CASE SERIES: ERCP IN PREGNANCY- CAN WE AVOID RADIATION?

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:

Tab. 1:

Patient details

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.