Commitment, confirmation, and clearance: new techniques for nonradiation ERCP during pregnancy (with videos) - 23/08/11
Reprint requests: Paul R. Tarnasky, MD, University of Texas Southwestern, Ste no. 630, 221 West Colorado Blvd, Pavilion II, Dallas, TX 75208.Dallas, Texas, USA
Abstract |
Background |
Symptomatic choledocholithiasis during pregnancy can be treated with ERCP, but fluoroscopy may pose a risk to the fetus. Nonradiation ERCP may be a safer form of treatment, but its performance has not been optimized.
Objectives |
The purpose of this study was to evaluate new methods of nonradiation ERCP during pregnancy, including wire-guided cannulation techniques to achieve bile-duct access without the use of fluoroscopy, and the use of peroral choledochoscopy to confirm ductal clearance.
Study Design |
A retrospective review of consecutive ERCPs performed on pregnant women.
Setting |
Urban referral hospital.
Patients |
Pregnant women with symptomatic choledocholithiasis.
Interventions |
All patients underwent therapeutic ERCP without any use of fluoroscopy. Endoscopist-controlled wire-guided cannulation was performed to achieve biliary access.
Main Outcome Measurements |
The rate of successful biliary cannulation and short-term outcomes.
Limitations |
ERCP procedures were performed by a single endoscopist.
Results |
Successful bile-duct cannulation with sphincterotomy and the removal of biliary stones or sludge was performed without fluoroscopy in 21 pregnant women. There was one case of mild post-ERCP pancreatitis. Choledochoscopy confirmed ductal clearance in 5 cases.
Conclusions |
Nonradiation ERCP is a safe and effective treatment for symptomatic choledocholithiasis during pregnancy. Wire-guided biliary cannulation and choledochoscopy may enhance the performance of ERCP in this setting.
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Vol 67 - N° 2
P. 364-368 - febbraio 2008 Ritorno al numero
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