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CC BY-NC-ND 4.0 · Endosc Int Open 2021; 09(02): E116-E121
DOI: 10.1055/a-1320-0084
Original article

Multicenter experience with digital single-operator cholangioscopy in pregnant patients

Olaya I. Brewer Gutierrez
1   Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, Maryland, United States
,
Gala Godoy Brewer
1   Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, Maryland, United States
,
Claudio Zulli
2   Division of Gastroenterology, University Hospital G. Fucito, Ruggi d’Aragona, Salermo, Italy
,
Sooraj Tejaswi
3   Division of Gastroenterology & Hepatology, University of California Davis School of Medicine, Sacramento California, United States
,
Rishi Pawa
4   Division of Gastroenterology, Wake Forest Baptist Medical Center, Winston Salem, NC
,
Priya Jamidar
5   Division of Digestive Diseases, Yale University School of Medicine, New Haven, Connecticut, United States
,
Carlos Robles-Medranda
6   Division of Gastroenterology and Endoscopy Division, Instituto Ecuatoriano de Enfermedades Digestivas, Guayaquil, Ecuador
,
Swati Pawa
4   Division of Gastroenterology, Wake Forest Baptist Medical Center, Winston Salem, NC
,
Jose V. Camilion
7   Nova Southeastern College of Ostheopathic Medicine, Davie, Florida, United States
,
Roberto Oleas
6   Division of Gastroenterology and Endoscopy Division, Instituto Ecuatoriano de Enfermedades Digestivas, Guayaquil, Ecuador
,
Nasim Parsa
8   Division of Gastroenterology and Hepatology, University of Missouri, Columbia, MO
,
Thomas Runge
1   Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, Maryland, United States
,
Diana Miaw
9   Division of Gynecology & Obstetrics, Johns Hopkins Medical Institution, Baltimore, Maryland, United States
,
Yervant Ichkhanian
1   Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, Maryland, United States
,
Mouen A. Khashab
1   Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, Maryland, United States
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Abstract

Background and study aims The use of fluoroscopy during pregnancy should be minimized given that a clear-cut safe radiation dose in pregnancy is unknown. The role of digital single-operator cholangioscopy (D-SOC) as an alternative to standard enodoscopic retrograde cholangiopancreatography (ERCP) in pregnant patients has not been comprehensively studied. This study assessed [1] Technical success defined as performance of ERCP with D-SOC without the use of fluoroscopy in pregnant patients; [2] safety of D-SOC in pregnancy; and [3] maternal and neonatal outcomes after D-SOC during/after pregnancy.

Patients and methods This was an international, multicenter, retrospective study at 6 tertiary centers. Pregnant patients who underwent D-SOC for the treatment of bile duct stones and/or strictures were included.

Results A total of 10 patients underwent D-SOC. Indications for ERCP were choledocholithiasis, strictures, previous stent removal, and choledocholithiasis/stent removal. Bile duct cannulation without fluoroscopy was achieved in 10 of 10 patients (100 %). Moreover, 50 % of patients (5/10) completed a fluoroless ERCP with D-SOC. Mean fluoroscopy dose and fluoroscopy time were 3.4 ± 7.2 mGy and 0.5 ± 0.8 min, respectively. One case of mild bleeding and one case of moderate post-ERCP pancreatitis occurred. The mean gestational age at delivery was 36.2 ± 2.6 weeks. Median birth weight was 2.5 kg [IQR: 2.2–2.8]. No birth defects were noted.

Conclusion ERCP guided by D-SOC appears to be a feasible and effective alternative to standard ERCP in pregnant patients. It enables avoidance of radiation in half of cases.



Publication History

Received: 08 May 2020

Accepted: 19 October 2020

Article published online:
25 January 2021

© 2021. 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
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Comment to this article:

Endoscopy International Open – recently publishedEndoscopy 2021; 53(03): 341-341
DOI: 10.1055/a-1327-5573

 

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