title: ERCP without radiation during pregnancy in the minimal invasive world.
abstract: BACKGROUND
  The current guidelines recommend endoscopic retrograde cholangiopancreatography (ERCP) procedures in pregnant women with minimal radiation exposure. Regarding the safety of ERCP during pregnancy, data are limited in the literature. In this study, we report our experience with five ERCP procedures performed in five pregnant women without radiation at a single tertiary health center.
  
  
  METHODS
  Between May 2007 and February 2012, five pregnant patients underwent ERCP without radiation, analyzed retrospectively. Clinical disease was confirmed with either pre-procedure ultrasonography and magnetic resonance cholangiopancreatography in all patients. In all cases, selective deep cannulation was performed and confirmed by the aspiration and/or direct visualization of the bile. The data regarding laboratory, ultrasonography, magnetic resonance imaging, endoscopic findings, and clinical course of the patients were analyzed. Fetal complications were noted at delivery and 30 days postdelivery follow-up.
  
  
  RESULTS
  The mean patient age was 26 years (22-33) and the mean duration of pregnancy was 20 weeks (12-32). In all cases, no secondary ERCP procedures were needed. Also, no maternal and fetal adverse events and complications were determined after the procedures or on follow-up. All stages of the procedure including cannulation, sphincterotomy, and stone extraction were performed without the use of fluoroscopy.
  
  
  CONCLUSIONS
  As far we know, there is no report in the literature regarding the failure of endoscopic retraction of stones without fluoroscopy during pregnancy. Our series notes that ERCP is safe and prevents recurrent biliary pancreatitis during pregnancy. Unfortunately, due to the small limited number of patient data, our study notes the requirement of further large randomized and controlled series.
authors.affiliation: Department of General Surgery, Istanbul School of Medicine, Istanbul Medical Faculty, Istanbul University, Capa, 34093, Istanbul, Turkey.
authors.forename: Orhan
authors.initials: O
authors.lastname: Agcaoglu
authors.forename: Beyza
authors.initials: B
authors.lastname: Ozcinar
authors.forename: Ali Fuat Kaan
authors.initials: AF
authors.lastname: Gok
authors.forename: Fatih
authors.initials: F
authors.lastname: Yanar
authors.forename: Hakan
authors.initials: H
authors.lastname: Yanar
authors.forename: Cemalettin
authors.initials: C
authors.lastname: Ertekin
authors.forename: Kayihan
authors.initials: K
authors.lastname: Gunay
mesh_terms: D000328:Adult; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D002761:Cholangitis / Q000175:diagnosis* / Q000628:therapy; D042883:Choledocholithiasis / Q000150:complications / Q000601:surgery*; D005260:Female; D005865:Gestational Age; D006801:Humans; D008279:Magnetic Resonance Imaging; D010195:Pancreatitis / Q000150:complications* / Q000601:surgery; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000601:surgery*; D011256:Pregnancy Outcome; D018566:Pregnancy, High-Risk; D012189:Retrospective Studies; D016896:Treatment Outcome