Airway Management Strategies and Outcomes During Endoscopic Retrograde Cholangiopancreatography

Open Access

Abstract

Background: Endoscopic Retrograde Cholangiopancreatography (ERCP) requires adequate sedation or anesthesia, but airway management remains challenging due to prone positioning and shared airway access. This study aimed to evaluate airway management strategies and their associated clinical outcomes during ERCP. Methods & Materials: This prospective observational study was conducted at the Department of Gastroenterology, Popular Medical College Hospital and Popular Diagnostic Centre PLC Limited, Dhaka, Bangladesh, over six months from November 2025 to April 2026. A total of 200 adult patients undergoing ERCP were included using purposive consecutive sampling. Airway management techniques, peri-procedural events and outcomes were recorded. Data were analyzed using SPSS version 25.0, with appropriate descriptive and inferential statistics applied. Results: Among 200 patients, the cohort was balanced for gender (51% male) with the largest age group being 51-60 years (21.5%). Monitored anesthesia care (MAC) was the most common airway strategy (43.5%), followed by SAD (26.0%) and ETT (23.5%). Hypotension (21.0%) and oxygen desaturation (19.0%) were the leading complications; 40.5% had no complications. Desaturation rates varied significantly by airway strategy (p = 0.012): highest with MAC (25.3%) and lowest with ETT (8.5%). Conclusion: Sedation-based airway management is commonly used during ERCP but is associated with a higher risk of oxygen desaturation. Careful selection of airway strategy and vigilant monitoring are essential to improve patient safety and outcomes.