Endoscopic retrograde cholangiopancreatography during pregnancy without radiation

Abstract

AIM: To present our experience with pregnant patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) without using radiation, and to evaluate the acceptability of this alternative therapeutic pathway for ERCP during pregnancy. METHODS:Between 2000 and 2008, six pregnant women underwent seven ERCP procedures. ERCP was performed under mild sedoanalgesia induced with pethidine HCl and midazolam. The bile duct was cannulated with a guidewire through the papilla. A catheter was slid over the guidewire and bile aspiration and/or visualization of the bile oozing around the guidewire was used to confirm correct cannulation. Following sphincterotomy, the bile duct was cleared by balloon sweeping. When indicated, stents were placed. Confirmation of successful biliary cannulation and stone extraction was made by laboratory, radiological and clinical improvement. Neither fluoroscopy nor spot radiography was used during the procedure. RESULTS:The mean age of the patients was 28 years (range, 21-33 years). The mean gestational age for the fetus was 23 wk (range, 14-34 wk). Five patients underwent ERCP because of choledocholithiasis and/or choledocholithiasis-induced acute cholangitis. In one case, a stone was extracted after precut papillotomy with a needle-knife, since the stone was impacted. One patient had ERCP because of persistent biliary fistula after hepatic hydatid disease surgery. Following sphincterotomy, scoleces were removed from the common bile duct. Two weeks later, because of the absence of fistula closure, repeat ERCP was performed and a stent was placed. The fistula was closed after stent placement. Neither post-ERCP complications nor premature birth or abortion was seen. CONCLUSION:Non-radiation ERCP in experienced hands can be performed during pregnancy. Stent placement should be considered in cases for which complete common bile duct clearance is dubious because of a lack of visualization of the biliary tree.

Guidelines for endoscopy in pregnant and lactating women

“…Bile duct cannulation can be confirmed by bile aspiration or visualization of bile around the guidewire. [44][45][46] After biliary sphincterotomy and balloon sweeping, stone extraction can be confirmed by normalization of laboratory indices 44 or by inspection of the bile duct with choledochoscopy 45 or EUS. EUS performed before ERCP can help to delineate anatomy and determine the number, size, and location of stones.…”

Radio induced cancer risk during ERCP: Is it a real clinical problem?

“…For this reason, in high-risk situations like pregnancy, the priority is to minimize the dose and some authors have reported cases in which fluoroscopy was not needed (9,10).…”

Hepatic hydatid disease requiring urgent treatment during pregnancy

“…[16,17] Although "nonradiation ERCP" in pregnant patients has been reported, [18,19] the experience is limited. Complete ductal clearance cannot be ascertained without a choledochoscopy, which may not be technically possible in every case.…”

“…Ortanca (sınırlar) hasta yaşı 27 (23-39) yıl, ortanca (sınır-lar) gestasyon yaşı 18 (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24) haftaydı. Semptomlar şid-detli karın ağrısı (4), kusma (2), sarılık (2), kaşıntı (2) ve ağır dispepsiydi (1); semptomsuz hastada (1), jinekolojik ultrasonografi sırasında rastlantısal olarak, kapalı intraperitoneal yırtılma gözlendi.…”