High-flow versus standard nasal cannula oxygenation during prone-position ERCP under nurse-administered propofol sedation: a randomized controlled trial
In brief
High-flow oxygen cuts low-oxygen events from 14% to 1.3% during prone biliary procedures
In a randomized trial of 300 adults undergoing prone endoscopic bile-duct procedures with propofol sedation, high-flow oxygen reduced low-oxygen events and the need for airway maneuvers compared with standard nasal oxygen. Hypotension was more common but did not require treatment or stop procedures; the two-center findings need confirmation in broader practice.
- Journal
- Surgical endoscopy (Q1)
- Published
- 2 November 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Piyapoom Pakvisal, Aniwat Saleepol, Nutbordee Nalinthassanai, Kasenee Tiankanon, Thanawat Luangsukrerk, Parit Mekaroonkamol, et al.
- PMID
- 42972061
- DOI
- 10.1007/s00464-026-13536-4
Why clinicians should know about it
- Picked for Gastroenterology (paper of the day, 5 November 2026): Randomized trial of oxygen support during sedated ERCP
Abstract
BACKGROUND: Hypoxemia affects up to 23% of patients undergoing ERCP under nurse-administered propofol sedation (NAPS) with a standard nasal cannula (SNC). High-flow nasal cannula (HFNC) provides heated, humidified oxygen at high gas flow with more controlled inspired oxygen delivery than conventional low-flow oxygen and may reduce hypoxemic events during sedation. We compared HFNC with SNC during ERCP under NAPS. METHODS: In this two-center, prospective, randomized trial, 300 adults undergoing ERCP between October 2025 and June 2026 were allocated 1:1 to HFNC (flow 50 L/min; FiO2 0.50) or SNC (5 L/min). All procedures were performed in the prone position under propofol-based NAPS. The primary outcome was hypoxemia (SpO2 < 92% for > 10 s). Secondary outcomes included airway interventions and cardiovascular events. RESULTS: Baseline characteristics, procedural factors, and sedation dosages were comparable. Hypoxemia occurred in 2 of 150 patients (1.3%) with HFNC versus 21 of 150 (14.0%) with SNC (RR 0.10, 95% CI 0.02-0.36; P < 0.001). Jaw-thrust maneuvers (1.3 vs. 12.0%; P < 0.001) and nasopharyngeal airway insertion (0 vs. 9.3%; P < 0.001) were also less frequent with HFNC. No patient required emergency intubation. Hypotension was more frequent with HFNC (16.7 vs. 8.0%; P = 0.02), but no episode required vasopressors or procedure termination. In post hoc analyses, HFNC reduced hypoxemic events in both BMI subgroups; however, the treatment-by-BMI interaction was not significant (P for interaction = 0.65). CONCLUSIONS: HFNC oxygenation strategy reduced hypoxemic events and rescue airway interventions during ERCP under NAPS, although transient hypotension occurred more frequently. No significant treatment-by-BMI interaction was observed. TRIAL REGISTRY: Thai Clinical Trials Registry, TCTR20250901001.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.