Ultrasound-guided ERC in pregnancy (10 weeks pregnant) without fluoroscopy – presentation of a sphincterotome in the CBD

Purpose: Obstructive biliary disease in pregnancy is rare. Reports range from therapeutic ERC with position control by aspiration of bile to short fluoroscopy with or without insertion of an endoprostheses. First Trimester X-rays should be used only if clearly indicated. The aim was to identify whether an ultrasound-guided ERC is effective and safe in early pregnancy.

Material and methods: A 37-year-old woman presented with clinical and laboratory parameters of cholestasis. Ultrasound confirmed choledocholithiasis with enlargement of the CBD. ERC was performed in left lateral position under external ultrasound guidance and general anesthesia.

Results: Cannulation of the CBD was performed using a guidewire sphincterotome. After successful aspiration of bile the sphincterotome was further inserted into the bile duct. The sphincterotome was reliably identified by ultrasound in the CBD. Subsequently endoscopic sphincterotomy was performed and the stone extracted with a balloon. Following the EST glistening aerobilia could be visualized. After the procedure bile ducts on ultrasound normalized, laboratory parameters of cholestasis declined.

Fig. 1: sphincterotome in the CBD

Conclusion: Götzberger et al. (Z Gastroenterol 2010; 48 – PP5) described CEUS-ERC as an option for position control in pregnancy. Unfortunately SonoVue^® is not approved for the use in pregnancy we are limited to an ultrasound-guided stone extraction without fluoroscopy. This was considered in our case. Ultrasound-guided ERC and presentation of a sphincterotome in the CBD is effective and safe in early pregnancy. This has previously been shown to be effective and safe by Freistühler et al. (Z Gastroenterol 1999; 37:27 – 30) and Huang et al. (Chin Med J 2013; 126:46 – 50).