Seated Versus Standing Endoscopic Retrograde Cholangiopancreatography: Association With Operator Fatigue and Pain

Abstract

Background and study aims Endoscopic retrograde cholangiopancreatography (ERCP) is a physically demanding procedure for operators that can provoke musculoskeletal symptoms. However, burden reduction and operating performance from a seated operating posture have not been established. Thus, we evaluated the association between seated operating posture and acute changes in operator fatigue and pain during ERCP. Patients and methods In this single-center observational study, 113 ERCP cases with paired pre- and post-procedure assessments were analyzed. Operator-reported global fatigue and pain were measured using numeric rating scales and expressed as pre- to post-procedure changes (ΔFatigue and ΔPain). Linear mixed-effects models were constructed to compare posture (seated vs. standing) and symptom changes, adjusting for procedure time and operator experience, with operator ID included as a random intercept. Feasibility and safety outcomes were also compared. Results The seated posture was associated with significantly smaller increases in fatigue and pain than standing. In adjusted mixed-effects analyses, the seated posture remained independently associated with smaller increases in both ΔFatigue (estimate −1.650; p < 0.0001) and ΔPain (estimate −1.614; p < 0.0001), whereas longer procedure time was independently associated with greater ΔFatigue but not ΔPain. Procedural success rates, fluoroscopy-related parameters, and adverse events were comparable between groups. Operator-reported comfort was significantly higher in the seated group (p < 0.0001). Conclusions Seated ERCP was independently associated with reduced acute operator fatigue and pain, apparently without compromising procedural performance. These findings demonstrate that posture modification offers a simple and practical ergonomic approach to reducing operator burden during routine ERCP.