Reply to Cemachovic

We appreciate Dr. Cemachovic’s thoughtful comments regarding our manuscript. Endoscopic retrograde cholangiopancreatography (ERCP) is traditionally performed with patients in the prone position [1] [2] [3]. The prone position is considered optimal for visualization and cannulation of the papilla and for obtaining high quality radiographic images. In fact, most institutions in Japan do perform ERCP in the prone position using total intravenous anesthesia.

However, some physicians (i. e. in France) perform ERCP with patients in the supine position. In Japan, the supine position is usually limited to patients in whom ERCP could not be performed in the conventional prone position because they are in intensive care under general anesthesia with intubation. In our study, the position was prone in all patients because patients in a poor general condition with severe cardiopulmonary disease or altered consciousness were excluded from the study.

Previous reports show that there are no differences between prone position and supine position groups in the time to reach the major papilla, to achieve a successful cannulation of the desired duct, or in total duration of the procedure; both groups have comparable results in terms of procedural success, technical difficulty, and adverse events [1] [2] [3]. We often find it difficult to perform ERCP in the supine position in cases where it is required because we are not used to this patient position.

There are no data on whether the prone or supine position is more effective for trainees performing ERCP. We totally agree with Dr. Cemachovic that we should perform a new, multinational, randomized clinical trial to investigate this subject.

Publikationsverlauf

Artikel online veröffentlicht:
22. April 2020

• References

• 1 Mashiana HS, Jayaraj M, Mohan BP. et al. Comparison of outcomes for supine vs. prone position ERCP: a systematic review and meta-analysis. Endosc Int Open 2018; 6: E1296-E1301
• 2 Tringali A, Mutignani M, Milano A. et al. No difference between supine and prone position for ERCP in conscious sedated patients: a prospective randomized study. Endoscopy 2008; 40: 93-97
• 3 Terruzzi V, Radaelli F, Meucci G. et al. Is the supine position as safe and effective as the prone position for endoscopic retrograde cholangiopancreatography? A prospective randomized study. Endoscopy 2005; 37: 1211-1214