Endoscopic Treatment of Acute Biliary Pancreatitis in Pregnancy

Article (PDF Available)inJournal of Clinical Gastroenterology 18(3):250-2 · May 1994with13 Reads
DOI: 10.1097/00004836-199404000-00022 · Source: PubMed
    • "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.
    Article · Jun 2008
  • [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.
    Article · Jul 1996
  • [Show abstract] [Hide abstract] 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.
    Article · Apr 1998
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