Impact of Patient Positioning and Endotracheal Intubation During ERCP: Insights from a Large Database

Endoscopic retrograde cholangiopancreatography (ERCP) is conventionally performed in the prone position after intubating the airway. However, ERCP can also be performed in the left lateral and supine positions without endotracheal intubation. We compared procedural metrics and outcomes in patients placed prone, supine, and left lateral during ERCP.

In this retrospective multi-center analysis using a large, organization-wide database, patients were categorized as prone, supine, and left lateral based on the positioning for ERCP. Procedural metrics were calculated using contemporaneous electronic health records. All-cause readmission within 7 and 30 days of ERCP was analyzed.

The 6510 patients who met selection criteria were categorized as follows: Supine: 3362; left lateral: 2149; and prone: 999. Endotracheal intubation was performed more frequently in supine (90%) and prone (95%) positions than left lateral position (27%; p < 0.01). The time intervals (minutes) for left lateral, prone, and supine positions were: induction time 7.54 ± 4.95, 9.3 ± 6.22, 6.77 ± 3.67; anesthesia ready time 8.98 ± 5.15, 14.13 ± 7.41, 9.41 ± 3.96; ERCP duration 31.71 ± 25.77, 40.99 ± 28.6, 36.49 ± 29.03 and total time in room 54.95 ± 30.26, 72.61 ± 32.76, 62.44 ± 33.06 (p < 0.001 for each measure between three groups) respectively. Regression and variable impact analysis demonstrated that endotracheal intubation was the most significant factor for increased induction time (100%), anesthesia ready time (97%), and duration of ERCP (55%). Adjusted odds of readmission at 7 days were lower in supine patients compared to prone (0.63; 95% CI 0.44, 0.91; p = 0.01).

Supine and left lateral positions improve procedural efficiency primarily due to reduced endotracheal intubation rates, without increasing readmission.