Published online Aug 16, 2014. doi: 10.4253/wjge.v6.i8.352
Revised: March 19, 2014
Accepted: June 27, 2014
Published online: August 16, 2014
AIM: To report the safety of continued use of endoscopic retrograde cholangiopancreatography (ERCP) during pregnancy at various maternal ages.
METHODS: A retrospective chart review of pregnant patients who underwent ERCP at a tertiary academic center was undertaken between 2002 and 2012. Pertinent past medical history and initial presenting laboratory data were collected. Review of the procedure note for each ERCP performed provided documentation of lead shielding, type of sedation, fluoroscopy time, and post-procedure complications. Patients’ clinical courses were reviewed until the time of delivery and pregnancy complications with fetal outcomes were examined. Data was stratified based upon the mother’s age at the time of ERCP: 18-21, 22-29, and ≥ 30 years of age.
RESULTS: Twenty pregnant patients who underwent ERCP between 2002 and 2012 were identified. The mean age at the time of ERCP was 26.4 years (18-38 years) and the average trimester was the second. The indications for ERCP were choledocholithiasis in 17 patients, gallstone pancreatitis in 2 patients, and cholangitis in 1 patient. The mean fluoroscopy time of ERCP was 3.8 min (0.3-23.6 min). Sphincterotomy was performed in 18 patients with therapeutic intent and not as a prophylactic measure to prevent recurrences. Clinical documentation of use of protective shielding was found in only 8 notes (40%). Post procedure complications were limited to two cases of post-ERCP pancreatitis (10%). Elective cholecystectomy was performed shortly after ERCP in 11 of the pregnant patients. Birth records were available for 16 patients, of which 15 had full-term pregnancies. Cesarean sections were performed in 5 (31%) patients. Term birth weight was greater than 2500 g in all cases except one in which the mother had a known hypercoagulable state.
CONCLUSION: ERCP during pregnancy is both safe and efficacious regardless of maternal age or trimester.
Core tip: The incidence of choledocholithiasis during pregnancy has been estimated to be 1 in 1000. Although Endoscopic retrograde cholangiopancreatography (ERCP) remains the gold standard for treatment of symptomatic choledocholithiasis during pregnancy, there still remain safety concerns about it use. Women who conceive at “extremes of age” are at an increased risk for complications during pregnancy. Our study supports the safety and efficacy of ERCP during the peripartum period for both mothers and their newborns. Neither advanced age nor trimester in which the procedure was performed carried a higher risk for adverse outcomes during pregnancy.