Evaluating the Safety of Endoscopy During Pregnancy: The Robust Statistical Power vs Limitations of a National Registry Study

Cappell, Mitchell S.

doi:10.1053/j.gastro.2016.12.014

Cited by 2 publications

(1 citation statement)

References 12 publications

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“…This increased rate is attributed to avoiding fluoroscopy to verify wire and catheter position and to time pressure to expeditiously perform ERCP during pregnancy[ 40 - 42 ]. This work is important in that it represents the largest study heretofore on ERCP during pregnancy, but is subject to limitations including lack of data on patient comorbidities, maternal alcohol or illicit drug use, endoscopic complications, type of ERCP (diagnostic vs therapeutic), ERCP indications, and use or lack of monitored anesthesia care[ 43 ]. Also, as aforementioned, usual measures to minimize pancreatitis after ERCP, such as high volume IV fluid infusion, indomethacin suppositories, and pancreatic stents are infrequently used during pregnancy.…”

Section: Resultsmentioning

confidence: 99%

Systematic review of safety and efficacy of therapeutic endoscopic-retrograde-cholangiopancreatography during pregnancy including studies of radiation-free therapeutic endoscopic-retrograde-cholangiopancreatography

Cappell

Stavropoulos

Friedel

2018

WJGE

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AIMTo systematically review safety/efficacy of therapeutic endoscopic-retrograde-cholangiopancreatography (ERCP) performed during pregnancy, considering fetal viability, fetal teratogenicity, premature delivery, and future postpartum development of the infant.METHODSSystematic computerized literature search performed using PubMed with the key words “ERCP” and “pregnancy”. Two clinicians independently reviewed the literature, and decided on which articles to incorporate in this review based on consensus and preassigned priorities. Large clinical trials, meta-analyses, systematic reviews, and controlled trials were assigned higher priority than review articles or small clinical series, and individual case reports were assigned lowest priority. Dr. Cappell has formal training and considerable experience in conducting systematic reviews, with 4 published systematic reviews in peer-reviewed journals indexed in PubMed during the last 2 years, and with a PhD in neurophysiology that involved 5 years of training and research in biomedical statistics.RESULTSAdvances in imaging modalities, including abdominal ultrasound, MRCP, and endoscopic ultrasound, have generally obviated the need for diagnostic ERCP in non-pregnant and pregnant patients. Clinical experience with performing ERCP during pregnancy is burgeoning, with > 500 cases of therapeutic ERCP reported in the literature, aside from a national registry study of 58 patients. These studies show that therapeutic ERCP has a very high rate of technical success in clearing the bile duct of gallstones, and has a relatively low and acceptable rate of maternal and fetal complications. The great majority of births after therapeutic ERCP are full-term, have normal birth weights, and are healthy. A recent trend is performing ERCP without radiation to eliminate radiation teratogenicity. Systematic literature review reveals 147 cases of ERCP without fluoroscopy in 8 clinical series. These studies demonstrate extremely high technical success in endoscopically removing choledocholithiasis, favorable maternal outcomes with rare maternal ERCP complications, and excellent fetal outcomes. ERCP without fluoroscopy generally confirms proper biliary cannulation by aspiration of yellow bile per sphincterotome or leakage of yellow bile around an inserted guide-wire.CONCLUSIONThis systematic literature review reveals ERCP is relatively safe and efficacious during pregnancy, with relatively favorable maternal and fetal outcomes after ERCP. Recommendations are provided about ERCP indications, special ERCP techniques during pregnancy, and prospects for future research.

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Section: Resultsmentioning

confidence: 99%

Systematic review of safety and efficacy of therapeutic endoscopic-retrograde-cholangiopancreatography during pregnancy including studies of radiation-free therapeutic endoscopic-retrograde-cholangiopancreatography

Cappell

Stavropoulos

Friedel

2018

WJGE

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Two case reports of novel syndrome of bizarre performance of gastrointestinal endoscopy due to toxic encephalopathy of endoscopists among 181767 endoscopies in a 13-year-university hospital review: Endoscopists, first do no harm!

Cappell¹

2020

WJG

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Evaluating the Safety of Endoscopy During Pregnancy: The Robust Statistical Power vs Limitations of a National Registry Study

Abstract: See "Outcomes of pregnancies for women undergoing endoscopy while they were pregnant: a nationwide cohort study," by Ludvigsson JF, Lebwohl B, Ekbom A, et al, on page 554.

Cited by 2 publications

References 12 publications

Systematic review of safety and efficacy of therapeutic endoscopic-retrograde-cholangiopancreatography during pregnancy including studies of radiation-free therapeutic endoscopic-retrograde-cholangiopancreatography

Systematic review of safety and efficacy of therapeutic endoscopic-retrograde-cholangiopancreatography during pregnancy including studies of radiation-free therapeutic endoscopic-retrograde-cholangiopancreatography

Two case reports of novel syndrome of bizarre performance of gastrointestinal endoscopy due to toxic encephalopathy of endoscopists among 181767 endoscopies in a 13-year-university hospital review: Endoscopists, first do no harm!

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