Choledocholithiasis is a serious problem in pregnancy, which can lead to life-threatening complications such as cholangitis and pancreatitis. Data on safety issues of endoscopic retrograde cholangiopancreatography with radiation in pregnancy are not conclusive for current clinical practice. A gastroenterology research group have presented their experience with non-radiation ERCP during pregnancy.
Hormonal changes during pregnancy increase the lithogenicity of bile and impair gallbladder emptying, which create a favorable environment for gallstone formation. Choledocholithiasis and consequent complications such as pancreatitis and cholangitis are potentially fatal diseases for the mother and fetus. During pregnancy, the treatment is usually conservative since surgery is associated with an increased rate of complications such as preterm labor and spontaneous abortion. In choledocholithiasis, endoscopic retrograde cholangiopancreatography (ERCP) is the first-line treatment of choice. However, a clear-cut safe radiation dose for ERCP in pregnancy is still unknown.
A research article to be published on August 7, 2009 in the World Journal of Gastroenterology addresses this question. A study conducted by Assoc. Prof. OV Ozkan from the University of Mustafa Kemal (Turkey) addressed this question. Five pregnant patients with choledocholithiasis and one with biliary fistula after hepatic hydatid disease surgery were included. ERCP procedures were performed without the use of radiation.
Confirmation of successful therapeutic ERCP was made by laboratory and clinical improvement of the patients. The fistula of the patient with hepatic hydatid surgery was closed after placement of the plastic stent by non-radiation ERCP. The laboratory abnormalities of the other patients with choledocholithiasis and/or choledocholithiasis-induced acute cholangitis were normalized after ERCP. Ultrasonographic confirmation of stone extraction was made in all patients with choledocholithiasis. Post-ERCP complications, premature birth, abortion or intrauterine growth retardation were not observed. The clinical follow-up of the patients until discharge was uneventful.
Experiences with non-radiation ERCP during pregnancy are very limited. The results of the present study may create a good reference for the effectiveness of therapeutic non-radiation ERCP with wire-guided cannulation in pregnant women with strong indications for ERCP, in experienced centers. Laboratory and ultrasonographic follow-up of the patients after the procedure may be a safe, simple and cost-effective strategy for monitoring the effectiveness of the procedure. Stent placement should be considered in cases in which clearance of the common bile duct has failed.
- Akcakaya A, Ozkan OV, Okan I, Kocaman O, Sahin M. Endoscopic retrograde cholangiopancreatography during pregnancy without radiation. World J Gastroenterol, 2009; 15(29): 3649-3652 [link]
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