Original article
Clinical endoscopy
Safety and utility of ERCP during pregnancy

https://doi.org/10.1016/j.gie.2008.05.024Get rights and content

Background

ERCP is an important diagnostic and therapeutic tool in patients with biliary and pancreatic disease. Its utility and safety during pregnancy is largely unknown because it is not often required and because its use has been only infrequently reported in the published literature.

Objective

Our purpose was to report the clinical experience with ERCP during pregnancy.

Design

Retrospective review, single academic center.

Patients

All (consecutive) pregnant women who underwent ERCP at Parkland Memorial Hospital from 2000 to 2006.

Main Outcome Measurements

History, clinical data, hospital course, procedure-related complication rates and outcomes, and delivery and fetal outcomes were abstracted from medical records.

Results

During the study period, 68 ERCPs were performed on 65 pregnant women. The calculated ERCP rate was 1 per 1415 births. The common indications for ERCP in pregnancy were recurrent biliary colic, abnormal liver function tests, and dilated bile duct on US. ERCP was technically successful in all patients. The median fluoroscopy time was 1.45 minutes (range 0-7.2 minutes). There was no perforation, sedation-related adverse event, postsphincterotomy bleeding, cholangitis, or procedure-related maternal or fetal deaths. Post-ERCP pancreatitis was diagnosed in 11 patients (16%). None of these 11 patients had local or systemic complications. Fifty-nine patients had complete follow-up. Endoscopic therapy at the time of ERCP was undertaken in all patients. Furthermore, 9 patients (32.1%) underwent cholecystectomy in the first and second trimesters for either acute cholecystitis (6) or symptomatic gallstones (3). Term pregnancy was achieved in 53 patients (89.8%). Patients having ERCP in the first trimester had the lowest percentage of term pregnancy (73.3%) and the highest risk of preterm delivery (20.0%) and low-birth-weight newborns (21.4%). None of the 59 patients with long-term follow-up had spontaneous fetal loss, perinatal death, stillbirth, or fetal malformation.

Limitation

Retrospective review.

Conclusions

ERCP can be performed safely during pregnancy. Further, ERCP performed in pregnancy leads to specific therapy in essentially all patients. However, ERCP may be associated with a higher rate of post-ERCP pancreatitis than in the general population.

Section snippets

Patients

This retrospective study was conducted over a 6-year period (September 2000 to September 2006) in the endoscopy unit at PMH. Through computerized diagnostic codes entered on discharge, we identified all consecutive pregnant patients who underwent ERCP and the annual birthing data during the same study period. A computerized database was established in 2000 at PMH. The patient history, hospital course, ERCP complications and outcomes, delivery, and fetal outcomes were retrieved through chart

Study patients

During the study period, 68 ERCPs were performed in 65 pregnant women with 45.6% (31/68) of the ERCPs performed during the third trimester of pregnancy (Table 1). At PMH, the annual numbers of births were as follows: 16,504 (2001), 15,677 (2002), 15,549 (2003), 16,223 (2004), 15,972 (2005), and 16,307 (2006), and there were 96,232 deliveries during the study period (Fig. 1). The calculated rate of ERCP in pregnancy is one per 1415 births. Patients of Hispanic ethnicity composed 85% (55/65) of

Discussion

In this report, we have detailed our experience with ERCP in pregnancy since 2000. The rate of ERCP in pregnancy in current series (1/1415 deliveries) appears to be higher than that reported in some studies. This may be a result of more aggressive use of therapeutic ERCP in pregnancy, such as to perform biliary sphincterotomy. Other explanations include an increased incidence of gallstones and choledocholithiasis in our patient populations or more aggressive disease. In some reports, biliary

Acknowledgments

We thank Dr Kenneth Leveno for his review of the manuscript and the PMH staff who contributed to the care of these patients.

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DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.

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