E0433 - Safety and Efficacy of the Utilization of Prone Position in ERCP With Those of the Left Lateral Decubitus Position: A Systematic Review

Adnan Malik, MD¹, Waseem Amjad, MD², Shailendra Singh, MD^3
1Mountain Vista Medical Center, Mesa, AZ; ²Harvard Medical School, Boston, MA; ³University of West Virginia, Morgantown, WV

Introduction: The prone position and the left lateral position are the most common positions to perform ERCP. The prone position is the most frequently used because it provides better visualization and easier cannulation of the pancreatic and CBD. Besides, the risk of aspiration and the incidence of complications is relatively decreased in this position. We aim to compare the safety and efficacy of the utilization of the prone positions in ERCP with those of the left lateral decubitus position.

Methods: We searched Web of science, Cochrane Central, PubMed, and SCOPUS for relevant clinical trials and excluded observational studies. Quality appraisal was evaluated according to GRADE and we assessed the risk of bias using Cochrane’s risk of bias tool. We included the following outcomes: Biliary cannulation success, Pancreatic duct Cannulation time, Overall adverse events, Pancreatitis, Bleeding, Cardiopulmonary event, Procedure time, and Ampullary localization time. We performed the analysis of homogeneous data under the fixed-effects model, while analysis of heterogeneous data was analyzed under the random-effects model.

Results: We included a total of five studies. The pooled analysis showed that the prone position was associated with higher success rate of biliary cannulation success and faster localization of the ampulla (RR=1.08 [1.03, 1.14], (P = 0.001) and (MD=-0.52 [-1.01, -0.02], (P = 0.04), respectively. There is no significant difference between both groups regarding the pancreatic duct Cannulation time (MD=-0.49 [-1.06, 0.08], (P = 0.09), Overall adverse events (RR= 0.79 [0.59, 1.06], (P = 0.12), Pancreatitis (RR= 1.36 [0.61, 3.06], (P = 0.45), Bleeding (RR=1.02 [0.34, 3.01], (P = 0.98), Cardiopulmonary event (RR=1.06 [0.35, 3.23], (P = 0.92), and Procedure time (MD=-1.08 [-3.79, 1.62], (P = 0.43).

Discussion: Our study concludes that the left lateral position was associated with a higher rate of successful common bile duct cannulation than the prone position in ERCP.


Disclosures:


Adnan Malik, MD¹, Waseem Amjad, MD², Shailendra Singh, MD³. E0433 - Safety and Efficacy of the Utilization of Prone Position in ERCP With Those of the Left Lateral Decubitus Position: A Systematic Review, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.