Table of Contents
ISRN Endoscopy
Volume 2013, Article ID 810269, 6 pages
http://dx.doi.org/10.5402/2013/810269
Clinical Study

Optimal Positioning for ERCP: Efficacy and Safety of ERCP in Prone versus Left Lateral Decubitus Position

1Division of Gastroenterology, Carl T. Hayden VA Medical Center, 650 E. Indian School Road, Phoenix, AZ 85012, USA
2Division of Gastroenterology, Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, AZ 85259, USA
3Division of Gastroenterology, Arizona Center for Digestive Health, 2680 S. Val Vista, Suite 116, Gilbert, AZ 85295, USA
4Division of Gastroenterology, University of New Mexico, 1 University Boulevard of New Mexico, Albuquerque, NM 87131, USA

Received 21 December 2012; Accepted 28 January 2013

Academic Editors: G. Larciprete, A. Mahajna, C. E. Moore, G. von Wichert, and K. Watabe

Copyright © 2013 Mashal Batheja et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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 ( ). Median (IRQ) times. (1) Ampullary localization: 90 sec (70–110) prone versus 100 sec (80–118) ( ); (2) bile duct cannulation: 140 sec (45–350) prone versus 165 sec (55–418) LLD ( ). Complications. No periprocedure; postprocedure 4 (10%) prone versus 3 (15%) LLD ( ). 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.