S2185 Does Supine Position for ERCP Save Time Without Sacrificing Technical Efficacy and Safety? A Retrospective Study

Introduction: Endoscopic retrograde cholangiopancreatography (ERCP) is typically performed in the prone position under general anesthesia. This necessitates repositioning from supine to prone and back again, for airway intubation and extubation. Doing ERCP in the supine position avoids these steps and may improve room utilization, but prior comparisons have demonstrated variable ERCP specific outcomes. This study was conducted to determine whether supine-ERCP can improve the overall efficiency without impacting ERCP outcomes. Methods: A total of 120 patients (60 supine, 60 prone) who underwent ERCP (±concomitant endoscopic ultrasound or esophagogastroduodenoscopy) over the 3-year period were included in this single center retrospective study. Time details of each case were collected, and were used to calculate various case time metrics, including total room time (duration from room-in to room-out), total procedure time (procedure-start to procedure-end), and peri-procedural time (room-in to procedure-start + procedure-end to room-out). Key ERCP metrics, such as ERCP procedure time, fluoroscopy time, use of salvage cannulation, and adverse events were also collected for comparison. Results: Supine position resulted in significantly shorter peri-procedural time at median of 38 minutes [interquartile range (IQR) 33-45], in comparison to prone at 47 min (40-53), P < 0.001. There were no significant differences between the 2 groups in terms of total procedure time and the total room time. Specific to ERCP, supine and prone position did not demonstrate significant differences in key metrics, such as ERCP procedure time [30 min (18-43) versus 25 min (15-56), respectively, P = 0.89], fluoroscopy time [0.70 min (0.50-1.05) vs 0.78 min (0.50–1.27), P = 0.32], rate of salvage cannulation [10 (17%) vs 8 (13%), P = 0.80], and rate of failed biliary access [3 (5.00%) vs 2 (3.33%), P = 1.00]. Number of adverse events were small, and were not significantly different between both groups. Conclusion: Supine position for ERCP, in comparison to prone, demonstrated shorter peri-procedural time without negatively affecting ERCP outcomes. This may potentially improve room utilization, improve patient safety, and decrease work-related injuries associated with position changes during prone ERCP.