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"The present study was based on this golden rule. Various publications involving a small number of patients have reported their experience on ERCP during pregnancy without fluoroscopy45678910. The different approaches in these publications were bile aspiration for confirmation of CBD cannulation, sphincterotomy and balloon extraction of stones. "
[Show abstract][Hide abstract]ABSTRACT: Management of choledocholithiasis during pregnancy is difficult. The aim of this study was to evaluate the safety and efficacy of managing common bile duct (CBD) stones during pregnancy using a two-stage procedure without any fetal radiation exposure.
Eleven consecutive pregnant women treated endoscopically for choledocholithiasis between 1996-2005, at a tertiary referral center, were included in this study. All the patients were treated by biliary sphincterotomy and stenting without any fluoroscopy or ultrasound assistance during pregnancy and definitive ERCP and stone clearance after delivery. Patients were followed at one week and were asked to come for definitive treatment after delivery.
All 11 patients were experiencing pain and jaundice while two patients had cholangitis. Abdominal ultrasound revealed dilated CBD in all patients and stones in 8 patients. Every patient demonstrated marked relief after the first stage procedure without any complication. ERCP after delivery revealed no CBD stones in one patient, 5-8 mm size stones in 8 patients and large stones (>15 mm) in two patients. One patient with large CBD stones required mechanical lithotripsy while another required surgery. CBD was cleared in 8 patients with small stones. Long-term fetal and maternal outcome was good in all the patients.
A two stage approach consisting of initial sphincterotomy with stenting without fluoroscopy during pregnancy followed by definitive ERCP after delivery seems to be a justified approach. This is the best most definitive way of avoiding radiation exposure to the fetus.
Preview · Article · Jun 2008 · Journal of gastrointestinal and liver diseases: JGLD
[Show abstract][Hide abstract]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.
Full-text · Article · Jul 2005 · Indian Journal of Gastroenterology
[Show abstract][Hide abstract]ABSTRACT: In America more than 100,000 high-risk patients/year have conditions normally evaluated by gastrointestinal endoscopy. This review analyzes the safety and efficacy of gastrointestinal endoscopy in high-risk patients. Endoscopy during pregnancy raises the unique issue of fetal safety. The safety of esophagogastroduodenoscopy (EGD) during pregnancy has been examined in a case-controlled study of 83 patients, a mailed survey of 73 patients, and case reports. The safety of sigmoidoscopy during pregnancy has been examined in a case-controlled study of 45 patients, a mailed survey of 26 patients, and case reports. These studies suggest that EGD and sigmoidoscopy are not contraindicated during pregnancy. For example, EGD should be performed for significant upper gastrointestinal bleeding. The safety of colonoscopy during pregnancy is inadequately analyzed. In a study of 34 EGDs performed within 3 weeks of myocardial infarction, no endoscopic complications occurred in 26 clinically stable patients with uncomplicated myocardial infarction. However, 3 major endoscopic complications occurred in 8 clinically unstable patients. In a study of 9 sigmoidoscopies within 3 weeks of myocardial infarction, no sigmoidoscopic complications occurred in 7 clinically stable patients. Several studies have shown that EGD, sigmoidoscopy, or colonoscopy is safe in patients with advanced HIV infection. AIDS patients should generally be endoscoped with the same aggressiveness as other patients. However, endoscopy may be unwise in any terminal patient. No complication occurred in 60 patients undergoing EGD within 3 weeks of esophageal, gastric, or duodenal surgery. One minor complication occurred in 36 patients undergoing sigmoidoscopy within 3 weeks of colonic surgery. These results suggest that EGD or sigmoidoscopy is not contraindicated within 3 weeks of gastrointestinal surgery. No complications occurred in 53 chronic obstructive pulmonary disease patients undergoing EGD. EGD appears to be safe in chronic obstructive pulmonary disease patients without severe hypoxemia or acute bronchospasm. Emergency EGD can be performed in patients with severe hypoxemia after endotracheal intubation.
No preview · Article · Jul 1996 · Digestive Diseases