Subscribe to RSS
DOI: 10.1055/a-1191-2680
Real-time transabdominal ultrasound-guided ERCP is feasible and effective in pregnancy: a case series
Abstract
Background and study aims Endoscopic retrograde cholangiopancreatography (ERCP) is commonly required in pregnancy for choledocholithiasis, however, radiation exposure is a major concern for patients. Real-time transabdominal (TA) ultrasound (US)-guided ERCP is a radiation-free technique that facilitates confirmation of biliary cannulation, equipment exchange and stone clearance. We present the largest Western case series of this modality in pregnancy and a review of the literature.
Four pregnant adult patients were referred to our tertiary center with suspected or documented choledocholithiasis and underwent real-time TA US-guided ERCP. US was successfully used to confirm positioning of the guidewire and ductal clearance. Procedures were successful in all patients with resolution of clinical symptoms and no immediate procedural complications. Two patients suffered adverse events later in their pregnancy.
Real-time TA US-guided ERCP is a technically feasible and effective modality that can be offered to obtain biliary access in a radiation-free fashion for specific subsets of pregnant patients with choledocholithiasis. Future studies are needed to confirm the safety of this technique.
Publication History
Received: 04 January 2020
Accepted: 20 April 2020
Article published online:
07 October 2020
© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
References
- 1 Wu W, Faigel DO, Sun G. et al. Non-radiation endoscopic retrograde cholangiopancreatography in the management of choledocholithiasis during pregnancy. Dig Endosc 2014; 26: 691-700
- 2 Shergill AK, Ben-Menachem T, Chandrasekhara V. et al. Guidelines for endoscopy in pregnant and lactating women. Gastrointest Endosc 2012; 76: 18-24
- 3 Samara ET, Stratakis J, Enele Melono JM. et al. Therapeutic ERCP and pregnancy: is the radiation risk for the conceptus trivial?. Gastrointest Endosc 2009; 69: 824-831
- 4 Cappell MS, Stavropoulos SN, Friedel D. Systematic review of safety and efficacy of therapeutic endoscopic-retrograde-cholangiopancreatography during pregnancy including studies of radiation-free therapeutic endoscopic-retrograde-cholangiopancreatography. World J Gastrointest Endosc 2018; 10: 308-321
- 5 Parada AA, Goncalves MO, Tafner E. et al. Endoscopic papillotomy under ultra-sonographic control. Int Surg 1991; 76: 75-76
- 6 Huang P, Zhang H, Zhang X. et al. Comparison of endoscopic retrograde cholangiopancreatography performed without radiography and with ultrasound-guidance in the management of acute pancreaticobiliary disease in pregnant patients. Chin Med J (Engl) 2013; 126: 46-50
- 7 Gotzberger M, Pichler M, Gulberg V. Contrast-enhanced US-guided ERCP for treatment of common bile duct stones in pregnancy. Gastrointest Endosc 2012; 76: 1069-1070
- 8 Meves V, Pohl J. Trans-Abdominal ultrasound guided erc in a pregnant woman with bile duct stones. Video J Encycl GI Endosc 2014; 2: 9-11
- 9 Tang S-J, Mayo MJ, Rodriguez-Frias E. et al. Safety and utility of ERCP during pregnancy. Gastrointest Endosc 2009; 69: 453-461
- 10 Mehta PP, Sanaka MR, Parsi MA. et al. Association of procedure length on outcomes and adverse events of endoscopic retrograde cholangiopancreatography. Gastroenterol Rep 2014; 2: 140-144