Subscribe to RSS
DOI: 10.1055/s-0038-1637653
CASE SERIES: ERCP IN PREGNANCY- CAN WE AVOID RADIATION?
Publication History
Publication Date:
27 March 2018 (online)
Aims:
To highlight the use of non-radiation ERCP in pregnant patients with acute gallstone pancreatitis at a university hospital in East London.
Methods:
Three consecutive pregnant patients with acute gallstone pancreatitis who underwent ERCP were identified between 2016 – 17 & their outcomes reviewed. Patients were consented for use of fluoroscopy & prepared with lead aprons to shield the fetus. ERCPs were performed by a single endoscopist under conscious sedation. In all three patients there was attempt to confirm selective biliary cannulation, without use of fluoroscopy, by demonstrating aspiration of bile via a sphincterotome. Full-thickness wire-guided sphincterotomy was performed using Olympus CleverCut Sphincterotome with subsequent 12 mm extraction balloon-trawl to confirm bile duct clearance. Plastic biliary stents were inserted if indicated.
Results:
Patient |
Gestation |
Previous episodes of pancreatitis |
ERCP timing post admission (days) |
Screening time (Secs) |
Cholecystectomy timing post ERCP (days) |
1 |
8/40 |
3 |
9 |
0 |
3 |
2 |
9/40 |
1 |
5 |
0 |
3 |
3 |
22/40 |
0 |
12 |
2.7 |
Previous |
Patients 1 & 2 had successful ERCP+sphincterotomy using aspiration of bile to confirm successful cannulation of the biliary tree. No complications were experienced. Both patients underwent laparoscopic cholecystectomy 3 days later & had resolution of liver enzymes on discharge. They were subsequently reviewed by Obstetricians & fetal ultrasound showed no concerns. For Patient 3 the endoscopist was unable to gain biliary cannulation without fluoroscopy. Selective cholangiogram revealed dilated biliary tree with multiple filling defects. To minimise duration of screening, a 7 cm 7Fr double pigtail biliary Teflon stent was placed following sphincterotomy. Repeat ERCP and stent removal is planned post-partum. The patient made a good recovery with no complications and she was seen in antenatal clinic at 26/40 with no concerns.
Conclusions:
Although non-radiation ERCP can be technically challenging, this may be an effective alternative to conventional ERCP in experienced centres, avoiding radiation exposure to the fetus.