Safety of ERCP in Pregnant Women with Biliary Pancreatitis – BORN Study – an International Survey

Aims Acute biliary pancreatitis in pregnant patients is a rare condition that presents a challenge for clinicians. Endoscopic retrograde cholangiopancreatography (ERCP) is indicated during pregnancy in cases of choledocholithiasis, cholangitis, and some cases of gallstone pancreatitis. This study aimed to investigate the safety and effectiveness of ERCP during acute biliary pancreatitis in pregnancy.

Methods An international survey was conducted across twenty centres worldwide in 2023 using Excel and Redcap platforms. The survey encompassed questions related to demographic information, clinical presentation, management strategies, including ERCP, timing of cholecystectomy, approaches to the procedure, complications, and outcomes (including recurrence of acute pancreatitis, other gallstone-related complications, and maternal and fetal outcomes). For descriptive statistics, the number of patients, mean, standard deviation (SD), minimum, median, and maximum values were calculated for continuous variables, and case number and percentage were calculated for categorical values. A t-test and the Mann–Whitney U and Mood’s test were used to determine statistical significance.

Results In this study, pregnant women with biliary acute pancreatitis during pregnancy were included. According to our international survey, 24% (21/88) of the patients had ERCP during their hospitalization. Patients who underwent ERCP had lower rates of readmission (n=4, 19% vs. n=13, 16%; p=0.746), preterm birth (n=1, 5.9% vs. n=8, 12%; p=0.678), and fetal loss (n=2, 9.5% vs. n=4, 4.8%; p=0.345) compared to those who did not. The median gestational age was lower in patients who had ERCP (18 (11, 27) vs. 25 (15, 31)). Furthermore, the ERCP group had more frequent cholangitis and choledocholithiasis (n=9 vs. n=1; n=16 vs. n=7). The median cannulation time was 3 minutes, with a median radiation time of 3.5 minutes. Post-ERCP pancreatitis was diagnosed only in one case. Among patients who had ERCP, cholecystectomy was performed during pregnancy in seven cases.

Conclusions This is the fourth-largest study evaluating ERCP during biliary pancreatitis in pregnancy. Aligning with the current literature, we found that ERCP is a safe and effective procedure during pregnancy.

Publication History

Article published online:
27 March 2025