title: Endoscopic retrograde cholangiopancreatography (ERCP) in pregnancy without the use of radiation.
abstract: BACKGROUND
  Biliary disease in pregnancy is a relatively uncommon condition; the diagnosis of this condition is not standardized. Furthermore, the use of radiographic imaging studies and therapeutic approaches in pregnancy is limited because of the possibility of fetal exposure.
  
  
  METHODS
  During a 2-year interval of 2001 to 2002, we successfully performed endoscopic retrograde cholangiopancreatography (ERCP) studies in 6 pregnant women between 6 and 30 weeks of gestation with symptomatic acute cholangitis or pancreatitis without irradiation exposure or major maternal complications. Five of the women had classic symptoms of severe right upper quadrant abdominal pain, gallbladder stones, jaundice, and dilated bile ducts on ultrasonic evaluation. One woman had severe recurrent pancreatitis during early pregnancy 4 years after a cholecystectomy. The cases are compiled to provide a descriptive review of ERCP without the use of radiation imaging treatment for these conditions.
  
  
  RESULTS
  Maternal outcome: After ERCP, jaundice resolved in all cases. No further episodes of pancreatitis occurred during the 1 affected pregnancy. No post-ERCP complications occurred during this series. Two patients required cholecystectomy later, one in the postpartum period and the other 5 weeks post-ERCP. Fetal outcome: Two infants were born at term without complications. Two infants were born prematurely at 35 weeks, 1 with significant growth retardation and pulmonary complications and 1 without developmental problems or complications. Two mothers were lost to follow-up; the outcomes of their pregnancies are unknown.
  
  
  CONCLUSIONS
  The use of ERCP in pregnancy is limited because of the undesirable effects of radiation exposure to the fetus.
authors.affiliation: Obstetrics and Gynecology Residency Program, Methodist Hospitals of Dallas, Dallas, Texas, USA.
authors.forename: D C
authors.initials: DC
authors.lastname: Simmons
authors.forename: P R
authors.initials: PR
authors.lastname: Tarnasky
authors.forename: M E
authors.initials: ME
authors.lastname: Rivera-Alsina
authors.forename: J F
authors.initials: JF
authors.lastname: Lopez
authors.forename: C D
authors.initials: CD
authors.lastname: Edman
mesh_terms: D000328:Adult; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D002761:Cholangitis / Q000175:diagnosis* / Q000628:therapy; D005260:Female; D005865:Gestational Age; D006801:Humans; D008423:Maternal Age; D010195:Pancreatitis / Q000175:diagnosis* / Q000628:therapy; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis* / Q000628:therapy; D011256:Pregnancy Outcome; D018566:Pregnancy, High-Risk; D011827:Radiation; D012307:Risk Factors; D012494:Sampling Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index