Patient Positioning and Papilla Accessibility in ERCP: Preliminary Findings from a Prospective Study

Aims This study aims to assess whether changing the patient's position during the procedure can improve papilla accessibility.

Methods We conducted a prospective observational study over a 7-month period, including patients admitted to the Hepatogastroenterology Department at CHU HASSAN II who underwent ERCP. The protocol involved performing the procedure under intubation in the supine position and occasionally under sedation in the left lateral decubitus position as the initial posture. Patient repositioning was performed in cases where papilla access was difficult. Data were collected using a detailed case record form, which included parameters such as age, sex, indication for ERCP, and the impact of positional changes on papilla accessibility.

Results The study included 132 patients, with 42% (n=56) requiring a positional change during ERCP. In this group, the mean age was 65.4 years, with a slight female predominance (55.3%). The main indications for ERCP were bile duct stones (51.7%), tumor-related strictures (35%), and other causes such as fistulized hydatid cysts and acute pancreatitis. Patient repositioning improved papilla access in 80% (n=45) of cases, while it had no effect in the remaining 20%. Analysis of papilla localization in patients who benefited from repositioning showed that 64.4% (n=29) were located in D2, 31% (n=14) in the superior genu, and 2 cases in D3.

Conclusions The findings of this study suggest that changing the patient’s position, whether from supine to lateral decubitus or vice versa, can significantly facilitate papilla access during cannulation for stone extraction or stent placement. Further studies are warranted to explore this simple but effective strategy in enhancing procedural success during ERCP.

 

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Conflicts of Interest

Authors do not have any conflict of interest to disclose.

Publication History

Article published online:
27 March 2025