Does lower gastrointestinal endoscopy during pregnancy pose a risk for mother and child? – a systematic review

Abstract

BackgroundGastrointestinal endoscopy plays a crucial role in the diagnosis and management of gastrointestinal disorders. When endoscopy is indicated during pregnancy, concerns about the effects on pregnancy outcome often arise. The aim of this study was to assess whether lower gastrointestinal endoscopies (LGEs) across all three trimesters of pregnancy affects pregnancy outcomes.MethodsA systematic literature search was performed using Embase (including MEDLINE), Medline OvidSP, Cochrane Central Register of Controlled Trials, Web-of-Science, Google scholar and Pubmed. All original research articles from 1990 until May 2014 involving pregnant women who underwent LGE for any indication were included. Adverse pregnancy events like spontaneous abortion, preterm birth and fetal demise were assessed for a temporal and etiological relation with the LGE.ResultsIn total, 5514 references were screened by two independent reviewers. Eighty-two references met the inclusion criteria and were selected. Two retrospective, controlled studies, one uncontrolled study and 79 case reports were identified. In the three studies, birth outcomes did not differ between women undergoing LGE during pregnancy, compared to women that had an indication for LGE but in whom LGE was not performed because of pregnancy. In 79 case reports, 92 patients are described who underwent 100 LGE’s during pregnancy. LGEs performed in all trimesters (n = 32, 39 and 29) were both temporally and etiologically related to 1, 3 and 2 adverse events, respectively.ConclusionBased on the available literature, this review concludes that lower gastrointestinal endoscopy during pregnancy is of low risk for mother and child in all three trimesters of pregnancy.Electronic supplementary materialThe online version of this article (doi:10.1186/s12876-015-0244-z) contains supplementary material, which is available to authorized users.

The Toronto Consensus Statements for the Management of Inflammatory Bowel Disease in Pregnancy

“…The investigators suggested that lower gastrointestinal endoscopy is likely safe to perform throughout all 3 trimesters of pregnancy. 164 This is further supported by a recent prospective cohort study in which 42 pregnant patients with IBD underwent lower gastrointestinal endoscopy, with no increased adverse outcomes for the mother or the newborn related to endoscopy. 165 Although 2 spontaneous abortions were temporally and probably related to endoscopy, the overall rate of spontaneous abortion was lower in cases than in controls (4.8% vs 23.8%; P ¼ .01).…”

“…163 A systematic review of controlled trials, cohort studies, and case series reported on the outcomes of 100 lower gastrointestinal endoscopies performed in all 3 trimesters of pregnancy. 164 Six adverse events were classified as related to the procedure: 3 with flexible sigmoidoscopy (incomplete spontaneous abortion, fetal death, and suspected perforation leading to emergency cesarean delivery) and 3 with colonoscopy (fetal death, pregnancy termination by physicians, and premature spontaneous labor). All but one of these events was classified as probably or possibly related to the procedure but could have been related to another intervention performed at the time or the underlying maternal disease.…”

Monitoring inflammatory bowel disease during pregnancy: Current literature and future challenges

“…Colonoscopy may be indicated in a pregnancy state, to evaluate the extent of ulcerative colitis that may determine the need for additional immunosuppressive agents or in small bowel Crohn’s disease. A systematic review of lower gastrointestinal endoscopies performed in all three trimesters of pregnancy evaluated any adverse pregnancy outcomes that were noted to be in a temporal or etiological relation with the procedure[ 12 ]. This review comprised of 100 endoscopies, with a total of six reported adverse events that were related to the procedure.…”

Evaluation and management of esophageal manifestations in systemic sclerosis

“…Thus, only few studies assess pH parameters in patients with SSc. Abnormal pH monitoring has been seen in up to 85% of patients [ 33 - 35 ]. Although the number of reflux events is similar between SSc patients and non-scleroderma patients, a small but well-designed study [ 36 ] found that SSc patients showed a greater number of events with longer duration.…”