Endoscopic treatment of acute biliary pancreatitis in pregnancy.

XXI Internal Medicine Department, Cardarelli Hospital, Napoli, Italy.
Journal of Clinical Gastroenterology (Impact Factor: 3.19). 05/1994; 18(3):250-2. DOI: 10.1097/00004836-199404000-00022
Source: PubMed
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    ABSTRACT: Endoscopic retrograde cholangiopancreatography (ERCP) is currently the treatment of choice for symptomatic choledocholithiasis in pregnant patients. We aimed to present our experience with pregnant patients who underwent nonradiation ERCP and to evaluate the safety and efficacy of a new technique. A retrospective analysis of nonradiation ERCP in 22 pregnant patients with symptomatic choledocholithiasis between January 2002 and December 2013 was performed. The bile aspiration technique with wire-guided sphincterotome was used to confirm selective biliary cannulation. Transpapillary pancreatic septotomy was performed in cases with difficult biliary cannulation (n = 3). After endoscopic biliary sphincterotomy, endoscopic papillary balloon dilation was performed with a 6- or 8-mm dilation balloon in all patients to reduce the risk of recurrent cholangitis because of residual or additional stones. Stones were extracted by balloon sweeping after dilation. All patients were followed for 6 months after the ERCP procedure. Biliary cannulation was achieved in all patients. Endoscopic papillary balloon dilation was performed with a 6-mm balloon in 17 patients and an 8-mm balloon in five patients. The stones were extracted in 18 of the 22 patients by balloon sweeping, but no stones were extracted in the remaining four patients. There were two cases of mild post-ERCP pancreatitis. All patients delivered at term, and none experienced recurrence of choledocholithiasis and/or cholangitis during the 6-month follow-up. Endoscopic biliary sphincterotomy plus endoscopic papillary balloon dilation in nonradiation ERCP is a safe and effective treatment method for symptomatic choledocholithiasis during pregnancy.
    Surgical Endoscopy 04/2015; DOI:10.1007/s00464-015-4190-1 · 3.31 Impact Factor
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    ABSTRACT: To report the safety of continued use of endoscopic retrograde cholangiopancreatography (ERCP) during pregnancy at various maternal ages.
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    ABSTRACT: Biliary disease in pregnancy is a relatively uncommon condition; the diagnosis of this condition is not standardized. Furthermore, the use of radiographic imaging studies and therapeutic approaches in pregnancy is limited because of the possibility of fetal exposure.Study designDuring a 2-year interval of 2001 to 2002, we successfully performed endoscopic retrograde cholangiopancreatography (ERCP) studies in 6 pregnant women between 6 and 30 weeks of gestation with symptomatic acute cholangitis or pancreatitis without irradiation exposure or major maternal complications. Five of the women had classic symptoms of severe right upper quadrant abdominal pain, gallbladder stones, jaundice, and dilated bile ducts on ultrasonic evaluation. One woman had severe recurrent pancreatitis during early pregnancy 4 years after a cholecystectomy. The cases are compiled to provide a descriptive review of ERCP without the use of radiation imaging treatment for these conditions.ResultsMaternal outcome: After ERCP, jaundice resolved in all cases. No further episodes of pancreatitis occurred during the 1 affected pregnancy. No post-ERCP complications occurred during this series. Two patients required cholecystectomy later, one in the postpartum period and the other 5 weeks post-ERCP. Fetal outcome: Two infants were born at term without complications. Two infants were born prematurely at 35 weeks, 1 with significant growth retardation and pulmonary complications and 1 without developmental problems or complications. Two mothers were lost to follow-up; the outcomes of their pregnancies are unknown.Conclusion The use of ERCP in pregnancy is limited because of the undesirable effects of radiation exposure to the fetus.
    American Journal of Obstetrics and Gynecology 05/2004; 190(5):1467-1469. DOI:10.1016/S0002-9378(04)00173-5 · 3.97 Impact Factor