalizability and reproducibility of the results. It would be interesting to see whether our results are confirmed by other authors with different training and experience.

Competing interests: none

References

• 1 Froehlich F. Patient position during ERCP: prone versus supine. What about left lateral throughout?.  Endoscopy. 2006;  38 755
• 2 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