1. Patient undergoing ERCP without preceding endoscopic ultrasound (EUS)

2. At least one of the following risk factors for adverse events during sedation:

1. STOP-BANG score of 3 or higher

2. Abdominal ascites on either physical exam or imaging within the last 14 days

3. BMI greater than or equal to 35

4. Chronic lung disease

5. ASA class 4

6. Mallampati Class 4 airway (only hard palate visible)

7. Concurrent moderate to heavy alcohol use (≥4 drinks/day for men and ≥3 drinks/day for women)

Patient Positioning and Airway Management During ERCP