ERCP In Pregnancy Research Articles

Debunking Old Beliefs: Endoscopic Retrograde Cholangiopancreatography in Pregnancy

Pregnancy is a state associated with an increased risk of lithogenesis on the gallbladder. Cholelithiasis during pregnancy has an incidence of 12%, with pregnancy being an important risk factor for gallstones. The delayed endoscopic intervention has been associated with an increased risk of adverse events. Using the resource of ERCP in pregnancy is valuable in diseases of the biliary tract. The use of measures to reduce exposure to radiation should be the norm and the delay of this procedure should not be carried out when there are precise indications for it.

Tu1042 SAFETY OF ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP) IN PREGNANCY: A SYSTEMATIC REVIEW AND META-ANALYSIS

ERCP is a technically challenging procedure rarely associated with serious post-procedure complications. Pregnancy promotes cholelithiasis due to hormonal changes and ERCP may be needed during pregnancy. Limited clinical data are available on the outcomes of ERCP in pregnancy due to the limited number of cases. We performed a systematic review and a meta-analysis to assess the safety of ERCP in pregnancy. A systematic search of PubMed, Medline/Ovid, Web of Science, and Google Scholar through November 20th, 2017 using PRISMA and MOOSE guidelines identified 26 studies that reported the outcomes of ERCP in pregnancy. Random-effects pooled event rate and 95% confidence intervals were estimated. Heterogeneity was measured by I2 and meta-regression analysis was conducted. 26 studies reporting on 1298 pregnant patient who underwent ERCP were identified. Median age was 27.1 years. The pooled event rate for overall non-pregnancy related complications in pregnant patients was 0.122 (95% CI=0.105-0.142; p-value < 0.01). Sub-group analysis showed that the pooled rates of Post ERCP Pancreatitis (PEP) and bleeding were 0.117 (95%CI=0.100-0.137) p-value < 0.01 and 0.046 (95%CI=0.029-0.073) p-value < 0.01 respectively. The pooled event rate for overall pregnancy-related complications was 0.070 (95% CI 0.035-0.134) p-value < 0.01. Substantial heterogeneity was noted in the analysis. ERCP done by experienced endoscopists is a safe procedure during pregnancy with careful selection of cases and limited use of fluoroscopy the maternofetal complications could be reduced.Overall pregnancy-related complications meta-analysis forest plot.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Utility and Safety of ERCP in Pregnancy: A Systematic Review Presidential Poster

Utility and Safety of ERCP in Pregnancy: A Systematic Review Presidential Poster

Mo1356 Safety of ERCP in Pregnancy: Fluoroscopy Time and Fetal Exposure, Does It Matter?

Pancreaticobiliary disease in pregnancy is common and can lead to significant maternal and fetal morbidity. Several studies have found ERCP to be safe in pregnancy, but the measurement of fetal radiation exposure is still questioned. Our aim was to analyze the relationship between the fluoroscopy time and the estimated fetal radiation exposure as well as the outcome of the ERCP in the pregnant women.

Safety and utility of ERCP during pregnancy

ERCP is an important diagnostic and therapeutic tool in patients with biliary and pancreatic disease. Its utility and safety during pregnancy is largely unknown because it is not often required and because its use has been only infrequently reported in the published literature. Our purpose was to report the clinical experience with ERCP during pregnancy. Retrospective review, single academic center. All (consecutive) pregnant women who underwent ERCP at Parkland Memorial Hospital from 2000 to 2006. History, clinical data, hospital course, procedure-related complication rates and outcomes, and delivery and fetal outcomes were abstracted from medical records. During the study period, 68 ERCPs were performed on 65 pregnant women. The calculated ERCP rate was 1 per 1415 births. The common indications for ERCP in pregnancy were recurrent biliary colic, abnormal liver function tests, and dilated bile duct on US. ERCP was technically successful in all patients. The median fluoroscopy time was 1.45 minutes (range 0-7.2 minutes). There was no perforation, sedation-related adverse event, postsphincterotomy bleeding, cholangitis, or procedure-related maternal or fetal deaths. Post-ERCP pancreatitis was diagnosed in 11 patients (16%). None of these 11 patients had local or systemic complications. Fifty-nine patients had complete follow-up. Endoscopic therapy at the time of ERCP was undertaken in all patients. Furthermore, 9 patients (32.1%) underwent cholecystectomy in the first and second trimesters for either acute cholecystitis (6) or symptomatic gallstones (3). Term pregnancy was achieved in 53 patients (89.8%). Patients having ERCP in the first trimester had the lowest percentage of term pregnancy (73.3%) and the highest risk of preterm delivery (20.0%) and low-birth-weight newborns (21.4%). None of the 59 patients with long-term follow-up had spontaneous fetal loss, perinatal death, stillbirth, or fetal malformation. Retrospective review. ERCP can be performed safely during pregnancy. Further, ERCP performed in pregnancy leads to specific therapy in essentially all patients. However, ERCP may be associated with a higher rate of post-ERCP pancreatitis than in the general population.

Safety and Efficacy of ERCP in Pregnancy

Purpose: To report our experience with ERCP during pregnancy including safety and efficacy. Methods: A retrospective review of all consecutive ERCPs performed on pregnant patients from October 2001 to May 2006. Results: Three ERCPs were performed on pregnant patients. Two patients presented with cholelithiasis, abnormal liver function tests and dilatation of the biliary tree by abdominal ultrasound. One patient had biliary leak demonstrated by intrabdominal fluid collection on ultrasound after laproscopic cholecystectomy. Two of the three underwent ERCP under general anesthesia and one patient underwent consious sedation supervised by an anesthesiologist. Techniques to minimize fluoroscopy were used including aspiration of bile to identify correct position of the sphincterotome. All patients with choledocholithiasis underwent sphincterotomy with stone extraction. The patient with biliary leak underwent stent placement without sphincterotomy. The procedures were successful in all cases including the biliary leak which resolved completely in two weeks. No complications related to the procedure were identified in the the mother or the babies. Conclusions: ERCP can be performed safely in pregnancy if precautions are taken to minimize radiation exposure.

Safety and efficacy of ERCP in pregnancy

Choledocholithiasis during pregnancy increases the risk of morbidity and mortality for both fetus and mother because of cholangitis and pancreatitis. ERCP has been advocated as safe and effective in pregnant women, but fetal radiation exposure is not routinely monitored. The aim of this study was to record fetal exposure to ionizing radiation during ERCP and to assess outcome. Seventeen ERCPs were performed in pregnant women between January 1995 and August 2003. Techniques to minimize fluoroscopy were used, and fluoroscopy times were recorded. Thermoluminescent dosimeters affixed to the skin of the mother were used to estimate fetal radiation exposure. Mean gestational age was 18.6 (8.9) weeks (range 5-33 weeks). Mean fluoroscopy time was 14 (13) seconds (range 1-48 seconds). Estimated fetal radiation exposure was 40 (46) mrad (range 1-180 mrad). There was a correlation between fluoroscopy time and radiation exposure, but there was a wide range of radiation exposure for individual fluoroscopy times. Complications included post-sphincterotomy bleeding in one patient (controlled by hemoclip placement) and post-ERCP pancreatitis in one patient that necessitated 3 days of hospitalization. Two women developed third-trimester preeclampsia, and labor was induced in both. Thirteen of the 15 patients who delivered were contacted and they confirmed that their child was in good health. ERCP with modified techniques is safe during pregnancy. Dosimetry should be routinely recorded.

Safety of ERCP during pregnancy

Objectives There are few data in the literature regarding the indications, therapy, and safety of endoscopic management of pancreatico-biliary disorders during pregnancy. We report the largest single center experience with ERCP in pregnancy. Methods We reviewed 15 patients that underwent ERCP during pregnancy. In all patients, the pelvis was lead-shielded and the fetus was monitored by an obstetrician. Fluoroscopy was minimized and hard copy radiographs taken only when essential. Results The mean patient age was 28.9 yr (15–36 yr). The mean duration of gestation was 25 wk (12–33 wk); one patient was in the first, five in the second, and nine in the third trimester. The indications were gallstone pancreatitis (n = 6), choledocholithiasis on ultrasound (n = 5), elevated liver enzymes and a dilated bile duct on ultrasound (n = 2), abdominal pain and gallstones (n = 1), and chronic pancreatitis (n = 1). ERCP findings were bile duct stones (n = 6), patulous papilla (n = 1), bile duct debris (n = 1), normal bile duct and gallstones or gallbladder sludge (n = 3), dilated bile duct and gallstones (n = 1), normal bile duct and no gallstones (n = 2), and chronic pancreatitis (n = 1). Six patients underwent sphincterotomies and one a biliary stent insertion. One sphincterotomy was complicated by mild pancreatitis. All infants delivered to date have had Apgar-scores >8, and continuing pregnancies are uneventful. Mean fluorosocopy time was 3.2 min (SD ± 1.8). An estimated fetal radiation exposure was 310 mrad (SD ± 164) which is substantially below the accepted teratogenic dose. Conclusions ERCP in pregnancy seems to be safe for both mother and fetus; however, it should be restricted to therapeutic indications with additional intraprocedure safety measures.

Endoscopic retrograde cholangiopancreatography in pregnancy.

Pancreaticobiliary disease in pregnancy is relatively uncommon. The frequency of choledocholithiasis in pregnancy requiring intervention has been reported to be as low as one in 1200 deliveries. Traditionally, intervention in these patients has been surgical. Although surgery has an overall low morbidity and mortality for the expectant mother, it carries with it a 4- to 6-wk recovery period and a possibly increased risk of fetal wastage. Published information regarding the role and safety of ERCP in pregnancy is limited. This series of 23 pregnant patients undergoing ERCP was collected from six different medical centers. Twenty-three pregnant patients with symptomatic pancreaticobiliary disease underwent a total of 29 ERCPs (three patients had diagnostic ERCP, and 20 had therapeutic ERCP). Fifteen, eight, and six procedures were performed in the first, second, and third trimesters, respectively. The only ERCP complication was pancreatitis in one patient. There was one spontaneous abortion (3 months after ERCP) and one neonatal death; however, casual relationship to ERCP was not apparent. Diagnostic and therapeutic ERCP appears reasonably safe and effective in pregnancy. Cautious and selective use of this procedure offers a viable alternative to surgery or observation in patients with emergent pancreaticobiliary problems.