Brief Article
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World J Gastrointest Endosc. Apr 16, 2013; 5(4): 148-153
Published online Apr 16, 2013. doi: 10.4253/wjge.v5.i4.148
Safety of endoscopic retrograde cholangiopancreatography in pregnancy: Fluoroscopy time and fetal exposure, does it matter?
Ioana Smith, Monica Gaidhane, Allen Goode, Michel Kahaleh
Ioana Smith, Department of Medicine, University of Alabama, Birmingham, AL 35487, United States
Monica Gaidhane, Michel Kahaleh, Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, NY 10021, United States
Allen Goode, Radiology and Medical Imaging, University of Virginia, Charlottesville, VI 22908, United States
Author contributions: Smith I and Goode A drafted the manuscript, revised the manuscript for important intellectual content; Gaidhane M and Kahaleh M acquired, analysed and interpreted the data and revised the manuscript for important intellectual content.
Correspondence to: Michel Kahaleh, MD, AGAF, FACG, FASGE, Chief of Endoscopy, Division of Gastroenterology and Hepatology, Weill Cornell Medical College, 1305 York Avenue, 4th floor, New York, NY 10021, United States. mkahaleh@gmail.com
Telephone: +1-646-9624000 Fax: +1-646-9620110
Received: September 14, 2012
Revised: December 27, 2012
Accepted: January 23, 2013
Published online: April 16, 2013
Abstract

AIM: To estimate the fetal radiation exposure using thermoluminescent dosimeters (TLD’s) in pregnant patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) and assess its relevance.

METHODS: Data on thirty-five therapeutic ERCPs conducted in pregnant patients from 2001 to 2009 were retrieved from a prospective database. Techniques to minimize fluoroscopy time were implemented and the fluoroscopy times captured. TLD’s were placed on the mother to estimate the fetal radiation exposure and the results were compared to the maximum allowed dose of radiation to the fetus [0.005 gray (Gy)]. Obstetrics consultations were obtained and the fetus was monitored before and after the ERCP. Fluoroscopy was performed at 75 kVp. ERCP was performed with the patients supine by dedicated biliary endoscopists performing more than 500 cases a year.

RESULTS: A total of 35 pregnant patients underwent ERCP and biliary sphincterotomy (14 in first trimester, 11 in second trimester, and 10 in third trimester). Mean maternal age was 25 years (range 16-37 years) and mean gestational age was 18.9 wk (range 4-35 wk). Mean fluoroscopy time was 0.15 min (range 0-1 min). For 23 women, the estimated fetal radiation exposure was almost negligible (< 0.0001 Gy) while for 8 women, it was within the 0.0001-0.0002 Gy range. Three women had an estimated fetal radiation exposure between 0.0002 and 0.0005 Gy and 1 woman had an estimated fetal radiation exposure greater than 0.0005 Gy. Complications included 2 post-sphincterotomy bleeds, 2 post-ERCP pancreatitis, and 1 fatal acute respiratory distress syndrome. One patient developed cholecystitis 2 d after ERCP.

CONCLUSION: ERCP with modified techniques is safe during pregnancy, and estimating the fetal radiation exposure from the fluoroscopy time or measuring it via TLD’s is unnecessary.

Keywords: Endoscopic retrograde cholangiopancreatography, Pregnancy, Fluoroscopy, Fetal exposure, Pancreaticobiliary disease