The management of gallstone pancreatitis in pregnancy: A systematic review of the literature on this clinical dilemma

Abstract

AbstractBackgroundAcute gallstone pancreatitis in pregnancy (GSPP) is a challenging clinical problem; associated with high maternal mortality and foetal loss if not treated appropriately. There are no current UK management guidelines. Our study therefore aims to review published evidence‐based strategies on the management of GSPP and suggest a rational approach.MethodThe PRISMA Guidelines were used to undertake this comprehensive systematic literature review. Electronic literature search of the databases (PubMed/ MEDLINE, Cochrane database, UpToDate and Google Scholar) was started on 19 November 2019 and completed on 1 March 2020. The key words used were “gallstone pancreatitis in pregnancy”, “biliary pancreatitis” and “laparoscopy in pregnancy”.DiscussionThere are no national or international guidelines on the management of GSPP. However a number surgical societies, e.g. SAGES, have published advice to support clinical decision‐making. Gestational age is a main factor that determines diagnostic studies or intervention, such as endoscopic or surgical therapy. Management should ideally be deferred to the second trimester. Therapeutic endoscopic retrograde cholangiopancreatography (ERCP) can be carried out successfully, by limiting fluoroscopy time, shielding the pelvis and foetus, and reduced radiation dose. A critical part not to be overlooked is the consent, portraying the risks to the mother and foetus with continuous counselling.ConclusionOur review highlights the challenges that persist in the management of gall stone pancreatitis in pregnancy. A multidisciplinary approach is crucial to achieve the best outcomes. Timely action as clinically appropriate is recommended; and this has to be tailored to the needs of both lives.