Introduction Pregnancy is associated with an increased risk of gallstone formation, which in turn causes cholangitis and pancreatitis. The prevalence of gallstones in pregnancy has been reported as 3.3 – 12.2%. Cholecystectomy is the second most common non-obstetric surgical procedure in pregnancy, exceeded only by appendicectomy. ERCP is the first-line treatment of choice for cholangitis and pancreatitis caused by choledocholithiasis. However, the use of ERCP in pregnancy is limited because of the primary concern of foetal safety in relation to exposure to ionising radiation. A clear-cut safe radiation dose for ERCP in pregnancy is still unknown. There have been only a few studies of non-radiation ERCP during pregnancy. Our aim is to present our experience with pregnant patients who underwent ERCP without using radiation, and to evaluate the safety and efficacy of this therapeutic pathway for ERCP during pregnancy.
Methods A retrospective analysis of ERCPs in pregnant women in a single centre in North London (Chase Farm Hospital) between January 2005 and November 2011 was performed. The unit policy of ERCP in pregnant women is to perform the procedure in the left lateral position using midazolam/pethidine combination. Guidewire cannulation of the bile duct is adopted with bile aspiration and/or visualisation of bile oozing around the guide wire used as confirmation of biliary cannulation. Bile duct clearance after sphincterotomy is then performed. No fluoroscopy is used during the procedure, but was available if required. Confirmation of successful therapeutic ERCP was made by laboratory and clinical improvement of the patients.
Results Out of 2255 procedures, 4 (0.17%) were performed on pregnant women. The mean age was 31 years (range 29–36), the mean gestation was 16.75 weeks (range 4–30), with two patients in their first, one in their second and third trimesters each. The indications for ERCP were cholangitis and pancreatitis (two), cholangitis (one) and choledocholithiasis on ultrasonography (one). In two cases, precut papillotomy with a needle-knife was used, since the stone was impacted. Sphincterotomy was used in two cases. Stones were removed by balloon or basket trawls and no stents were placed. After ERCP, jaundice resolved in all cases. Post-ERCP complications, premature birth, abortion or intrauterine growth retardation were not observed.
Conclusion Our series showed that in experienced hands, successful therapeutic ERCPs with wire-guided cannulation can be performed safely without radiation in pregnant women with strong indications. We would recommend use of this technique (wire-guided cannulation without radiation) if ERCP is required during pregnancy.
Disclosure of Interest None Declared
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