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    ABSTRACT: Only limited data are available regarding the safety of therapeutic ERCP in pregnancy. We report our experience with therapeutic ERCP in pregnant women. Medical records of 18 pregnant women (first trimester 4, second 6, third 8) who underwent ERCP between July 1994 and December 2004 were reviewed. Patients and their families were contacted to assess the well being of mother and baby. All the women underwent therapeutic ERCP and biliary sphincterotomy for common bile duct (CBD) stones. In 4 patients, 10-Fr CBD stents were inserted; three of these four cases required mechanical lithotripsy after delivery. Median procedure time was 17 min and median fluoroscopy time was 8 seconds. One patient each developed mild post ERCP pancreatitis and post sphincterotomy bleed. One woman had a preterm delivery. At follow up after a median of 6 years, all the babies were healthy. Therapeutic ERCP can be performed safely in all the trimesters of pregnancy provided appropriate precautions are taken.
    Indian Journal of Gastroenterology 07/2005; 24(4):161-3.
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    ABSTRACT: More than 12,000 pregnant patients in the United States per year have conditions normally evaluated by esophagogastroduodenoscopy (EGD). More than 6000 pregnant patient in the United States per year have conditions normally evaluated by sigmoidoscopy or colonoscopy. Endoscopy during pregnancy raises the unique issue of fetal safety, and endoscopic medications comprise a significant component of fetal risks from endoscopy. This article analyzes the safety of endoscopic medications during pregnancy, reviews the literature on the safety of gastrointestinal endoscopy during pregnancy, proposes guidelines for endoscopic indications during pregnancy, and describes modifications of gastrointestinal endoscopy during pregnancy to increase fetal and maternal safety.
    Gastroenterology Clinics of North America 04/1998; 27(1):37-71. DOI:10.1016/S0889-8553(05)70347-2 · 2.82 Impact Factor
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    ABSTRACT: Gallstones are the most common cause of acute pancreatitis during pregnancy. Without intervention, gallstone pancreatitis during pregnancy is associated with an antepartum recurrence rate of 70%, which exposes the mother and fetus to an increased risk of morbidity and mortality. A safe, effective means to prevent recurrent gallstone pancreatitis during pregnancy is desirable. Since 1991, we have managed gallstone pancreatitis in three pregnant patients with endoscopic retrograde cholangiogram (ERC), followed by spincterotomy, despite the absence of common bile duct stones. All patients were judged to have mild pancreatitis by modified Ranson criteria and the Multiorgan System Failure criteria. During cholangiogram, fetal shielding was employed and fluoroscopy times ranged from 36 s to 7.2 min. One patient experienced postprocedure pancreatitis of 48-h duration. None of the patients experienced further episodes of pancreatitis and none underwent predelivery cholecystectomy. In pregnancy-associated gallstone pancreatitis, endoscopic sphincterotomy prevents recurrence of pancreatitis and the need for cholecystectomy during gestation. We believe endoscopic sphincterotomy represents a promising management alternative for gallstone pancreatitis during pregnancy. Further investigation is warranted.
    Surgical Endoscopy 06/1998; 12(5):394-9. DOI:10.1007/s004649900689 · 3.26 Impact Factor
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