Risks versus benefits of gastrointestinal endoscopy during pregnancy

Abstract

Although gastrointestinal endoscopy is generally safe, its safety must be separately analyzed during pregnancy with regard to fetal safety. Fetal risks from endoscopic medications are minimized by avoiding FDA category D drugs, minimizing endoscopic medications, and anesthesiologist attendance at endoscopy. Esophagogastroduodenoscopy seems to be relatively safe for the fetus and may be performed when strongly indicated during pregnancy. Despite limited clinical data, endoscopic banding of esophageal varices and endoscopic hemostasis of nonvariceal upper gastrointestinal bleeding seems justifiable during pregnancy. Flexible sigmoidoscopy during pregnancy also appears to be relatively safe for the fetus and may be performed when strongly indicated. Colonoscopy may be considered in pregnant patients during the second trimester if there is a strong indication. Data on colonoscopy during the other trimesters are limited. Therapeutic endoscopic retrograde cholangiopancreatography seems to be relatively safe during pregnancy and should be performed for strong indications (for example, complicated choledocholithiasis). Endoscopic safety precautions during pregnancy include the performance of endoscopy in hospital by an expert endoscopist and only when strongly indicated, deferral of endoscopy to the second trimester whenever possible, and obstetric consultation.

ACG Clinical Guideline: Liver Disease and Pregnancy

“…As outlined in the general endoscopy section above, endoscopy during pregnancy appears safe, but must be considered carefully in terms of the indication for endoscopy, the risks vs. benefi t evaluation and whether it will lead to management changes ( 15,173 ).…”

“…One of the most commonly used sedation medications during pregnancy is meperidine, an opiate analgesic, which has more recently been replaced by shorter acting agents, such as propofol, with lower risk for respiratory depression and seizures. Meperidine crosses the placenta and is converted to a long-lasting normeperidine, so repeated or prolonged meperidine administration should be avoided late in pregnancy or at term, as meperidine is an FDA pregnancy category C ( 14,15 ).…”

“…Aft er 36 weeks, women with severe preeclampsia should be delivered promptly to limit maternal and fetal complications (strong recommendation, very low level of evidence). 15. Hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome should be managed by prompt delivery, especially aft er 34 weeks gestation (strong recommendation, very low level of evidence).…”

Guidelines for endoscopy in pregnant and lactating women

“…Other risks to the fetus include teratogenesis (from medications given to the mother and/or ionizing radiation exposure) and premature birth. 4 In situations where therapeutic intervention is necessary, endoscopy offers a relatively safe alternative to radiologic or surgical interventions. 3,[5][6][7][8][9][10] The main indications for endoscopy in pregnancy are outlined in Table 2, and general principles that apply to endoscopy in pregnancy are shown in Table 3.…”

Fulminant ulcerative colitis in a healthy pregnant woman

“…Although there are limited data [15,16] on the safety of colonoscopy during pregnancy, it appears relatively safe, but requires several precautions concerning sedation and the left-sided position of the mother during the procedure, particularly in the third trimester. Obviously, it should be performed only when strongly indicated by an expert endoscopist after obstetric consultation [17] . In our case, the colonoscopy was performed not only for the diagnosis of UC complicated by toxic megacolon, but also to perform a colonoscopic decompression.…”