Respiratory safety and resource utilization in ERCP: a comparative study of high-flow nasal oxygen, conventional...

Endoscopic retrograde cholangiopancreatography (ERCP) poses significant respiratory challenges due to shared airways, prone positioning and deep sedation requirements. High-flow nasal oxygen (HFNO) has emerged as a potential non-invasive oxygenation strategy. This study compared the clinical efficacy and volumetric oxygen consumption of HFNO with conventional simple mask (SM) oxygenation and general anesthesia (GA) in ERCP procedures.

This retrospective cohort study included 194 adult patients (SM: n = 67, HFNO: n = 56, GA: n = 71) who underwent ERCP between May 2025 and January 2026. Primary outcomes were desaturation incidence (SpO₂ < 92%) and volumetric oxygen consumption. Secondary outcomes included minimum SpO₂, airway interventions, and normalized propofol dose requirements. Subgroup analyses were performed for elderly (≥65 years) and ASA III patients.

Desaturation occurred in 59.7% of SM patients versus 0% in both HFNO and GA groups (p < 0.001). In elderly patients (n = 119), desaturation reached 81% in SM versus 0% in HFNO and GA. Minimum SpO₂ was significantly lower in SM (90%) compared to HFNO (99%) and GA (99%) (p < 0.001). Airway interventions were required in 31.4% of SM patients, 5.4% of HFNO patients (p = 0.004). Oxygen consumption was highest in HFNO (500 L) compared to SM (175 L) and GA (34.5 L) (p < 0.001). To ensure an objective comparison, propofol requirements were statistically analyzed using weight-and-time-normalized values (mg/kg/h); the significantly lower demand in the GA group was attributed to the anesthetic-sparing effect of volatile maintenance, whereas no significant difference was found between the two sedation-based groups (p = 0.110).

HFNO provided a high level of respiratory stability, matching the observed 0% desaturation rate of the GA group, even in high-risk populations. While the anesthetic paradigms differ fundamentally, our findings suggest that HFNO can achieve a safety profile that approximates the clinical outcomes of general anesthesia regarding oxygenation maintenance.