Conservative management of cholelithiasis and its complications in pregnancy is associated with recurrent symptoms and more emergency department visits
ABSTRACT Pancreaticobiliary complications of gallstones are common in pregnancy and can result in serious sequelae. Previous studies have shown conflicting results regarding different approaches of treatment.
To compare the outcomes of conservative treatment versus operative and endoscopic interventions in the management of complications related to gallstones during pregnancy.
Retrospective chart review.
Tertiary-care referral facility.
A total of 112 patients who had complications related to gallstones during pregnancy.
Patients were classified into 3 groups: conservative treatment, laparoscopic cholecystectomy (LC), and ERCP.
We collected demographic data and information regarding treatment complications and pregnancy outcomes.
A total of 112 pregnant patients met the inclusion criteria, with a mean age of 25 years. Main clinical presentations were biliary colic (n = 56), biliary pancreatitis (n = 27), acute cholecystitis (n = 17), and choledocholithiasis (n = 12). A total of 68 patients underwent conservative treatment, 13 patients underwent ERCP, 27 patients had LC, and 4 patients received both ERCP and LC. Recurrent biliary symptoms were significantly more common in patients who received conservative treatment (P = .0005). The number of emergency department visits was significantly higher in the conservative treatment group compared with the active intervention group (P = .0006). The number of hospitalizations also was higher in the conservative treatment group (P = .03). Fetal birth weight was similar in both groups (P = .1). Patients treated conservatively were more likely to undergo cesarean section operations for childbirth (P = .04).
Single-center, retrospective study.
Conservative treatment of cholelithiasis and its complications during pregnancy is associated with recurrent biliary symptoms and frequent emergency department visits. ERCP and LC are safe alternative approaches during pregnancy.
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ABSTRACT: Background/Aims: To explore the efficacy and safety of modified endoscopic retrograde cholangiopancreatographies (ERCP) management of acute cholangitis during the third trimester of pregnancy. Methodology: Seventeen pregnancy women who were diagnosed as acute cholangitis during their third trimester and received modified ERCP between January 2000 and January 2012 in our solo medical center, were included in this study. All cases received two-stage interventions: 7 cases had caesarean birth in one week with endoscopic nasobiliary drainage (ENBD) after the first ERCP, and cleaned their bile ducts by second ERCP 1 week postpartum; 10 cases received endoscopic retrograde biliary drainage (ERBD) by bile duct plastic stents, and took out stents and stones by second ERCPs between 2 weeks and 1 month after termination of pregnancy. Results: The complication rate was 5.88% (2/34) in all 34 ERCPs on 17 cases (one biliary tract hemorrhage and one case of acute mild pancreatitis). All clinical symptoms were significantly alleviated; 11 cases had term labors and 6 cases had premature delivery. All 18 babies were healthy in follow-up 3 months postpartum. Conclusions: Modified ERCP is a safe procedure for acute cholangitis in pregnant women during the third trimester.Hepato-gastroenterology 02/2013; 60(127). DOI:10.5754/hge121258 · 0.91 Impact Factor
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ABSTRACT: PURPOSE OF REVIEW: As indications for interventional radiology procedures during pregnancy continue to expand, anesthesiologists must be aware of the indications for specific procedures as well as provide the safest possible anesthetic care to both the mother and the fetus in nontraditional environments. RECENT FINDINGS: Among the different imaging modalities employed for interventional procedures, ultrasonography and MRI without gadolinium-based contrast are preferred because they are free of ionizing radiation. Providers continue to report cases in which interventional techniques are used in a well tolerated and effective manner. The current literature emphasizes radiation-sparing maneuvers to minimize maternal and fetal ionizing radiation exposure. Maternal physiologic changes should be considered when planning anesthetic management for interventional radiology procedures. Because most of these procedures are performed outside the operating rooms or labor and delivery suites, the anesthesiologists should familiarize themselves with the environment prior to providing anesthesia. SUMMARY: The risk to the fetus of the imaging procedure must be weighed against the benefit to the mother of early and accurate diagnosis and treatment of the underlying pathology. As the organizational aspects of providing care become more complex, simulation, guidelines, and protocols may become important to the safe care of these patients.Current opinion in anaesthesiology 06/2013; DOI:10.1097/ACO.0b013e3283625e89 · 2.53 Impact Factor
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ABSTRACT: Pregnancy is a risk factor for gallstone disease; in some patients, cholecystectomy may be delayed to the postpartum period. Our aim was to examine the effect of antepartum interventions on postpartum outcomes in complicated gallstone disease (CGD) during pregnancy. Retrospective analysis of patients seeking medical care for CGD (cholecystitis, choledocholithiasis, or gallstone pancreatitis) during pregnancy at a single tertiary care institution over a 10-year period (2002-2012). Patients were contacted via standardized telephone survey to account for outside hospitalizations. We identified 56 patients with CGD during pregnancy, 42.9 % initially presenting during the second trimester. Choledocholithiasis was the most common diagnosis (n = 30). Antepartum cholecystectomy was performed in 17.9 %. Seventeen patients did not follow up postpartum and did not complete telephone survey. Of the remaining 29 patients, 58.6 % had recurrent postpartum symptoms, 35.3 % recurred within 1 month, and 82.4 % within 3 months of delivery. Antepartum ERCP with biliary sphincterotomy decreased postpartum symptom recurrence (38.5 vs. 75.0 %, p = 0.07). The majority of patients with CGD who do not undergo antepartum cholecystectomy have recurrent postpartum symptoms often within 3 months postpartum. When appropriate, physicians should advocate for antepartum or early postpartum cholecystectomy to minimize symptom recurrence and unplanned hospitalizations.Journal of Gastrointestinal Surgery 09/2013; 17(11). DOI:10.1007/s11605-013-2330-2 · 2.39 Impact Factor