ARTICLE IN PRESSBritish Journal of Anaesthesia,xxx(xxx):xxx (xxxx)BJAdai:10.1016jbja.2023.03.012Advance Access Publication Date:xxxSpecial ArticleSPECIAL ARTICLEConsensus guidelines for the perioperative management of patientsundergoing endoscopic retrograde cholangiopancreatographyOmid Azimaraghi,Mohammad Bilal2,Somchai Amornyotin,Mustafa Arain3,Matthias Behrends4,Tyler M.Berzin5,James L.Buxbaum5,Curtis Choice1,Philipp Fassbender17,Mandeep S.Sawhney5,Eswar Sundar,Karuna Wongtangman1,Kate Leslie10.11 and Matthias Eikermann112.Department of Anesthesiology,Montefiore Medical Center,Albert Einstein College of Medicine,New York,NY,USA,2Division of Gastroenterology Hepatology,Minneapolis VA Medical Center,University of Minnesota,Minneapolis,MN,USA,Center for Interventional Endoscopy,AdventHealth,Orlando,FL,USA,Department of Anesthesia andPerioperative Care,University of California,San Francisco,CA,USA,5Division of Gastroenterology,Beth Israel DeaconessMedical Center,Harvard Medical School,Boston,MA,USA,Department of Internal Medicine,University of SouthernCalifornia,Keck School of Medicine,Los Angeles,CA,USA,Klinik fuir Anasthesiologie,Operative Intensivmedizin,Schmerz-und Palliativmedizin,Marien Hospital Herne,Universitatsklinikum der Ruhr-Universitat Bochum,HerneGermany,Department of Anesthesia,Critical Care and Pain Medicine,Beth Israel Deaconess Medical Center,HarvardMedical School,Boston,MA,USA,Department of Anesthesiology,Faculty of Medicine,Siriraj Hospital,MahidolUniversity,Bangkok,Thailand,1Monash University,Melbourne,VIC,Australia,Royal Melbourne Hospital andUniversity of Melbourne,Melbourne,VIC,Australia and 12Klinik fur Anasthesiologie und Intensivmedizin,UniversitatDuisburg-Essen,Essen,GermanyCorresponding author.E-mail:meikermannmontefiore.orgSummaryDeep sedation without tracheal intubation (monitored anaesthesia care)and general anaesthesia with tracheal intu-bation are commonly used anaesthesia techniques for endoscopic retrograde cholangiopancreatography(ERCP).Thereare distinct pathophysiological differences between monitored anaesthesia care and general anaesthesia that need to beconsidered depending on the nature and severity of the patient's underlying disease,comorbidities,and procedural risks.An international group of expert anaesthesiologists and gastroenterologists created clinically relevant questionsregarding the merits and risks of monitored anaesthesia care us general anaesthesia in specific clinical scenarios forplanning optimal anaesthetic approaches for ERCP.Using a modified Delphi approach,the group created practical rec-ommendations for anaesthesiologists,with the aim of reducing the incidence of perioperative adverse outcomes whilemaximising healthcare resource utilisation.In the majority of clinical scenarios analysed,our expert recommendationsfavour monitored anaesthesia care over general anaesthesia.Patients with increased risk of pulmonary aspiration andthose undergoing prolonged procedures of high complexity were
