|
1
|
Joseph M, Schiff R, Mark J, Kramer R. Influence of pediatric ERCP positioning on procedural outcomes: A single-center study. J Pediatr Gastroenterol Nutr 2025; 80:345-352. [PMID: 39686550 DOI: 10.1002/jpn3.12438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2024] [Revised: 11/06/2024] [Accepted: 11/26/2024] [Indexed: 12/18/2024]
Abstract
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.
Collapse
Affiliation(s)
- Michael Joseph
- Section of Pediatric Gastroenterology, Hepatology and Nutrition, Children's Hospital of Colorado, Digestive Health Institute, Aurora, Colorado, USA
| | - Rebecca Schiff
- Section of Pediatric Gastroenterology, Hepatology and Nutrition, Children's Hospital of Colorado, Digestive Health Institute, Aurora, Colorado, USA
| | - Jacob Mark
- Section of Pediatric Gastroenterology, Hepatology and Nutrition, Children's Hospital of Colorado, Digestive Health Institute, Aurora, Colorado, USA
| | - Robert Kramer
- Section of Pediatric Gastroenterology, Hepatology and Nutrition, Children's Hospital of Colorado, Digestive Health Institute, Aurora, Colorado, USA
| |
Collapse
|
|
2
|
Meeusen V, Kim M, Ma R, Roque M, Sivalingam P, Hamarneh Z, Hourigan L. A Randomized Controlled Trial of Patient Positioning During Endoscopic Retrograde Cholangiopancreatography (ERCP) Procedures: A Comparison Between Semi-Prone- and Prone-Positioned Patients. Gastroenterol Nurs 2025; 48:51-61. [PMID: 39874119 PMCID: PMC11776873 DOI: 10.1097/sga.0000000000000849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 07/02/2024] [Indexed: 01/30/2025] Open
Abstract
The prone "swimmers" position is preferable for endoscopic retrograde cholangiopancreatography (ERCP) as it provides the best visualization for selective bile duct cannulation. However, "swimmers" position does not comply with best-practice patient positioning guidelines. Our objective was to determine whether the semi-prone patient position was suitable for ERCP without negatively influencing the outcomes of the procedure. We conducted a randomized controlled trial, 50 patients in prone and 50 patients in semi-prone patient position, measuring the number of attempts and time to successfully cannulate the bile duct. Safety outcomes measured were airway access, pharyngeal endoscope passage, and complications. Between the two groups, there were no statistical differences in demographic variables, selective bile duct cannulation attempts, or cannulation time. Airway access scored significantly better in the semi-prone position. There was a significant positive correlation between the total number of cannulation attempts and papilla type. No intra- or post-procedural significant complications occurred. The semi-prone position was comparable to the "swimmers" position regarding the number of attempts and time required for selective bile duct cannulation but scored significantly better in airway access by anesthetists. A semi-prone patient position is advisable for ERCP procedures as it complies with best-practice patient positioning guidelines.
Collapse
Affiliation(s)
- Vera Meeusen
- About the authors: Gastroenterology & Hepatology Department, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia (Meeusen, Ma, Roque, Hamarneh, and Hourigan)
- Anaesthesia Department, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia (Kim and Sivalingam)
- Faculty of Medicine, The University of Queensland, St Lucia, Queensland, Australia (Meeusen, Sivalingam, Hamarneh, and Hourigan)
| | - Mijin Kim
- About the authors: Gastroenterology & Hepatology Department, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia (Meeusen, Ma, Roque, Hamarneh, and Hourigan)
- Anaesthesia Department, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia (Kim and Sivalingam)
- Faculty of Medicine, The University of Queensland, St Lucia, Queensland, Australia (Meeusen, Sivalingam, Hamarneh, and Hourigan)
| | - Regan Ma
- About the authors: Gastroenterology & Hepatology Department, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia (Meeusen, Ma, Roque, Hamarneh, and Hourigan)
- Anaesthesia Department, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia (Kim and Sivalingam)
- Faculty of Medicine, The University of Queensland, St Lucia, Queensland, Australia (Meeusen, Sivalingam, Hamarneh, and Hourigan)
| | - Marilyn Roque
- About the authors: Gastroenterology & Hepatology Department, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia (Meeusen, Ma, Roque, Hamarneh, and Hourigan)
- Anaesthesia Department, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia (Kim and Sivalingam)
- Faculty of Medicine, The University of Queensland, St Lucia, Queensland, Australia (Meeusen, Sivalingam, Hamarneh, and Hourigan)
| | - Pal Sivalingam
- About the authors: Gastroenterology & Hepatology Department, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia (Meeusen, Ma, Roque, Hamarneh, and Hourigan)
- Anaesthesia Department, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia (Kim and Sivalingam)
- Faculty of Medicine, The University of Queensland, St Lucia, Queensland, Australia (Meeusen, Sivalingam, Hamarneh, and Hourigan)
| | - Zaki Hamarneh
- About the authors: Gastroenterology & Hepatology Department, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia (Meeusen, Ma, Roque, Hamarneh, and Hourigan)
- Anaesthesia Department, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia (Kim and Sivalingam)
- Faculty of Medicine, The University of Queensland, St Lucia, Queensland, Australia (Meeusen, Sivalingam, Hamarneh, and Hourigan)
| | - Luke Hourigan
- About the authors: Gastroenterology & Hepatology Department, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia (Meeusen, Ma, Roque, Hamarneh, and Hourigan)
- Anaesthesia Department, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia (Kim and Sivalingam)
- Faculty of Medicine, The University of Queensland, St Lucia, Queensland, Australia (Meeusen, Sivalingam, Hamarneh, and Hourigan)
| |
Collapse
|
|
3
|
Alrufayi B, Almutairi S, Zagnoon A. Successful Endoscopic Retrograde Cholangiopancreatography for Management of Choledocholithiasis in a Patient With Situs Inversus Totalis: A Case Report and Literature Review. GASTRO HEP ADVANCES 2024; 4:100555. [PMID: 39866714 PMCID: PMC11761330 DOI: 10.1016/j.gastha.2024.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 09/16/2024] [Indexed: 01/28/2025]
Abstract
Situs inversus totalis is a rare congenital disorder defined by the transposition of all viscera to the opposite side of the body. Because of this anatomical alteration, endoscopic retrograde cholangiopancreatography (ERCP) in such a population is significantly challenging. Herein we report a case of a 50-year-old woman presented with epigastric and left upper quadrant pain. Preoperative examination revealed abnormal liver chemistries, situs inversus totalis, and multiple distal common bile duct stones with intrahepatic and extrahepatic bile duct dilatation on abdominal ultrasound. The patient underwent a successful ERCP to relieve biliary obstruction. It was performed while the patient was placed in a supine position with the endoscopist standing on the left side of the patient. The major emphasis in ERCP is adjusting the patient and endoscopist positions during the procedure. The advantage of the supine position is that the endoscope could easily reach the pyloric ring and, after reaching the duodenum, the papilla could be reached without difficulty.
Collapse
Affiliation(s)
- Bashayer Alrufayi
- Internal Medicine Department, Prince Mohammed Bin Abdulaziz Hospital, Ministry National Guard - Health Affairs, Almadinah, Almunawwarah, KSA
| | - Saad Almutairi
- Internal Medicine Department, Prince Mohammed Bin Abdulaziz Hospital, Ministry National Guard - Health Affairs, Almadinah, Almunawwarah, KSA
| | - Abbas Zagnoon
- Gastroenterology Division, Medicine Department, Prince Mohammed Bin Abdulaziz Hospital, Ministry National Guard - Health Affairs, Almadinah, Almunawwarah, KSA
| |
Collapse
|
|
4
|
Muhammedoğlu B, Pektezel MY, Ulaş M, Topuz S, Hüseyinoğlu E. Ocular and the whole body radiation exposure during endoscopic retrograde cholangiopancreatography. Turk J Surg 2024; 40:183-189. [PMID: 39917406 PMCID: PMC11792896 DOI: 10.47717/turkjsurg.2024.6461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Accepted: 08/22/2024] [Indexed: 02/09/2025]
Abstract
Objectives This study aimed to analyze the average whole body radiation exposure, which changes significantly according to during endoscopic retrograde cholangiopancreatography (ERCP) difficulty and to determine whether an ocular protection device must be used by analyzing applied ocular radiation. Material and Methods Patients >18 years of age in whom an ERCP had been indicated were prospectively included in the study. Results A total of 1173 patients were included. Increased applied radiation dose significantly correlated with increased shot rate (Rho= 0.789, p <0.001), ERCP duration (Rho= 0.487, p <0.001), cost (Rho= 0.129, p <0.001), and LOS (Rho= 0.109, p <0.001). The whole body, skin, and eye radiation exposure doses were found to be lower than the recommended limit per year (20 mSv/year). Conclusion Limit of ocular radiation exposure during ERCP did not exceed the recommended annual limit (20 mSv/year), and it was also detected to be much lower than that. Therefore, the use of ocular visors is not recommended.
Collapse
Affiliation(s)
- Bahtiyar Muhammedoğlu
- Department of Gastroenterological Surgery, Kahramanmaraş Sütçü İmam University Faculty of Medicine, Kahramanmaraş, Türkiye
| | - Mehmet Yasir Pektezel
- Clinic of Intensive Care Unit, Kahramanmaraş Necip Fazıl City Hospital, Kahramanmaraş, Türkiye
| | - Murat Ulaş
- Department of Gastroenterological Surgery, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Türkiye
| | - Sezgin Topuz
- Department of General Surgery, Kahramanmaraş Sütçü İmam University Faculty of Medicine, Kahramanmaraş, Türkiye
| | | |
Collapse
|
|
5
|
Li JS, Fang J. Further research is needed to recommend an individualized ERCP position. Gastrointest Endosc 2023; 98:1038-1039. [PMID: 37977664 DOI: 10.1016/j.gie.2023.07.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 07/11/2023] [Indexed: 11/19/2023]
Affiliation(s)
- Jia-Su Li
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jun Fang
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan, China
| |
Collapse
|
|
6
|
Issa D, Sharaiha RZ, Abdelfattah T, Htway Z, Tabibian JH, Thiruvengadam S, Dawod QM, Wangrattanapranee P, Dawod E, Mukewar S, Mahadev S, Carr-Locke DL, Sampath K. Clinical outcomes and learning curve for ERCP during advanced endoscopy training: a comparison of supine versus prone positioning. Gastrointest Endosc 2023; 98:629-633.e1. [PMID: 37385547 DOI: 10.1016/j.gie.2023.06.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/31/2023] [Accepted: 06/10/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND AND AIMS No studies have evaluated trainees' outcomes when learning ERCP with patients in the supine and prone positions simultaneously. We aimed to assess whether patient position impacts procedural outcomes and learning curve. METHODS We prospectively evaluated patients undergoing ERCP by a supervised advanced endoscopy trainee (AET) at a tertiary care center. Adult patients with native papillae were included. The AET was universally given 5 attempts per cannulation. Outcomes were evaluated quarterly. RESULTS Successful cannulation was achieved in 44 supine (69%) and 17 prone (68%) patients (P = .95). Although mean time to reach the papilla was shorter in the supine patient position, time to biliary cannulation (7.8 vs 9.4 minutes, P = .53) and number of attempts were similar. A stepwise increase was seen in cannulation rates throughout the academic year (P < .01) and increased more in supine patients (P = .01). Procedure and total room times were shorter in supine patients. CONCLUSIONS Shorter procedure and room turnover times and a comparable cannulation rate were found for supine versus prone ERCP.
Collapse
Affiliation(s)
| | - Reem Z Sharaiha
- Division of Gastroenterology & Hepatology, Weill Cornell Medicine, New York, New York, USA
| | - Thaer Abdelfattah
- Division of Gastroenterology & Hepatology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Zin Htway
- Department of Epidemiology, California State University Channel Islands, Walden University, Camarillo, California, USA
| | - James H Tabibian
- Division of Gastroenterology, Olive View Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | | | - Qais M Dawod
- Division of Gastroenterology & Hepatology, Weill Cornell Medicine, New York, New York, USA
| | | | - Enad Dawod
- Division of Gastroenterology & Hepatology, Weill Cornell Medicine, New York, New York, USA
| | - Saurabh Mukewar
- Division of Gastroenterology & Hepatology, Weill Cornell Medicine, New York, New York, USA
| | - Srihari Mahadev
- Division of Gastroenterology & Hepatology, Weill Cornell Medicine, New York, New York, USA
| | - David L Carr-Locke
- Division of Gastroenterology & Hepatology, Weill Cornell Medicine, New York, New York, USA
| | - Kartik Sampath
- Division of Gastroenterology & Hepatology, Weill Cornell Medicine, New York, New York, USA
| |
Collapse
|
|
7
|
Azimaraghi O, Bilal M, Amornyotin S, Arain M, Behrends M, Berzin TM, Buxbaum JL, Choice C, Fassbender P, Sawhney MS, Sundar E, Wongtangman K, Leslie K, Eikermann M. Consensus guidelines for the perioperative management of patients undergoing endoscopic retrograde cholangiopancreatography. Br J Anaesth 2023; 130:763-772. [PMID: 37062671 DOI: 10.1016/j.bja.2023.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 02/26/2023] [Accepted: 03/08/2023] [Indexed: 04/18/2023] Open
Abstract
Deep sedation without tracheal intubation (monitored anaesthesia care) and general anaesthesia with tracheal intubation are commonly used anaesthesia techniques for endoscopic retrograde cholangiopancreatography (ERCP). There are distinct pathophysiological differences between monitored anaesthesia care and general anaesthesia that need to be considered depending on the nature and severity of the patient's underlying disease, comorbidities, and procedural risks. An international group of expert anaesthesiologists and gastroenterologists created clinically relevant questions regarding the merits and risks of monitored anaesthesia care vs general anaesthesia in specific clinical scenarios for planning optimal anaesthetic approaches for ERCP. Using a modified Delphi approach, the group created practical recommendations for anaesthesiologists, with the aim of reducing the incidence of perioperative adverse outcomes while maximising healthcare resource utilisation. In the majority of clinical scenarios analysed, our expert recommendations favour monitored anaesthesia care over general anaesthesia. Patients with increased risk of pulmonary aspiration and those undergoing prolonged procedures of high complexity were thought to benefit from general anaesthesia with tracheal intubation. Patient age and ASA physical status were not considered to be factors for choosing between monitored anaesthesia care and general anaesthesia. Monitored anaesthesia care is the favoured anaesthesia plan for ERCP. An individual risk-benefit analysis that takes into account provider and institutional experience, patient comorbidities, and procedural risks is also needed.
Collapse
Affiliation(s)
- Omid Azimaraghi
- Department of Anesthesiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, USA
| | - Mohammad Bilal
- Division of Gastroenterology & Hepatology, Minneapolis VA Medical Center, University of Minnesota, Minneapolis, MN, USA
| | - Somchai Amornyotin
- Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Mustafa Arain
- Center for Interventional Endoscopy, AdventHealth, Orlando, FL, USA
| | - Matthias Behrends
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, CA, USA
| | - Tyler M Berzin
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - James L Buxbaum
- Department of Internal Medicine, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
| | - Curtis Choice
- Department of Anesthesiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, USA
| | - Philipp Fassbender
- Department of Anesthesiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, USA; Klinik für Anästhesiologie, Operative Intensivmedizin, Schmerz- und Palliativmedizin, Marien Hospital Herne, Universitätsklinikum der Ruhr-Universität Bochum, Herne, Germany
| | - Mandeep S Sawhney
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Eswar Sundar
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Karuna Wongtangman
- Department of Anesthesiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, USA; Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kate Leslie
- Monash University, Melbourne, VIC, Australia; Royal Melbourne Hospital and University of Melbourne, Melbourne, VIC, Australia
| | - Matthias Eikermann
- Department of Anesthesiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, USA; Klinik für Anästhesiologie und Intensivmedizin, Universität Duisburg-Essen, Essen, Germany.
| |
Collapse
|
|
8
|
Keswani RN, Duloy A, Nieto JM, Panganamamula K, Murad MH, Bazerbachi F, Shaukat A, Elmunzer BJ, Day LW. Interventions to improve the performance of ERCP and EUS quality indicators. Gastrointest Endosc 2023; 97:825-838. [PMID: 36967249 DOI: 10.1016/j.gie.2022.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 12/11/2022] [Indexed: 04/21/2023]
Affiliation(s)
- Rajesh N Keswani
- Division of Gastroenterology, Department of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Anna Duloy
- Division of Gastroenterology, Department of Medicine, University of Colorado, Aurora, Colorado, USA
| | - Jose M Nieto
- Digestive Disease Consultants, Jacksonville, Florida, USA
| | - Kashyap Panganamamula
- Division of Gastroenterology, Department of Medicine, University of Pennsylvania, Penn Presbyterian Medical Center, Philadelphia, Pennsylvania, USA
| | - M Hassan Murad
- Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Fateh Bazerbachi
- CentraCare, Interventional Endoscopy Program, St Cloud Hospital, St Cloud, Minnesota, USA
| | - Aasma Shaukat
- Division of Gastroenterology and Hepatology, NYU Grossman School of Medicine, New York, New York, USA
| | - B Joseph Elmunzer
- Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Lukejohn W Day
- Division of Gastroenterology, Department of Medicine, Zuckerberg San Francisco General Hospital and University of San Francisco, San Francisco, California, USA
| |
Collapse
|
|
9
|
Ding B, Wang J, Wei X, Du Y, Xia L, Sun C, Han K, Yang X, Guo X, Pan Y, Wang X. Efficacy and safety of ERCP in patients with situs inversus totalis: multicenter case series and literature review. BMC Gastroenterol 2022; 22:497. [DOI: 10.1186/s12876-022-02593-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 11/24/2022] [Indexed: 12/02/2022] Open
Abstract
Abstract
Background
Endoscopic retrograde cholangiopancreatography (ERCP) in patients with situs inversus totalis (SIT) is rarely understood due to its rarity. Patient position and endoscope manipulation were the main concerns in published case reports. The aim of this study was to investigate the efficacy and safety of ERCP in SIT patients.
Methods
Patients with SIT who underwent ERCP were enrolled in nine endoscopic centers in China. ERCP procedural details and complications in SIT patients were retrieved from electronic medical record. The data was retrospectively analyzed.
Results
From 2011 to 2021, totally 14 patients with SIT undergoing ERCP were identified. The mean age was 56.8 years old and the male–female ratio was 5:2. The main indication for ERCP was common bile duct stones (13/14, 92.9%). All procedure were performed by experienced endoscopists. 21.4% (3/14) of patients were under regular position (prone), while 78.6% under modified position (supine, left or right lateral). Difficult cannulation was occurred in 71.4% (10/14) of patients. The rate of successful cannulation was 85.7% (12/14). Complication occurred in 3 patients (3/14, 21.4%), including 1 bleeding, 1 pneumonia and 1 acute myocardial infarction. No post-pancreatitis or death happened. Compared to patients in modified position, those in prone position had numerically less successful cannulations (66.7% vs. 90.9%) and higher adverse events (33.3% vs. 18.2%).
Conclusions
ERCP in patient with SIT is challenging even for experienced endoscopists, modified patient positions might have potential benefits concerning more successful cannulations and less complications. More case experiences are need for comprehensive understanding of ERCP in patients with SIT.
Collapse
|
|
10
|
Phillpotts S, Webster G, Arvanitakis M. Endoscopic Management of Complex Biliary Stones. Gastrointest Endosc Clin N Am 2022; 32:477-492. [PMID: 35691692 DOI: 10.1016/j.giec.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Complex biliary stones may be challenging to remove with standard endoscopic techniques. Factors contributing to complexity include large stone size (≥15 mm), multiple stones, high stone:distal duct ratio, stones above strictures and those in difficult anatomic position. In these cases, additional techniques may be needed, such as endoscopic papillary large balloon dilatation, mechanical lithotripsy, cholangioscopic visually directed lithotripsy, and extracorporeal shockwave lithotripsy. The choice of technique depends on local expertise and resources. Cases should be planned to identify the appropriate technique to avoid multiple procedures. This article describes the factors linked to difficulty and the steps to overcome them.
Collapse
Affiliation(s)
- Simon Phillpotts
- Department of Gastroenterology, University College London Hospitals, 250 Euston Road, London, England
| | - George Webster
- Department of Gastroenterology, University College London Hospitals, 250 Euston Road, London, England.
| | - Marianna Arvanitakis
- Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, CUB Hôpital Erasme, Université Libre de Bruxelles, Route de Lennik 808, Brussels 1070, Belgium
| |
Collapse
|
|
11
|
Dietrich CF, Bekkali NL, Burmeister S, Dong Y, Everett SM, Hocke M, Ignee A, On W, Hebbar S, Oppong K, Sun S, Jenssen C, Braden B. Controversies in ERCP: Indications and preparation. Endosc Ultrasound 2022; 11:186-200. [PMID: 34677145 PMCID: PMC9258020 DOI: 10.4103/eus-d-21-00106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 07/13/2021] [Indexed: 11/29/2022] Open
Abstract
The aim of the series of papers on controversies of biliopancreatic drainage procedures is to discuss the pros and cons of the varying clinical practices and techniques in ERCP and EUS for drainage of biliary and pancreatic ducts. The first part focuses on indications, clinical and imaging prerequisites before ERCP, sedation options, post-ERCP pancreatitis (PEP) prophylaxis, and other related technical topics. In the second part, specific procedural ERCP-techniques including precut techniques and its timing as well as management algorithms are discussed. In addition, controversies in EUS-guided bile duct and pancreatic drainage procedures are under preparation.
Collapse
Affiliation(s)
- Christoph F. Dietrich
- Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, China
- Johann Wolfgang Goethe University, Frankfurt/Main, Germany
- Department of Allgemeine Innere Medizin, Kliniken Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland
| | - Noor L. Bekkali
- Translational Gastroenterology Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Sean Burmeister
- Surgical Gastroenterology Unit, Groote Schuur Hospital, Cape Town, South Africa
| | - Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | | | - Michael Hocke
- Medical Department, Helios Klinikum Meiningen, Meiningen, Germany
| | - Andre Ignee
- Medical Department 2, Caritas-Krankenhaus, Uhlandstr 7, D-97980 Bad Mergentheim, Germany
| | - Wei On
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Srisha Hebbar
- University Hospitals of North Midlands, North Midlands, United Kingdom
| | - Kofi Oppong
- HPB Unit, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Siyu Sun
- Endoscopy Center, Sheng Jing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Christian Jenssen
- Department of Internal Medicine, Krankenhaus Märkisch-Oderland, Strausberg, Germany
- Brandenburg Institute for Clinical Ultrasound at Medical University Brandenburg, Neuruppin, Germany
| | - Barbara Braden
- Translational Gastroenterology Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
- Johann Wolfgang Goethe University, Frankfurt/Main, Germany
| |
Collapse
|
|
12
|
Varma P, Ket S, Paul E, Barnes M, Devonshire DA, Croagh D, Swan MP. Does ERCP position matter? A randomized controlled trial comparing efficacy and complications of left lateral versus prone position (POSITION study). Endosc Int Open 2022; 10:E403-E412. [PMID: 35433220 PMCID: PMC9010096 DOI: 10.1055/a-1749-5043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 11/10/2021] [Indexed: 11/08/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Poornima Varma
- Department of Gastroenterology & Hepatology, Austin Health, Heidelberg, Australia
| | - Shara Ket
- Department of Gastroenterology & Hepatology, Monash Medical Centre, Clayton, Australia
| | - Eldho Paul
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Monash Medical Centre, Clayton, Australia
| | - Malcolm Barnes
- Department of Gastroenterology & Hepatology, Monash Medical Centre, Clayton, Australia
| | - David A. Devonshire
- Department of Gastroenterology & Hepatology, Monash Medical Centre, Clayton, Australia
| | - Daniel Croagh
- Department of Upper GI Surgery, Monash Medical Centre, Clayton, Australia,Department of Surgery, Monash University, Clayton, Australia
| | - Michael P. Swan
- Department of Gastroenterology & Hepatology, Monash Medical Centre, Clayton, Australia
| |
Collapse
|
|
13
|
McCarty TR, Hathorn KE, Creighton DW, AlSamman MA, Thompson CC. Safety and sedation-associated adverse event reporting among patients undergoing endoscopic cholangiopancreatography: a comparative systematic review and meta-analysis. Surg Endosc 2021; 35:6977-6989. [PMID: 33966121 DOI: 10.1007/s00464-020-08210-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 12/02/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND AIM There is wide variation in choice of sedation and airway management for endoscopic retrograde cholangiopancreatography (ERCP). The aim of this study was to perform a systematic review and meta-analysis to investigate safety outcomes of deep sedation with monitored anesthesia care (MAC) versus general endotracheal anesthesia (GETA). METHODS Individualized search strategies were performed in accordance with PRISMA and MOOSE guidelines. This meta-analysis was performed by calculating pooled proportions using random effects models. Measured outcomes included procedure success, all-cause and anesthesia-associated adverse events, and post-procedure recovery time. Heterogeneity was assessed with I2 statistics and publication bias by funnel plot and Egger regression testing. RESULTS Five studies (MAC: n = 1284 vs GETA: n = 615) were included. Patients in the GETA group were younger, had higher body mass index (BMI), and higher mean ASA scores (all P < 0.001) with no difference in Mallampati scores (P = 0.923). Procedure success, all-cause adverse events, and anesthesia-associated events were similar between groups [OR 1.16 (95% CI 0.51-2.64); OR 1.16 (95% CI 0.29-4.70); OR 1.33 (95% CI 0.27-6.49), respectively]. MAC resulted in fewer hypotensive episodes [OR 0.32 (95% CI 0.12-0.87], increased hypoxemic events [OR 5.61 (95% CI 1.54-20.37)], and no difference in cardiac arrhythmias [OR 0.48 (95% CI 0.13-1.78)]. Procedure time was decreased for MAC [standard difference - 0.39 (95% CI - 0.78-0.00)] with no difference in recovery time [standard difference - 0.48 (95% CI - 1.04-0.07)]. CONCLUSIONS This study suggests MAC may be a safe alternative to GETA for ERCP; however, MAC may not be appropriate in all patients given an increased risk of hypoxemia.
Collapse
Affiliation(s)
- Thomas R McCarty
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Kelly E Hathorn
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - David W Creighton
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Mohd Amer AlSamman
- Department of Internal Medicine, Warren Alpert Medical School of Brown University, Miriam Hospital, Providence, RI, USA
| | - Christopher C Thompson
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
| |
Collapse
|
|
14
|
Patient Positioning Guidelines for Gastrointestinal Endoscopic Procedures. Gastroenterol Nurs 2021; 44:185-191. [PMID: 34037567 DOI: 10.1097/sga.0000000000000534] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 04/23/2020] [Indexed: 12/22/2022] Open
Abstract
Patient positioning during gastrointestinal endoscopic procedures has received minimal attention compared with surgical procedures performed in the surgical setting. However, prolonged endoscopic interventions on patients and the increasing requirement for general anesthesia have changed to need for patient positioning guidelines. The objective of this study was to test whether patient positioning guidelines for surgical procedures in surgical suites are suitable for gastrointestinal endoscopic procedures without negatively impacting safety and procedure duration. This was an observational feasibility study with volunteers of different body mass index categories. Volunteers were positioned in supine, lateral, and prone positions on an operating table and thereafter on an endoscopy stretcher and asked for comfort levels. Except for arm and head positioning in lateral and prone positions, it was possible to replicate the patient positioning guidelines. Alternative options were explored for the positioning of arms and head to optimize oral access. Besides minor adjustments, we were able to replicate the positioning guidelines and adhere to pressure and nerve injury prevention guidelines. Concept endoscopic patient positioning guidelines were developed. It is recommended to review the "swimmer's" position. Endoscopic patient positioning guidelines should become part of the National Practice Standards and education curriculum of endoscopy nurses.
Collapse
|
|
15
|
Osagiede O, Bolaños GA, Cochuyt J, Cruz LM, Kröner PT, Lukens FJ, Corral JE. Impact of supine versus prone position on endoscopic retrograde cholangiopancreatography performance: a retrospective study. Ann Gastroenterol 2021; 34:582-587. [PMID: 34276199 PMCID: PMC8276359 DOI: 10.20524/aog.2021.0609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 12/28/2020] [Indexed: 11/11/2022] Open
Abstract
Background Endoscopic retrograde cholangiopancreatography (ERCP) is frequently performed in the prone or supine position. We compared the technical success and other outcomes between these positions. Methods This was a retrospective cohort study using the Clinical Outcomes Research Initiative database. Demographics, procedure and fluoroscopy time, visualization of main structures, and technical success rates were compared between the supine and prone positions. Univariate and multivariate regressions were performed to adjust for age, sex, ethnicity and clinical setting. Results A total of 21,090 patients who underwent ERCP were included, of whom 1769 (8.4%) were supine and 19,321 (91.6%) were prone. The common bile duct (CBD) was visualized and cannulated in 89.1% of supine vs. 91.4% of prone positions (P=0.017), while the ampulla was visualized in 97.1% of supine vs. 97.7% of prone (P=0.414). The ERCP was incomplete in 10% of supine vs. 5% of prone cases (P<0.001). On multivariate analysis, supine position required shorter procedure times than prone (adjusted odds ratio [aOR] 0.98, 95% confidence interval [CI] 0.98-0.98; P<0.001). The supine position also yielded lower odds of CBD visualization and cannulation (aOR 0.63, 95%CI 0.44-0.91; P=0.011) and higher odds of an incomplete examination (aOR 1.84, 95%CI 1.46-2.30; P<0.001) vs. prone. Conclusions The supine position leads to shorter procedures but is more likely to result in poorer visualization and cannulation of the CBD and an incomplete examination. This may reflect the technical difficulty of performing ERCP in the supine position for the endoscopist. Our study supports recommendations for an individualized ERCP approach.
Collapse
Affiliation(s)
- Osayande Osagiede
- Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, New York (Osayande Osagiede)
| | - Gabriel A Bolaños
- Department of Medicine, University of South Alabama, Mobile, Alabama (Gabriel A. Bolaños)
| | - Jordan Cochuyt
- Department of Health Science Research, Mayo Clinic, Jacksonville, Florida (Jordan Cochuyt)
| | - Luisa M Cruz
- School of Medicine, Universidad Francisco Marroquín, Guatemala City, Guatemala (Luisa M. Cruz)
| | - Paul T Kröner
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida (Paul T. Kröner, Frank J. Lukens, Juan E. Corral), USA
| | - Frank J Lukens
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida (Paul T. Kröner, Frank J. Lukens, Juan E. Corral), USA
| | - Juan E Corral
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida (Paul T. Kröner, Frank J. Lukens, Juan E. Corral), USA
| |
Collapse
|
|
16
|
Anesthesia-administered sedation for endoscopic retrograde cholangiopancreatography: monitored anesthesia care or general endotracheal anesthesia? Curr Opin Anaesthesiol 2019; 32:531-537. [PMID: 30994476 DOI: 10.1097/aco.0000000000000741] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW The decision to undertake monitored anesthesia care (MAC) or general endotracheal anesthesia (GEA) for patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) is influenced by many factors. These include locoregional practice preferences, procedure complexity, patient position, and comorbidities. We aim to review the data regarding anesthesia-administered sedation for ERCP and identify the impact of airway management on procedure success, adverse event rates and endoscopy unit efficiency. RECENT FINDINGS Several studies have consistently identified patients at high risk for sedation-related adverse events during ERCP. This group includes those with higher American Society of Anesthesiologists class and (BMI). ERCP is commonly performed in the prone position, which can make the placement of an emergent advanced airway challenging. Although this may be alleviated by performing ERCP in the supine position, this technique is more technically cumbersome for the endoscopist. Data regarding the impact of routine GEA on endoscopy unit efficiency remain controversial. SUMMARY Pursuing MAC or GEA for patients undergoing ERCP is best-approached on an individual basis. Patients at high risk for sedation-related adverse events likely benefit from GEA. Larger, multicenter randomized controlled trials will aid significantly in better delineating which sedation approach is best for an individual patient.
Collapse
|
|
17
|
Maple JT. Preparation of the Patient for ERCP. ERCP 2019:80-85.e3. [DOI: 10.1016/b978-0-323-48109-0.00010-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
|
|
18
|
Affiliation(s)
- Amit Maydeo
- Baldota Institute of Digestive Sciences (BIDS), Global Hospital, Parel, Mumbai 400012, India
| | - Gaurav Kumar Patil
- Baldota Institute of Digestive Sciences (BIDS), Global Hospital, Parel, Mumbai 400012, India
| |
Collapse
|
|
19
|
Mashiana HS, Jayaraj M, Mohan BP, Ohning G, Adler DG. Comparison of outcomes for supine vs. prone position ERCP: a systematic review and meta-analysis. Endosc Int Open 2018; 6:E1296-E1301. [PMID: 30410948 PMCID: PMC6221825 DOI: 10.1055/a-0603-3302] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 03/12/2018] [Indexed: 10/27/2022] Open
Abstract
Background While endoscopic retrograde cholangiopancreatography (ERCP) is usually performed in the prone position, some studies have advocated for ERCP in the supine position. Studies comparing the technical success and safety outcomes have shown variable results. We performed a systematic review and meta-analysis of studies reporting the comparison between the two positions for ERCP outcomes. Methods We conducted a search of electronic databases and conference proceedings including PubMed, EMBASE, and Web of Science databases (from inception through October 2016) to identify studies that reported the comparison of technical success and safety outcomes between supine and prone ERCP. The primary outcome was to estimate the pooled rates of technical success. The secondary outcome was to estimate the risks of complications, such as cardiopulmonary and post-ERCP pancreatitis (PEP). Results Six studies reporting on 309 supine and 1415 prone ERCPs were identified. The pooled technical success rates for completion of ERCP in supine and prone positions were 89.1 % (95 %CI = 80.9 - 94.0) and 95.6 % (95 %CI = 91.5 - 97.7), respectively. The pooled rates for complications (cardiopulmonary and PEP) in the supine position were 37.5 % (95 %CI = 19.1 - 60.3) and 3.5 % (95 %CI = 1.6 - 7.3), respectively. The pooled rates for complications (cardiopulmonary and PEP) in the prone position were 41.0 % (95 %CI = 20.9 - 64.8) and 3.9 % (95 %CI = 2.4 - 6.4), respectively. The mean time required for the procedure was 30 minutes and 29.8 minutes for supine and prone positions, respectively. Substantial heterogeneity was noted in the analysis. Conclusion Prone ERCPs have a higher technical success rate with a slightly lower mean duration but a higher number of adverse events. The decision with regard to patient position should be made after evaluating the overall clinical scenario.
Collapse
Affiliation(s)
- Harmeet Singh Mashiana
- Department of Internal Medicine, University of Nevada Las Vegas School of Medicine, Las Vegas, NV, USA
| | - Mahendran Jayaraj
- Department of Internal Medicine, University of Nevada Las Vegas School of Medicine, Las Vegas, NV, USA,Division of Gastroenterology, University of Nevada Las Vegas School of Medicine, Las Vegas, NV, USA
| | - Babu Pappu Mohan
- Department of Internal Medicine, University of Alabama, Tuscaloosa, AL, USA
| | - Gordon Ohning
- Division of Gastroenterology, University of Nevada Las Vegas School of Medicine, Las Vegas, NV, USA
| | - Douglas G. Adler
- Gastroenterology and Hepatology, University of Utah School of Medicine, Huntsman Cancer Center, Salt Lake City, UT, USA,Corresponding author Douglas G. Adler, MD Gastroenterology and HepatologyUniversity of Utah School of MedicineHuntsman Cancer Center30 N 1900 ERoom 4R118Salt Lake CityUtah 84132USA+1-801-581-8007
| |
Collapse
|
|
20
|
Angsuwatcharakon P, Janjeurmat W, Krisanachinda A, Ridtitid W, Kongkam P, Rerknimitr R. The difference in ocular lens equivalent dose to ERCP personnel between prone and left lateral decubitus positions: a prospective randomized study. Endosc Int Open 2018; 6:E969-E974. [PMID: 30083586 PMCID: PMC6070372 DOI: 10.1055/a-0599-5917] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 03/05/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND AND STUDY AIMS Endoscopic retrograde cholangiopancreatography (ERCP) is commonly performed in a prone or left lateral decubitus (LLD) position. The ocular lens equivalent doses between the two positions may be different because in the LLD position the tube voltage will automatically increase to maintain the image quality, and the increased distance between the image intensifier and the X-ray tube may result in more scattered radiation. We aimed to compare the ocular lens equivalent doses of ERCP personnel between the two different positions. PATIENTS AND METHODS Fifty-five patients with ERCP indications were randomized to either prone or LLD positions. One patient in an LLD position was excluded due to technical reasons. Indications for ERCP, patients' vertical thicknesses, fluoroscopy parameters, patients' skin dose rates, and the ocular-lens equivalent doses of ERCP personnel were compared. RESULTS Baseline characteristics were no different except for vertical thickness, which was significantly higher in the LLD group. The ocular lens equivalent doses (prone vs. LLD) of the primary endoscopist (19.2 vs. 30.7 µSv, P = 0.035), and the nurse anesthetist (17.3 vs. 42.2 µSv, P = 0.002) were significantly lower in the prone group than in the LLD group. The calculated annual number of procedures not to exceed the exposure allowance in prone and LLD positions were 1,042 and 651 procedures for the primary endoscopist and 1,157 and 473 procedures for the nurse anesthetist, respectively. CONCLUSIONS Ocular-radiation exposure to ERCP personnel was one-third lower in the prone than in LLD position. Therefore, more annual ERCPs could be performed by the personnel.
Collapse
Affiliation(s)
- Phonthep Angsuwatcharakon
- Division of Gastroenterology, Department of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand,Department of Anatomy, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Worawarut Janjeurmat
- Division of Gastroenterology, Department of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Anchali Krisanachinda
- Division of Nuclear Medicine, Department of Radiology, Faculty of Medicine Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Wiriyaporn Ridtitid
- Division of Gastroenterology, Department of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Pradermchai Kongkam
- Division of Gastroenterology, Department of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Rungsun Rerknimitr
- Division of Gastroenterology, Department of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand,Corresponding author Rungsun Rerknimitr, MD, FRCP (London), Professor of Medicine Division of Gastroenterology, Department of Medicine, Faculty of Medicine Chulalongkorn University and King Chulalongkorn Memorial Hospital1873 Rama 4 Road, PatumwanBangkok 10330Thailand+ 6622564356
| |
Collapse
|
|
21
|
Passi M, Inamdar S, Hersch D, Dowling O, Sejpal DV, Trindade AJ. Inpatient Choledocholithiasis Requiring ERCP and Cholecystectomy: Outcomes of a Combined Single Inpatient Procedure Versus Separate-Session Procedures. J Gastrointest Surg 2018; 22:451-459. [PMID: 28971298 DOI: 10.1007/s11605-017-3588-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Accepted: 09/13/2017] [Indexed: 01/31/2023]
Abstract
OBJECTIVES Separate-session endoscopic retrograde cholangiography (ERCP) and laparoscopic cholecystectomy (LC) is the usual method for management of inpatient choledocholithiasis. Our goal was to compare single operative-session LC and ERCP to a multi-session approach for both the same hospitalization and within 30 days after; there is limited data comparing the three groups. METHODS A retrospective review on inpatients with choledocholithiasis that underwent ERCP and LC was performed. Single operative-session ERCP + LC (SOS group) and separate hospitalization ERCP + LC (DH group) were compared against the control cohort: separate-session ERCP + LC performed during the same hospitalization (SH group). RESULTS Among the 214 cases, 37 (17%) had LC + ERCP performed under a single operative session (SOS), 130 (60.7%) cases had LC + ERCP performed in separate operative sessions during the same hospitalization (SH), and 47 (22%) cases had LC + ERCP performed in different hospitalizations, within 30 days (DH). There was no statistically significant difference in efficacy or adverse events. The SOS group had a statistically significant mean shorter length of hospital stay as compared to the SH and DH groups (5.46 vs 7.15 vs 9.38; p = 0.05 and 0.02). There was a statistically significant reduction in the total cost of care in the SOS group versus the SH group ($59,221 vs $75, 808; p = 0.007). CONCLUSION The SOS approach is safe, efficacious, and cost-efficient when compared to separate operative sessions. This approach can be considered in situations where it is preferable for the patient to undergo a single session of anesthesia, without compromising technical success and safety.
Collapse
Affiliation(s)
- Monica Passi
- Hofstra Northwell School of Medicine, Northwell Health System, Division of Gastroenterology, Department of Medicine, Long Island Jewish Medical Center, 270-05 76th Avenue, New Hyde Park, NY, 11040, USA
| | - Sumant Inamdar
- Hofstra Northwell School of Medicine, Northwell Health System, Division of Gastroenterology, Department of Medicine, Long Island Jewish Medical Center, 270-05 76th Avenue, New Hyde Park, NY, 11040, USA
| | - David Hersch
- Hofstra Northwell School of Medicine, Northwell Health System, Department of Anesthesia, Long Island Jewish Medical Center, New Hyde Park, NY, USA
| | - Oonagh Dowling
- Hofstra Northwell School of Medicine, Northwell Health System, Department of Anesthesia, Long Island Jewish Medical Center, New Hyde Park, NY, USA
| | - Divyesh V Sejpal
- Hofstra Northwell School of Medicine, Northwell Health System, Division of Gastroenterology, Department of Medicine, Long Island Jewish Medical Center, 270-05 76th Avenue, New Hyde Park, NY, 11040, USA
| | - Arvind J Trindade
- Hofstra Northwell School of Medicine, Northwell Health System, Division of Gastroenterology, Department of Medicine, Long Island Jewish Medical Center, 270-05 76th Avenue, New Hyde Park, NY, 11040, USA.
| |
Collapse
|
|
22
|
Park TY, Choi SH, Yang YJ, Shin SP, Bang CS, Suk KT, Baik GH, Kim DJ. The efficacy and safety of the left lateral position for endoscopic retrograde cholangiopancreatography. Saudi J Gastroenterol 2017; 23:296-302. [PMID: 28937025 PMCID: PMC5625367 DOI: 10.4103/sjg.sjg_121_17] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND/AIM Endoscopic retrograde cholangiopancreatography (ERCP) is typically performed in prone position. In cases of difficulty in prone position, ERCP can be performed in left lateral position. We aimed to evaluate the efficacy and safety of left lateral position for ERCP compared with those of prone position. PATIENTS AND METHODS Between August 2015 and March 2016, a total of 62 patients with native papilla who underwent ERCP were randomly assigned to undergo the procedure in left lateral position (n = 31) or prone position (n = 31). The outcomes of procedures were compared between the two groups. RESULTS There were no significant differences between the two groups in terms of the demographic data, indications for ERCP, comorbidities, anticoagulation agents, the types and doses of sedative agents, and procedural durations. The rates of technical success and adverse events were similar (96.8 and 40%, respectively, in left lateral group and 100 and 32.3%, respectively, in prone group). The rates of unintentional pancreatic duct (PD) cannulation and the acquisition of pancreatograms in left lateral group were significantly greater than those in prone group (9/30, 30.0% vs. 3/31, 9.7%, P = 0.046; 7/30, 23.3% vs. 1/31, 3.2%, P = 0.020, respectively). However, there was no significant difference in the rate of post-ERCP pancreatitis (6/30, 20% vs. 5/31, 16.1%, P = 0.694). CONCLUSION The left lateral position for ERCP can be as effective and safe as prone position. Due to increased rates of unintended PD cannulation and contrast injection, the initial use of left lateral position may be limited to cases that exhibit difficulty in prone position.
Collapse
Affiliation(s)
- Tae Young Park
- Department of Internal Medicine, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Gangwon-do, Korea
| | - Sang Hyeon Choi
- Department of Internal Medicine, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Gangwon-do, Korea
| | - Young Joo Yang
- Department of Internal Medicine, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Gangwon-do, Korea
| | - Suk Pyo Shin
- Department of Internal Medicine, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Gangwon-do, Korea
| | - Chang Seok Bang
- Department of Internal Medicine, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Gangwon-do, Korea
| | - Ki Tae Suk
- Department of Internal Medicine, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Gangwon-do, Korea
| | - Gwang Ho Baik
- Department of Internal Medicine, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Gangwon-do, Korea
| | - Dong Joon Kim
- Department of Internal Medicine, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Gangwon-do, Korea
| |
Collapse
|
|
23
|
Chandrasekhara V, Khashab MA, Muthusamy VR, Acosta RD, Agrawal D, Bruining DH, Eloubeidi MA, Fanelli RD, Faulx AL, Gurudu SR, Kothari S, Lightdale JR, Qumseya BJ, Shaukat A, Wang A, Wani SB, Yang J, DeWitt JM. Adverse events associated with ERCP. Gastrointest Endosc 2017; 85:32-47. [PMID: 27546389 DOI: 10.1016/j.gie.2016.06.051] [Citation(s) in RCA: 517] [Impact Index Per Article: 64.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 06/30/2016] [Indexed: 02/07/2023]
|
|
24
|
|
|
25
|
Efficacy and Safety of Propofol-Mediated Sedation for Outpatient Endoscopic Retrograde Cholangiopancreatography (ERCP). Dig Dis Sci 2016; 61:1686-91. [PMID: 26825844 DOI: 10.1007/s10620-016-4043-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 01/16/2016] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND AIMS Propofol sedation for endoscopy may result in a rapid and unpredictable progression from deep sedation to general anesthesia, leading to potential complications. We investigated the incidence and predictors of sedation-related adverse events (SAEs) in nonintubated patients who underwent outpatient ERCP procedures with propofol sedation. METHODS We conducted a retrospective study of patients who underwent propofol sedation for ERCP procedures. Patients were sedated using propofol in combination with low-dose opiates. Data collected included patient demographics, American Society of Anesthesiologists (ASAs) physical status, and procedure times. SAE includes hypoxia (pulse oximetry <90 %), hypotension (systolic blood pressure <90 mmHg), and conversation to endotracheal intubation. Factors associated with SAEs were examined by univariate analysis and multivariate regression analysis (MVA). RESULTS A total of 3041 patients were evaluated. The median BMI was 25.2 kg/m(2), and the median ASA score was 3. The mean (±SD) duration of the procedures was 59 ± 23 min. Hypoxia requiring airway manipulation occurred in 28 % (n = 843) patients and hypotension requiring vasopressors in 0.4 % (n = 12). Forty-nine (1.6 %) patients required endotracheal intubation as a result of food in the stomach. Procedures underwent early termination in 8 (0.3 %) cases due to sedation-related hypotension (n = 5) and refractory laryngospasm (n = 3). Six patients were admitted after the ERCP for aspiration pneumonia as a result of sedation. Patients who developed SAE were older, had a higher mean BMI, and had longer mean procedure durations. On MVA, older age (p = 0.003), female sex (p = 0.001), BMI (p = 0.02), and ASA class ≥3 (p = 0.01) independently predicted SAEs. CONCLUSIONS Propofol can be used safely and effectively as a sedative agent for patients undergoing ERCPs when administered by trained professionals. Age, female sex, BMI, and ASA class ≥3 are independent predictors of SAEs.
Collapse
|
|
26
|
Chawla S, Willingham FF. Cardiopulmonary complications of endoscopic retrograde cholangiopancreatography. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2014; 16:144-149. [DOI: 10.1016/j.tgie.2014.07.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
|
|
27
|
Zang JF, Zhang C, Gao JY. Endoscopic retrograde cholangiopancreatography and laparoscopic cholecystectomy during the same session: Feasibility and safety. World J Gastroenterol 2013; 19:6093-6097. [PMID: 24106411 PMCID: PMC3785632 DOI: 10.3748/wjg.v19.i36.6093] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2013] [Revised: 07/24/2013] [Accepted: 08/06/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To explore the feasibility and safety of endoscopic retrograde cholangiopancreatography and laparoscopic cholecystectomy (LC) performed during the same session.
METHODS: Between July 2010 and May 2013, 156 patients with gallstones and common bile duct (CBD) stones were enrolled in this retrospective study. According to the sequence of endoscopic procedures and LC, patients were classified into two groups: in group 1, patients underwent endoscopic stone extraction and LC during the same session, and in group 2, patients underwent LC at least 3 d after endoscopic stone extraction. Outcomes of the endoscopic procedures and LC were compared between the two groups, respectively.
RESULTS: There were 91 patients in group 1 and 65 patients in group 2. The characteristics of the two groups were similar. The mean duration of the endoscopic procedures was 34.9 min in group 1 and 35.3 min in group 2. There were no significant differences in the success rate of the endoscopic procedures (97.8% for group 1 vs 98.5% for group 2), the total rate of endoscopic complications (4.40% for group 1 vs 4.62% for group 2) and CBD stone clearance rate (96.7% for group 1 vs 96.9% for group 2). Duration of LC was 53.6 min in group 1 and 52.8 min in group 2. There were no significant differences in the overall LC-related morbidity and postoperative hospital stay.
CONCLUSION: Endoscopic stone extraction and LC performed during the same session was feasible and safe in patients with gallstones and concomitant CBD stones.
Collapse
|
|
28
|
Batheja M, Harrison ME, Das A, Engel R, Crowell M. Optimal Positioning for ERCP: Efficacy and Safety of ERCP in Prone versus Left Lateral Decubitus Position. ACTA ACUST UNITED AC 2013. [DOI: 10.5402/2013/810269] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background. ERCP is customarily performed with the patient in prone position. For patients intolerant of prone positioning, ERCP in left lateral decubitus (LLD) position offers a potential alternative. Aims. To compare efficacy and safety of ERCP in the LLD position versus prone position. Methods. Consecutive ERCP reports from August 2009 to October 2010 at Mayo Clinic Arizona were reviewed. Inclusion criteria. Age > 18 years, native papilla, and biliary indication. Primary outcome measure. Bile duct cannulation rate. Secondary outcomes. Times to ampullary localization and bile duct cannulation and complication rate. Results. ERCPs reviewed from 59 patients in two positions: 39 prone and 20 LLD. Cannulation Rate. 100% prone versus 90% in LLD (P=0.11). Median (IRQ) times. (1) Ampullary localization: 90 sec (70–110) prone versus 100 sec (80–118) (P=0.16); (2) bile duct cannulation: 140 sec (45–350) prone versus 165 sec (55–418) LLD (P=0.54). Complications. No periprocedure; postprocedure 4 (10%) prone versus 3 (15%) LLD (P=0.65). Conclusion. ERCP performed in LLD position allowed deep bile duct cannulation in 90% of patients without significantly increased procedural times or rate of complications as compared to prone position.
Collapse
Affiliation(s)
- Mashal Batheja
- Division of Gastroenterology, Carl T. Hayden VA Medical Center, 650 E. Indian School Road, Phoenix, AZ 85012, USA
| | - M. Edwyn Harrison
- Division of Gastroenterology, Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, AZ 85259, USA
| | - Ananya Das
- Division of Gastroenterology, Arizona Center for Digestive Health, 2680 S. Val Vista, Suite 116, Gilbert, AZ 85295, USA
| | - Rodney Engel
- Division of Gastroenterology, University of New Mexico, 1 University Boulevard of New Mexico, Albuquerque, NM 87131, USA
| | - Michael Crowell
- Division of Gastroenterology, Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, AZ 85259, USA
| |
Collapse
|
|
29
|
Maple JT. Preparation for ERCP. ERCP 2013:73-79.e2. [DOI: 10.1016/b978-1-4557-2367-6.00009-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
|
|
30
|
Gurusamy K, Wilson E, Burroughs AK, Davidson BR. Intra-operative vs pre-operative endoscopic sphincterotomy in patients with gallbladder and common bile duct stones: cost-utility and value-of-information analysis. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2012; 10:15-29. [PMID: 22077427 DOI: 10.2165/11594950-000000000-00000] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Patients with gallbladder and common bile duct stones are generally treated by pre-operative endoscopic sphincterotomy (ES) followed by laparoscopic cholecystectomy (POES). Recently, a meta-analysis has shown that intra-operative ES during laparoscopic cholecystectomy (IOES) results in fewer complications than POES, with similar efficacy. The cost effectiveness of IOES versus POES is unknown. OBJECTIVE The objective of this study was to compare the cost effectiveness of IOES versus POES from the UK NHS perspective. METHODS A decision-tree model estimating and comparing costs to the UK NHS and QALYs gained following a policy of either IOES or POES was developed with a time horizon of 3 years. Uncertainty was investigated with probabilistic sensitivity analysis, and the expected value of perfect information (EVPI) and partial information (EVPPI) were also calculated. RESULTS IOES was less costly than POES (approximately -£623 per patient [year 2008 values]) and resulted in similar quality of life (+0.008 QALYs per patient) as POES. Given a willingness-to-pay threshold of £20 000 per QALY gained, there was a 92.9% probability that IOES is cost effective compared with POES. Full implementation of IOES could save the NHS £2.8 million per annum. At a willingness to pay of £20 000 per QALY gained, the 10-year population EVPI was estimated at £0.6 million. CONCLUSIONS IOES appears to be cost effective compared with POES.
Collapse
Affiliation(s)
- Kurinchi Gurusamy
- Hepatopancreatobiliary and Liver Transplant Surgery, University Department of Surgery, Royal Free Campus UCL Medical School, London, UK.
| | | | | | | |
Collapse
|
|
31
|
Boix J, Lorenzo-Zúñiga V. Radiation dose to patients during endoscopic retrograde cholangiopancreatography. World J Gastrointest Endosc 2011; 3:140-4. [PMID: 21860683 PMCID: PMC3159502 DOI: 10.4253/wjge.v3.i7.140] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2010] [Revised: 06/23/2011] [Accepted: 07/31/2011] [Indexed: 02/05/2023] Open
Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) is an important tool for the diagnosis and treatment of the hepatobiliary system. The use of fluoroscopy to aid ERCP places both the patient and the endoscopy staff at risk of radiation-induced injury. Radiation dose to patients during ERCP depends on many factors, and the endoscopist cannot control some variables, such as patient size, procedure type, or fluoroscopic equipment used. Previous reports have demonstrated a linear relationship between radiation dose and fluoroscopy duration. When fluoroscopy is used to assist ERCP, the shortest fluoroscopy time possible is recommended. Pulsed fluoroscopy and monitoring the length of fluoroscopy have been suggested for an overall reduction in both radiation exposure and fluoroscopy times. Fluoroscopy time is shorter when ERCP is performed by an endoscopist who has many years experience of performing ERCP and carried out a large number of ERCPs in the preceding year. In general, radiation exposure is greater during therapeutic ERCP than during diagnostic ERCP. Factors associated with prolonged fluoroscopy have been delineated recently, but these have not been validated.
Collapse
Affiliation(s)
- Jaume Boix
- Jaume Boix, Vicente Lorenzo-Zúñiga, Endoscopy Unit, Department of Gastroenterology, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona 08916, Spain
| | | |
Collapse
|
|
32
|
Gurusamy K, Sahay SJ, Burroughs AK, Davidson BR. Systematic review and meta-analysis of intraoperative versus preoperative endoscopic sphincterotomy in patients with gallbladder and suspected common bile duct stones. Br J Surg 2011; 98:908-16. [PMID: 21472700 DOI: 10.1002/bjs.7460] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2011] [Indexed: 12/11/2022]
Abstract
BACKGROUND Most patients with gallbladder and common bile duct stones are treated by preoperative endoscopic sphincterotomy (POES) followed by laparoscopic cholecystectomy. Recently, intraoperative endoscopic sphincterotomy (IOES) during laparoscopic cholecystectomy has been suggested as an alternative treatment. METHODS Data from randomized clinical trials related to safety and effectiveness of IOES versus POES were extracted by two independent reviewers. Risk ratios (RRs) or mean differences were calculated with 95 per cent confidence intervals based on intention-to-treat analysis whenever possible. RESULTS Four trials with 532 patients comparing IOES with POES were included. There were no deaths. There was no significant difference in rates of ampullary cannulation (RR 1·01, 0·97 to 1·04; P = 0·70) or stone clearance by ES (RR 0·99, 0·96 to 1·02; P = 0·58) between the groups. The proportion of patients with at least one post-ES complication, including pancreatitis, bleeding, perforation, cholangitis, cholecystitis or gastric ulcer, was significantly lower in the IOES group (RR 0·37, 0·18 to 0·78; P = 0·009). There was no significant difference in morbidity after laparoscopic cholecystectomy or requirement for open operation between the groups. Mean hospital stay was 3 days shorter in the IOES group: mean difference - 2·83 (-3·66 to - 2·00) days (P < 0·001). CONCLUSION In patients with gallbladder and common bile duct stones, IOES is as effective and safe as POES and results in a significantly shorter hospital stay.
Collapse
Affiliation(s)
- K Gurusamy
- Hepatopancreatobiliary and Liver Transplant Surgery, University Department of Surgery, Royal Free Campus, University College London Medical School, London, UK.
| | | | | | | |
Collapse
|
|
33
|
ERCP in the sitting position--an alternative technique with potential benefits (with video). Surg Laparosc Endosc Percutan Tech 2011; 20:247-9. [PMID: 20729694 DOI: 10.1097/sle.0b013e3181ec886e] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The authors describe a new technique of performing endoscopic retrograde cholangiopancreatography in the sitting position with special emphasis on methods of stabilization of the duodenoscope during the procedure. The article is accompanied by an instructional video. The benefits of this comfortable alternative to the standard standing position and its potential limitations are discussed.
Collapse
|
|
34
|
Matsushita M, Shimatani M, Fukui Y, Okazaki K. Patients in the prone position for preventing aspiration pneumonia after peroral double-balloon enteroscopy. Gastrointest Endosc 2009; 70:816; author reply 816-7. [PMID: 19788987 DOI: 10.1016/j.gie.2009.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2009] [Accepted: 02/02/2009] [Indexed: 12/10/2022]
|
|
35
|
Costamagna G, Familiari P, Marchese M, Tringali A. Endoscopic biliopancreatic investigations and therapy. Best Pract Res Clin Gastroenterol 2008; 22:865-81. [PMID: 18790436 DOI: 10.1016/j.bpg.2008.05.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The management of most biliopancreatic diseases benefits from endoscopic treatment. Forty years after the first endoscopic cannulation of the ampulla of Vater, the overall effectiveness and safety of endoscopic retrograde cholangiopancreatography (ERCP) can be evaluated using the quality assurance programs that have recently been developed for gastrointestinal endoscopy, including ERCP. Such evaluation does not mean simply reporting therapeutic success and complication rates; rather, it involves a complex analysis of the entire gastrointestinal unit, of the medical practises, and of patient satisfaction. The overall quality of ERCP has been analysed and many quality deficits identified, even in referral centres. Training for such a specialised procedure is difficult and expensive. Competence in ERCP requires as many as 200 ERCP procedures. Quality assurance programs can help to improve the overall quality of endoscopic practise, including training of young endoscopists.
Collapse
Affiliation(s)
- Guido Costamagna
- Digestive Endoscopy Unit, Università Cattolica del Sacro Cuore, A. Gemelli University Hospital, 8 Largo Gemelli, Rome, RM 00168, Italy.
| | | | | | | |
Collapse
|
|
36
|
Wilcox CM. Should patients undergoing ERCP be placed in the prone or supine position? NATURE CLINICAL PRACTICE. GASTROENTEROLOGY & HEPATOLOGY 2008; 5:488-489. [PMID: 18628736 DOI: 10.1038/ncpgasthep1199] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2008] [Accepted: 05/12/2008] [Indexed: 02/07/2023]
Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) is generally performed in the prone or semi-prone position. Compared with the supine position, the left lateral and prone positions are believed to carry a lower risk of aspiration, allow easier intubation of the esophagus and provide a more comfortable position for the endoscopist. However, the supine position might be advantageous for the evaluation of pancreatic and biliary anatomy and for enhanced control of the airway. In this Practice Point commentary, I discuss the findings and limitations of a prospective, randomized study conducted by Tringali et al. that compared the performance of ERCP in the prone and supine positions by both experienced endoscopists and trainees. The results suggest no difference in the difficulty of the procedure on the basis of patient position. Objective measurements including mean time to visualize the papilla and opacification of the desired duct were no different. Likewise, overall technical success and complication rates were equivalent. These results suggest that either the supine or prone positions are adequate for the technical performance of ERCP. This commentary highlights the issues to consider when interpreting and generalizing these results in clinical practice.
Collapse
Affiliation(s)
- C Mel Wilcox
- UAB GI Division, University of Alabama, Birmingham, AL 35294-0007, USA.
| |
Collapse
|
|
37
|
Performing an ERCP with the patient in the supine position: necessity is the mother of improvisation. Gastrointest Endosc 2008; 67:1044-5. [PMID: 18513547 DOI: 10.1016/j.gie.2007.12.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2007] [Accepted: 12/07/2007] [Indexed: 12/19/2022]
|
|
38
|
Ferreira LEVVC, Baron TH. Comparison of safety and efficacy of ERCP performed with the patient in supine and prone positions. Gastrointest Endosc 2008; 67:1037-43. [PMID: 18206877 DOI: 10.1016/j.gie.2007.10.029] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2007] [Accepted: 10/09/2007] [Indexed: 02/08/2023]
Abstract
BACKGROUND ERCP is usually performed with the patient in the prone position. Little data exist on ERCP in the supine position, which is considered unsafe in nonintubated patients. OBJECTIVE Our purpose was to compare outcomes of ERCP in the prone and supine positions. DESIGN Retrospective study. SETTING Tertiary care medical center. PATIENTS All patients undergoing ERCP by one endoscopist over an 18-month period. MAIN OUTCOME MEASUREMENTS American Society of Anesthesiologists (ASA) score, procedural degree of difficulty, procedural time, success rates, complication rates, effects on oxygen desaturation and hemodynamics, amount of sedation, need for precut sphincterotomy. RESULTS A total of 649 patients were evaluated, of whom 506 patients were prone and 143 were supine. There were no differences between the groups with regard to sex, procedural time, ASA scores, need for precut sphincterotomy, adverse cardiovascular events, episodes of oxygen desaturation, dose of meperidine or midazolam, or oxygen supplementation. Complete success and complication rates were similar for both groups (90.2% and 11.2% for supine and 92.5% and 9.1% for prone, respectively). Procedural degree of difficulty was significantly higher in the supine group (P < .001). There were no episodes of aspiration in either group and no severe complications. LIMITATIONS Retrospective study, one endoscopist. CONCLUSIONS ERCP performed in nonintubated patients placed supine is often more difficult and may lead to more mild adverse respiratory events than when performed with the patient prone. Supine ERCP is appropriate in certain patients who cannot lie prone (abdominal pain, abdominal distention, ascites, recent abdominal or neck surgery, indwelling percutaneous tubes and need for access during the procedure to indwelling internal/external percutaneous biliary catheters, and in the morbidly obese) with more intensive monitoring in those who are not intubated.
Collapse
Affiliation(s)
- Lincoln E V V C Ferreira
- Department of Medicine, Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | | |
Collapse
|
|
39
|
Fiocca F, Donatelli G, Ceci V, Cereatti F, Romagnoli F, Simonelli L, Modini C. ERCP in total situs viscerum inversus. Case Rep Gastroenterol 2008; 2:116-20. [PMID: 21490849 PMCID: PMC3075177 DOI: 10.1159/000119713] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
A 69-year-old cholecystectomized female with known total situs viscerum inversus presented recurrent colicky pain in the left upper abdominal quadrant and jaundice. Laboratory parameters showed increased neutrophils and coniugated bilirubin of 5.53 mg/dl. US and MRCP confirmed total situs viscerum inversus and a dilatation of the intra- and extrahepatic ducts with a peripapillary 13 mm stone. ERCP, sphincterotomy and successful common bile duct stone extraction were performed in the conventional way. ERCP was carried out successfully despite situs inversus maintaining the patient in the prone position with the endoscopist on the right side of the table. Some authors have reported similar cases in whom ERCP was performed in other positions, while this report shows that an experienced endoscopist can achieve the same results in the conventional way as it is possible when anatomical changes, Billroth II or Roux-en-Y, or different positions of the patient, supine or on the left side, are present.
Collapse
Affiliation(s)
- F Fiocca
- Department of Emergency and Urgency, Policlinico Umberto I, University, 'La Sapienza', Rome, Italy
| | | | | | | | | | | | | |
Collapse
|