Safety and efficacy of ERCP in pregnancy.
BACKGROUND
Choledocholithiasis during pregnancy increases the risk of morbidity and mortality for both fetus and mother because of cholangitis and pancreatitis. ERCP has been advocated as safe and effective in pregnant women, but fetal radiation exposure is not routinely monitored. The aim of this study was to record fetal exposure to ionizing radiation during ERCP and to assess outcome.


METHODS
Seventeen ERCPs were performed in pregnant women between January 1995 and August 2003. Techniques to minimize fluoroscopy were used, and fluoroscopy times were recorded. Thermoluminescent dosimeters affixed to the skin of the mother were used to estimate fetal radiation exposure.


METHODS
Mean gestational age was 18.6 (8.9) weeks (range 5-33 weeks). Mean fluoroscopy time was 14 (13) seconds (range 1-48 seconds). Estimated fetal radiation exposure was 40 (46) mrad (range 1-180 mrad). There was a correlation between fluoroscopy time and radiation exposure, but there was a wide range of radiation exposure for individual fluoroscopy times. Complications included post-sphincterotomy bleeding in one patient (controlled by hemoclip placement) and post-ERCP pancreatitis in one patient that necessitated 3 days of hospitalization. Two women developed third-trimester preeclampsia, and labor was induced in both. Thirteen of the 15 patients who delivered were contacted and they confirmed that their child was in good health.


CONCLUSIONS
ERCP with modified techniques is safe during pregnancy. Dosimetry should be routinely recorded.
Kahaleh
Michel
M
Digestive Health Center, Radiation Oncology Physics, Department of Anesthesiology, University of Virginia Health System, Charlottesville, VA 22908, USA.
Hartwell
Gary D
GD
Arseneau
Kristen O
KO
Pajewski
Thomas N
TN
Mullick
Tarun
T
Isin
Gulkan
G
Agarwal
Suresh
S
Yeaton
Paul
P
D000293:Adolescent; D000328:Adult; D002760:Cholangiopancreatography, Endoscopic Retrograde; D042883:Choledocholithiasis / Q000000981:diagnostic imaging*; D005260:Female; D005333:Fetus / Q000528:radiation effects*; D005471:Fluoroscopy; D006801:Humans; D011247:Pregnancy; D011248:Pregnancy Complications / Q000000981:diagnostic imaging*; D011256:Pregnancy Outcome; D011829:Radiation Dosage; D012189:Retrospective Studies