title: Comparison of endoscopic retrograde cholangiopancreatography performed without radiography and with ultrasound-guidance in the management of acute pancreaticobiliary disease in pregnant patients.
abstract: BACKGROUND
  Currently, the recommendation when treating acute biliary or pancreatic disease during pregnancy is to perform endoscopic retrograde cholangiopancreatography (ERCP) without radiation exposure, either empirically (with no radiographic guidance) or with ultrasound guidance. However, few published studies compared these two ways. This study aimed to compare ultrasound-guided ERCP with the procedure without radiographic guidance in the treatment of acute pancreaticobiliary disease in pregnant patients.
  
  
  METHODS
  The clinical data of 68 pregnant patients with acute pancreaticobiliary disease admitted to our hospital between January 2004 and May 2010 were reviewed retrospectively. ERCP was performed without radiographic guidance in 36 cases (group A) and with ultrasound guidance in 32 cases (group B). Data on the following variables were compared between the two groups: surgical success rate, rate of complete stone removal, time to resolution of clinical manifestations and laboratory indicators, length of hospital stay, complications, outcome and differences in efficacy of ERCP during different stages of pregnancy.
  
  
  RESULTS
  In group A, the rates of surgical success and complete removal of stones were 69% and 60%, respectively; the corresponding values were 91% and 89% in group B (P < 0.05). Postoperatively, clinical manifestations improved rapidly in all patients; there was no statistically significant difference between the groups (P > 0.05). Leukocyte counts and liver function had improved significantly after one week in all patients; they recovered more quickly in group B ((8.64 ± 1.83) days vs. (14.57 ± 3.74) days, (14.29 ± 4.64) days vs. (20.00 ± 5.40) days, P < 0.01). The hospital stay was shorter in group B ((16.28 ± 7.25) days vs. (28.00 ± 6.83) days, P < 0.001). The complication rate was 14% in group A and 3% in group B (P < 0.05). There were no significant differences between the two groups in the procedure's efficacy during different stages of pregnancy.
  
  
  CONCLUSIONS
  In the treatment of acute pancreaticobiliary disease during pregnancy, ultrasound-guided ERCP is safer and more effective than performing the procedure empirically without radiographic guidance when performed by experienced practitioners. Its more widespread use is recommended.
authors.affiliation: Department of Gastroenterology, First People's Hospital of Hangzhou, Hangzhou, Zhejiang 310006, China.
authors.forename: Ping
authors.initials: P
authors.lastname: Huang
authors.forename: Hao
authors.initials: H
authors.lastname: Zhang
authors.forename: Xiao-feng
authors.initials: XF
authors.lastname: Zhang
authors.forename: Xiao
authors.initials: X
authors.lastname: Zhang
authors.forename: Wen
authors.initials: W
authors.lastname: Lü
authors.forename: Zhen
authors.initials: Z
authors.lastname: Fan
mesh_terms: D000208:Acute Disease; D000328:Adult; D001660:Biliary Tract Diseases / Q000601:surgery*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D005260:Female; D006801:Humans; D010182:Pancreatic Diseases / Q000601:surgery*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000601:surgery*; D012189:Retrospective Studies; D018084:Ultrasonography, Interventional