Comparative efficacy and safety of supine versus prone positioning in endoscopic retrograde cholangiopancreatography: a systematic review and meta-analysis.

Background/aims: Endoscopic retrograde cholangiopancreatography (ERCP) is conventionally performed in the prone position (PP). Recent studies have shown that the supine position (SP) is an effective alternative, with comparable success rates. We conducted a meta-analysis to directly compare the safety and efficacy of the two ERCP positions.

Methods: In line with Cochrane and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic review was performed through a comprehensive search of PubMed, Embase, Web of Science, and the Cochrane Library. Statistical analyses were performed using RevMan, with results considered significant at p<0.05 and reported as odds ratios (ORs) and mean differences (MDs).

Results: Eleven studies (24,285 patients) were included in the final analysis. Procedural success was significantly higher in the PP (OR, 0.52; 95% confidence interval [CI], 0.36-0.75; p<0.0004) than the SP. However, no significant difference was observed in procedure times (MD, 0.22; 95% CI, -7.07 to 7.50; p=0.95), number of cardiopulmonary complications (OR, 1.08; 95% CI, 0.47-2.48; p=0.86), or post-ERCP pancreatitis (OR, 1.12; 95% CI, 0.52-2.42; p=0.31) between the two groups.

Conclusions: The PP demonstrates superior ERCP success compared to the SP, without prolonging procedure time or increasing the risk of adverse events. However, given the comparable procedure times, incidence of adverse events, and increased comfort for both patients and anesthesiologists, the SP may be a suitable alternative for a select group of patients in whom the PP is not feasible, such as those with morbid obesity or recent abdominal surgery.