Research Article|Articles in Press

Prospective Randomized Comparison of Endoscopist-facilitated Endotracheal Intubation and Standard Intubation for ERCP

Published:March 04, 2023DOI:
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      Background & Aims

      Complex endoscopic procedures are increasingly performed with anesthesia support, which substantially impacts endoscopy unit efficiency. ERCP performed under general anesthesia presents unique challenges, as patients are typically first intubated, then transferred to the fluoroscopy table and positioned semi-prone. This requires additional time and staff while increasing the potential for patient/staff injury. We have developed the technique of Endoscopist-facilitated intubation using an endotracheal tube backloaded onto an ultraslim gastroscope as a potential solution to these issues and evaluated its utility prospectively.


      Sequential patients undergoing ERCP were randomized to Endoscopist-facilitated intubation or to Standard intubation. Demographic data, patient/procedure characteristics, endoscopy efficiency parameters and adverse events were analyzed.


      During the study period, 45 ERCP patients were randomized to either Endoscopist-facilitated intubation (n=23) or Standard intubation (n=22). Endoscopist-facilitated intubation was successful in all patients, without hypoxic events. Median time from patient arrival in room to procedural start was shorter in patients undergoing Endoscopist-facilitated intubation vs Standard intubation (8.2 min vs. 29 min, p<0.0001). Endoscopist-facilitated intubations were brisker than Standard intubations (0.63 min vs. 2.85 min, p<0.0001). Endoscopist-facilitated intubation patients reported less post-procedure throat discomfort (13% vs. 50%, p<0.01) and fewer myalgias (22% vs. 73%, p<0.01) than Standard intubation patients.


      Endoscopist-facilitated intubation was technically successful in every patient. Median Endoscopist-facilitated intubation time from patient arrival in room to procedural start was 3.5-fold lower and median Endoscopist-facilitated intubation time was over 4-fold lower than for Standard intubation. Endoscopist-facilitated intubation significantly enhanced endoscopy unit efficiency and minimized staff and patient injury. General adoption of this novel approach may represent a paradigm shift in the approach to safe and efficient intubation of all patients requiring general anesthesia. While the results of this controlled trial are promising, larger studies in a broad population are needed to validate these findings. NCT 03879720.


      Acronyms & Abbreviations:

      ERCP (Endoscopic Retrograde Cholangiopancreatography), EI (Endoscopist Facilitated Intubation), SI (Standard Intubation), Vs (versus), US (United States), CMS (Centers for Medicare and Medicaid Services), IQR (Interquartile ranges), SD (Standard Deviation), MAC (Monitored Anesthesia Care), GA (General Anesthesia)
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