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

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 com...

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Autores principales: Varma, Poornima, Ket, Shara, Paul, Eldho, Barnes, Malcolm, Devonshire, David A., Croagh, Daniel, Swan, Michael P.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Georg Thieme Verlag KG 2022
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9010096/
https://www.ncbi.nlm.nih.gov/pubmed/35433220
http://dx.doi.org/10.1055/a-1749-5043
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author Varma, Poornima
Ket, Shara
Paul, Eldho
Barnes, Malcolm
Devonshire, David A.
Croagh, Daniel
Swan, Michael P.
author_facet Varma, Poornima
Ket, Shara
Paul, Eldho
Barnes, Malcolm
Devonshire, David A.
Croagh, Daniel
Swan, Michael P.
author_sort Varma, Poornima
collection PubMed
description 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/m (2) in LL vs 0.16 mGy/m (2) 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.
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spelling pubmed-90100962022-04-15 Does ERCP position matter? A randomized controlled trial comparing efficacy and complications of left lateral versus prone position (POSITION study) Varma, Poornima Ket, Shara Paul, Eldho Barnes, Malcolm Devonshire, David A. Croagh, Daniel Swan, Michael P. Endosc Int Open 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/m (2) in LL vs 0.16 mGy/m (2) 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. Georg Thieme Verlag KG 2022-04-14 /pmc/articles/PMC9010096/ /pubmed/35433220 http://dx.doi.org/10.1055/a-1749-5043 Text en 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/) https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License, which permits unrestricted reproduction and distribution, for non-commercial purposes only; and use and reproduction, but not distribution, of adapted material for non-commercial purposes only, provided the original work is properly cited.
spellingShingle Varma, Poornima
Ket, Shara
Paul, Eldho
Barnes, Malcolm
Devonshire, David A.
Croagh, Daniel
Swan, Michael P.
Does ERCP position matter? A randomized controlled trial comparing efficacy and complications of left lateral versus prone position (POSITION study)
title Does ERCP position matter? A randomized controlled trial comparing efficacy and complications of left lateral versus prone position (POSITION study)
title_full Does ERCP position matter? A randomized controlled trial comparing efficacy and complications of left lateral versus prone position (POSITION study)
title_fullStr Does ERCP position matter? A randomized controlled trial comparing efficacy and complications of left lateral versus prone position (POSITION study)
title_full_unstemmed Does ERCP position matter? A randomized controlled trial comparing efficacy and complications of left lateral versus prone position (POSITION study)
title_short Does ERCP position matter? A randomized controlled trial comparing efficacy and complications of left lateral versus prone position (POSITION study)
title_sort does ercp position matter? a randomized controlled trial comparing efficacy and complications of left lateral versus prone position (position study)
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9010096/
https://www.ncbi.nlm.nih.gov/pubmed/35433220
http://dx.doi.org/10.1055/a-1749-5043
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