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Influence of pediatric ERCP positioning on procedural outcomes: A single-center study
Michael Joseph1, Rebecca Schiff1, Jacob Mark1
1Section of Pediatric Gastroenterology, Hepatology and Nutrition, Children's Hospital of Colorado, Digestive Health Institute, Aurora, Colorado, USA.
Insights
The supine position for pediatric endoscopic retrograde cholangiopancreatography (ERCP) reduces anesthesia time without compromising safety or success. This finding supports the supine approach for pediatric ERCP procedures.
Area of Science:
- Pediatric Gastroenterology
- Endoscopic Procedures
- Anesthesia Management
Background:
- Endoscopic retrograde cholangiopancreatography (ERCP) is traditionally performed in the prone position.
- Pediatric patient anatomy and anesthesia practices necessitate evaluating procedural positioning.
- Anesthesia time is a critical factor in pediatric procedures due to potential neurodevelopmental impacts.
Purpose of the Study:
- To evaluate the safety, procedural success, and efficiency of pediatric ERCP in prone versus supine positions.
- To determine the impact of patient positioning on total anesthesia time in pediatric ERCP.
- To identify factors influencing anesthesia duration during pediatric ERCP.
Main Methods:
- Retrospective review of 378 pediatric ERCPs performed between September 2016 and August 2023.
- Collection of demographic and procedural variables.
- Multivariate linear regression analysis to assess the effect of patient position on anesthesia time.
Main Results:
- The supine position was associated with a 9.3-minute decrease in anesthesia time.
- Factors increasing anesthesia time included additional procedures, longer procedure duration, and native papilla.
- A learning curve of 10-40 cases was observed for transitioning to the supine position, after which mean procedure time decreased by 11 minutes and total anesthesia time by 16 minutes.
Conclusions:
- The supine position may be preferred for pediatric ERCP due to significantly reduced anesthesia time.
- Similar procedural outcomes support the supine position, considering the impact of anesthesia duration on pediatric neurodevelopment and patient costs.
- This study is the first to specifically examine patient positioning's role in pediatric ERCP outcomes and anesthesia time.
Objectives:
Endoscopic retrograde cholangiopancreatography (ERCP) is traditionally done in the prone position. In pediatrics, patient anatomy and anesthesia practices are considerations that affect procedural success and anesthesia time. The aim of our study was to evaluate the safety, procedural success, and efficiency of pediatric ERCP in the prone versus supine positions.
Methods:
ERCPs from September 2016 to August 2023 were reviewed at our center. Demographic and procedure variables were collected. Multivariate linear regression was performed to determine the effect of patient position on total anesthesia time.
Results:
Two hundred and eighty-three patients (378 ERCPs) were included. There were significant differences in fellow involvement, proportion of native papillae, procedural indication, and total anesthesia time by ERCP position. Multivariate linear regression found that supine position was associated with 9.3-min decrease in anesthesia time and American Society of Anesthesiologists Class 1 or 2 was associated with 10.6-min decrease in anesthesia time. Factors that were associated with increased anesthesia time were additional procedure, increased procedure time, and native papilla. Finally, we found a learning curve for transitioning from prone to supine position was between 10 and 40 cases. After the learning curve, we found 11-min decrease in mean procedure time and 16-min decrease in total anesthesia time in the supine position.
Conclusions:
This is the first pediatric study to evaluate the role of patient positioning on ERCP outcomes and total anesthesia time. Given similar procedural outcomes, the impact of increased anesthesia time on neurodevelopment in children, and the cost to the patient, the supine position may be preferred to a prone position.
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