Safety and utility of ERCP during pregnancy.
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.


METHODS
Retrospective review, single academic center.


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


METHODS
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.


CONCLUSIONS
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.
Tang
Shou-Jiang
SJ
Division of Digestive and Liver Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA. sjtang2000@yahoo.com
Mayo
Marlyn J
MJ
Rodriguez-Frias
Edmundo
E
Armstrong
Luis
L
Tang
Linda
L
Sreenarasimhaiah
Jayaprakash
J
Lara
Luis F
LF
Rockey
Don C
DC
D000328:Adult; D001649:Bile Duct Diseases / Q000000981:diagnostic imaging*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects; D005260:Female; D006801:Humans; D010182:Pancreatic Diseases / Q000000981:diagnostic imaging*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000000981:diagnostic imaging*; D012189:Retrospective Studies