S2274 Impact of Patient Positioning on Endoscopic Retrograde Cholangiopancreatography (ERCP) Outcomes: A Comparative Analysis of Supine, Prone, and Left Lateral Positions

Introduction: Endoscopic retrograde cholangiopancreatography (ERCP) typically uses the prone position to reduce aspiration risk and improve biliary imaging. The left lateral decubitus position aligns the esophagus, stomach, and duodenum, enhancing stability and minimizing abdominal compression, making it a viable alternative. The supine position offers benefits for anesthesia access and patients with obesity or wounds, but complicates endoscope alignment. While data exists on supine versus prone positioning, research comparing all 3 is limited. This study compares ERCP outcomes in the prone, left lateral, and supine positions to determine the optimal approach for achieving success and safety. Methods: A retrospective review was conducted for adult patients (18 years and older) who underwent ERCP at a tertiary care hospital. Patients were categorized into 3 groups based on their positioning during the procedure: supine, prone, and left lateral. The primary outcome was the visualization and cannulation of the common bile duct (CBD), as well as the technical success of the procedure. Secondary outcomes included visualization of the major and minor papillae, as well as the incidence of post-ERCP pancreatitis. Results: Of the 459 patients, 373 (81.3%) were prone, 40 (8.7%) were supine, and 46 (10%) were left lateral. Patient demographics and medical history were similar across groups. Significant differences were observed in the procedure location (P < 0.05) and time of day (P = 0.001). Emergent surgery was more frequent in the supine position (2.5%) compared to left lateral (2.2%) and prone (0%) (P = 0.012); other complication rates were similar across groups. There were no statistically significant differences between CBD cannulation, ampulla visualization, technical success of the procedure, total recovery time, fluoroscopy time, and total procedure time among the 3 groups (P > 0.05). Conclusion: ERCP performed in prone, left lateral, and supine positions yielded comparable rates of CBD cannulation, ampulla visualization, and overall technical success. While the supine position was associated with a higher rate of emergent surgery, no significant differences were observed in other procedural or recovery metrics. These findings suggest that alternative positions, particularly left lateral, may offer safe and effective options when prone positioning is not feasible, supporting individualized patient-centered positioning strategies in ERCP.