Can Positioning the Patient in the Right Lateral Position during Recovery Prevent Post-ERCP Pancreatitis? An In-Vitro Evaluation

Joseph Leung, Wen Lee, Alan Chin, Stanley Chang, Nirmal S Mann

Research output: Contribution to journalArticle

Abstract

Background: Post-ERCP pancreatitis is a known complication of diagnostic and therapeutic ERCP procedures. It is suggested that raised intra-pancreatic (IP) pressure secondary to overfilling with contrast, or obstruction to pancreatic flow by edema/coagulation at the pancreatic orifice may cause post-ERCP pancreatitis. Aim: In vitro study to determine the effects of changing the patient's recovery position on IP and pancreatic duct drainage. Method: A model pancreatic duct (PD) was constructed with a 25 cm length of silicon tube (internal diameter 3 mm). The time taken to drain a fixed volume of water through the PD with different orifice sizes (3 and 4 mm) and positions (right lateral decubitus, supine and left lateral decubitus) of the pancreas were measured. The pressure changes within the PD measured with a perfusion manometry system in different positions were compared. In addition, the IP changes following injection of water into the PD were measured. The results were expressed as mean ± SD of three sets of measurements for each study. Results: The IP pressure measured at the tail dropped from 10.8 cm to 5.4 cm H2O with drainage of 30 ml of water, and from 10.8 cm to 9.0 cm H2O with the drainage of 10 ml of water. Drainage time taken to empty 30 ml of water was faster in the right lateral position (7.47 ± 0.08 min) versus the supine position (38.8 ± 0.22 min, p<0,001). A larger 4 mm orifice provides faster drainage (2.03 ± 0.14 min) for 10 ml of water versus a 3 mm orifice (3.29 ± 0.25 min, p<0.003). With the perfusion study, IP in the right lateral position is 10.08 ± 1.40 mm Hg lower than the supine IP (p<0.005 and 0.006 respectively). The IP increased significantly following injection of water. Conclusion: In vitro studies showed that fluid tends to drain more rapidly in the right lateral position, with a correspondingly lower IP. Clinically, this may promote drainage of contrast or pancreatic juice and reduce back pressure effects on the pancreatic acini. This recovery position may have a benefit in preventing post-ERCP pancreatitis.

Original languageEnglish (US)
Pages (from-to)37-40
Number of pages4
JournalInternational Medical Journal
Volume11
Issue number1
StatePublished - Mar 2004

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Endoscopic Retrograde Cholangiopancreatography
Patient Rights
Pancreatitis
Pancreatic Ducts
Drainage
Water
Pressure
Perfusion
Pancreatic Juice
Injections
Supine Position
Manometry
Silicon
In Vitro Techniques
Pancreas
Edema

Keywords

  • In vitro evaluation
  • Positioning the patient
  • Post ERCP pancreatitis
  • Prevention

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Can Positioning the Patient in the Right Lateral Position during Recovery Prevent Post-ERCP Pancreatitis? An In-Vitro Evaluation. / Leung, Joseph; Lee, Wen; Chin, Alan; Chang, Stanley; Mann, Nirmal S.

In: International Medical Journal, Vol. 11, No. 1, 03.2004, p. 37-40.

Research output: Contribution to journalArticle

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abstract = "Background: Post-ERCP pancreatitis is a known complication of diagnostic and therapeutic ERCP procedures. It is suggested that raised intra-pancreatic (IP) pressure secondary to overfilling with contrast, or obstruction to pancreatic flow by edema/coagulation at the pancreatic orifice may cause post-ERCP pancreatitis. Aim: In vitro study to determine the effects of changing the patient's recovery position on IP and pancreatic duct drainage. Method: A model pancreatic duct (PD) was constructed with a 25 cm length of silicon tube (internal diameter 3 mm). The time taken to drain a fixed volume of water through the PD with different orifice sizes (3 and 4 mm) and positions (right lateral decubitus, supine and left lateral decubitus) of the pancreas were measured. The pressure changes within the PD measured with a perfusion manometry system in different positions were compared. In addition, the IP changes following injection of water into the PD were measured. The results were expressed as mean ± SD of three sets of measurements for each study. Results: The IP pressure measured at the tail dropped from 10.8 cm to 5.4 cm H2O with drainage of 30 ml of water, and from 10.8 cm to 9.0 cm H2O with the drainage of 10 ml of water. Drainage time taken to empty 30 ml of water was faster in the right lateral position (7.47 ± 0.08 min) versus the supine position (38.8 ± 0.22 min, p<0,001). A larger 4 mm orifice provides faster drainage (2.03 ± 0.14 min) for 10 ml of water versus a 3 mm orifice (3.29 ± 0.25 min, p<0.003). With the perfusion study, IP in the right lateral position is 10.08 ± 1.40 mm Hg lower than the supine IP (p<0.005 and 0.006 respectively). The IP increased significantly following injection of water. Conclusion: In vitro studies showed that fluid tends to drain more rapidly in the right lateral position, with a correspondingly lower IP. Clinically, this may promote drainage of contrast or pancreatic juice and reduce back pressure effects on the pancreatic acini. This recovery position may have a benefit in preventing post-ERCP pancreatitis.",
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AU - Chang, Stanley

AU - Mann, Nirmal S

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N2 - Background: Post-ERCP pancreatitis is a known complication of diagnostic and therapeutic ERCP procedures. It is suggested that raised intra-pancreatic (IP) pressure secondary to overfilling with contrast, or obstruction to pancreatic flow by edema/coagulation at the pancreatic orifice may cause post-ERCP pancreatitis. Aim: In vitro study to determine the effects of changing the patient's recovery position on IP and pancreatic duct drainage. Method: A model pancreatic duct (PD) was constructed with a 25 cm length of silicon tube (internal diameter 3 mm). The time taken to drain a fixed volume of water through the PD with different orifice sizes (3 and 4 mm) and positions (right lateral decubitus, supine and left lateral decubitus) of the pancreas were measured. The pressure changes within the PD measured with a perfusion manometry system in different positions were compared. In addition, the IP changes following injection of water into the PD were measured. The results were expressed as mean ± SD of three sets of measurements for each study. Results: The IP pressure measured at the tail dropped from 10.8 cm to 5.4 cm H2O with drainage of 30 ml of water, and from 10.8 cm to 9.0 cm H2O with the drainage of 10 ml of water. Drainage time taken to empty 30 ml of water was faster in the right lateral position (7.47 ± 0.08 min) versus the supine position (38.8 ± 0.22 min, p<0,001). A larger 4 mm orifice provides faster drainage (2.03 ± 0.14 min) for 10 ml of water versus a 3 mm orifice (3.29 ± 0.25 min, p<0.003). With the perfusion study, IP in the right lateral position is 10.08 ± 1.40 mm Hg lower than the supine IP (p<0.005 and 0.006 respectively). The IP increased significantly following injection of water. Conclusion: In vitro studies showed that fluid tends to drain more rapidly in the right lateral position, with a correspondingly lower IP. Clinically, this may promote drainage of contrast or pancreatic juice and reduce back pressure effects on the pancreatic acini. This recovery position may have a benefit in preventing post-ERCP pancreatitis.

AB - Background: Post-ERCP pancreatitis is a known complication of diagnostic and therapeutic ERCP procedures. It is suggested that raised intra-pancreatic (IP) pressure secondary to overfilling with contrast, or obstruction to pancreatic flow by edema/coagulation at the pancreatic orifice may cause post-ERCP pancreatitis. Aim: In vitro study to determine the effects of changing the patient's recovery position on IP and pancreatic duct drainage. Method: A model pancreatic duct (PD) was constructed with a 25 cm length of silicon tube (internal diameter 3 mm). The time taken to drain a fixed volume of water through the PD with different orifice sizes (3 and 4 mm) and positions (right lateral decubitus, supine and left lateral decubitus) of the pancreas were measured. The pressure changes within the PD measured with a perfusion manometry system in different positions were compared. In addition, the IP changes following injection of water into the PD were measured. The results were expressed as mean ± SD of three sets of measurements for each study. Results: The IP pressure measured at the tail dropped from 10.8 cm to 5.4 cm H2O with drainage of 30 ml of water, and from 10.8 cm to 9.0 cm H2O with the drainage of 10 ml of water. Drainage time taken to empty 30 ml of water was faster in the right lateral position (7.47 ± 0.08 min) versus the supine position (38.8 ± 0.22 min, p<0,001). A larger 4 mm orifice provides faster drainage (2.03 ± 0.14 min) for 10 ml of water versus a 3 mm orifice (3.29 ± 0.25 min, p<0.003). With the perfusion study, IP in the right lateral position is 10.08 ± 1.40 mm Hg lower than the supine IP (p<0.005 and 0.006 respectively). The IP increased significantly following injection of water. Conclusion: In vitro studies showed that fluid tends to drain more rapidly in the right lateral position, with a correspondingly lower IP. Clinically, this may promote drainage of contrast or pancreatic juice and reduce back pressure effects on the pancreatic acini. This recovery position may have a benefit in preventing post-ERCP pancreatitis.

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