Abstract
Background
Endoscopic retrograde cholangiopancreatography (ERCP) is currently the treatment of choice for symptomatic choledocholithiasis in pregnant patients. We aimed to present our experience with pregnant patients who underwent nonradiation ERCP and to evaluate the safety and efficacy of a new technique.
Methods
A retrospective analysis of nonradiation ERCP in 22 pregnant patients with symptomatic choledocholithiasis between January 2002 and December 2013 was performed. The bile aspiration technique with wire-guided sphincterotome was used to confirm selective biliary cannulation. Transpapillary pancreatic septotomy was performed in cases with difficult biliary cannulation (n = 3). After endoscopic biliary sphincterotomy, endoscopic papillary balloon dilation was performed with a 6- or 8-mm dilation balloon in all patients to reduce the risk of recurrent cholangitis because of residual or additional stones. Stones were extracted by balloon sweeping after dilation. All patients were followed for 6 months after the ERCP procedure.
Results
Biliary cannulation was achieved in all patients. Endoscopic papillary balloon dilation was performed with a 6-mm balloon in 17 patients and an 8-mm balloon in five patients. The stones were extracted in 18 of the 22 patients by balloon sweeping, but no stones were extracted in the remaining four patients. There were two cases of mild post-ERCP pancreatitis. All patients delivered at term, and none experienced recurrence of choledocholithiasis and/or cholangitis during the 6-month follow-up.
Conclusions
Endoscopic biliary sphincterotomy plus endoscopic papillary balloon dilation in nonradiation ERCP is a safe and effective treatment method for symptomatic choledocholithiasis during pregnancy.
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References
Everson GT (1992) Gastrointestinal motility in pregnancy. Gastroenterol Clin North Am 21:751
Scott LD (1992) Gallstone disease and pancreatitis in pregnancy. Gastroenterol Clin North Am 21:803–815
Glenn FS, McSherry CK, Charles K (1992) Gallstones and pregnancy among 200 young women treated with cholecystectomy. Surg Gynecol Obstet 175:41–46
Williams EJ, Green J, Beckingham I, Parks R, Martin D, Lombard M, British Society of Gastroenterology (2008) Guidelines on the management of common bile duct stones (CBDS). Gut 57:1004–1021
Tang SJ, Mayo MJ, Rodriguez-Frias E, Armstrong L, Tang L, Sreenarasimhaiah J, Lara LF, Rockey DC (2009) Safety and utility of ERCP during pregnancy. Gastrointest Endosc 69:453–461
Samara ET, Stratakis J, Enele Melono JM, Mouzas IA, Perisinakis K, Damilakis J (2009) Therapeutic ERCP and pregnancy: Is the radiation risk for the conceptus trivial? Gastrointest Endosc 69:824–831
International Commission on Radiological Protection (2000) Pregnancy and medical radiation. Publication 84. Pergamon, Oxford
Savas MC, Kadayifci A, Koruk M (2003) Re: Tham et al.: safety of ERCP during pregnancy. Am J Gastroenterol 98:2331–2332
Sharma SS, Maharshi S (2008) Two stage endoscopic approach for management of choledocholithiasis during pregnancy. J Gastrointest Liver Dis 17:183–185
Uomo G, Manes G, Picciotto FP, Rabitti PG (1994) Endoscopic treatment of acute biliary pancreatitis in pregnancy. J Clin Gastroenterol 18:250–252
Shelton J, Linder JD, Rivera-Alsina ME, Tarnasky PR (2008) Commitment, confirmation, and clearance: new techniques for nonradiation ERCP during pregnancy (with videos). Gastrointest Endosc 67:364–368
Agcaoglu O, Ozcinar B, Gok AF, Yanar F, Yanar H, Ertekin C, Gunay K (2013) ERCP without radiation during pregnancy in the minimal invasive world. Arch Gynecol Obstet 288:1275–1278
Huang P, Zhang H, Zhang XF, Zhang X, Lu W, Fan Z (2013) Comparison of endoscopic retrograde cholangiopancreatography performed without radiography and with ultrasound-guidance in the management of acute pancreaticobiliary disease in pregnant patients. Chin Med J 126:46–50
Yang J, Zhang X, Zhang X (2013) Therapeutic efficacy of endoscopic retrograde cholangiopancreatography among pregnant women with severe acute biliary pancreatitis. J Laparoendosc Adv Surg Tech A 23:437–440
Al-Hashem H, Muralidharan V, Cohen H, Jamidar PA (2009) Biliary disease in pregnancy with an emphasis on the role of ERCP. J Clin Gastroenterol 43:58–62
Dumonceau JM, Garcia-Fernandez FJ, Verdun FR, Carinou E, Donadille L, Damilakis J, Mouzas I, Paraskeva K, Ruiz-Lopez N, Struelens L, Tsapaki V, Vanhavere F, Valatas V, Sans-Merce M, European Society of Digestive Endoscopy (2012) Radiation protection in digestive endoscopy: European Society of Digestive Endoscopy (ESGE) guideline. Endoscopy 44:408–421
ASGE Standards of Practice Committee, Maple JT, Ben-Menachem T, Anderson MA, Appalaneni V, Banerjee S, Cash BD, Fisher L, Harrison ME, Fanelli RD, Fukami N, Ikenberry SO, Jain R, Khan K, Krinsky ML, Strohmeyer L, Dominitz JA (2010) The role of endoscopy in the evaluation of suspected choledocholithiasis. Gastrointest Endosc 71:1–9
Catalano MF, Linder JD, Geenen JE (2004) Endoscopic transpancreatic papillary septotomy for inaccessible obstructed bile ducts: comparison with standard pre-cut papillotomy. Gastrointest Endosc 60:557–561
Wu W, Faigel DO, Sun G, Yang Y (2014) Non-radiation endoscopic retrograde cholangiopancreatography in the management of choledocholithiasis during pregnancy. Dig Endos 26:691–700
Vohra S, Holt EW, Bhat YM, Kane S, Shah JN, Binmoeller KF (2014) Successful single-session endosonography-based endoscopic retrograde cholangiopancreatography without fluoroscopy in pregnant patients with suspected choledocholithiasis: a case series. J Hepatobiliary Pancreat Sci 21:93–97
Freistuhler M, Braess A, Petrides AS (1999) Ultrasound-controlled endoscopic papillotomy in pregnancy in severe biliary pancreatitis. Z Gastroenterol 37:27–30
Gotzberger M, Pichler M, Gulberg V (2012) Contrast-enhanced US-guided ERCP for treatment of common bile duct stones in pregnancy. Gastrointest Endosc 76:1069–1070
Stavropoulos S, Larghi A, Verna E, Stevens P (2005) Therapeutic endoscopic retrograde cholangiopancreatography without fluoroscopy in four critically ill patients using wire-guided intraductal ultrasound. Endoscopy 37:389–392
Chong VH, Jalihal A (2010) Endoscopic management of biliary disorders during pregnancy. Hepatobiliary Pancreat Dis Int 9:180–185
Girotra M, Jani N (2010) Role of endoscopic ultrasound/SpyScope in diagnosis and treatment of choledocholithiasis in pregnancy. World J Gastroenterol 16:3601–3602
ASGE Standards of Practice Committee, Anderson MA, Fisher L, Jain R, Evans JA, Appalaneni V, Ben-Menachem T, Cash BD, Decker GA, Early DS, Fanelli RD, Fisher DA, Fukami N, Hwang JH, Ikenberry SO, Jue TL, Khan KM, Krinsky ML, Malpas PM, Maple JT, Sharaf RN, Shergill AK, Dominitz JA (2012) Complications of ERCP. Gastrointest Endosc 75:467–473
Baron TH, Harewood GC (2004) Endoscopic balloon dilation of the biliary sphincter compared to endoscopic biliary sphincterotomy for removal of common bile duct stones during ERCP: a metaanalysis of randomized, controlled trials. Am J Gastroenterol 99:1455–1460
Weinberg BM, Shindy W, Lo S (2006) Endoscopic balloon sphincter dilation (sphincteroplasty) versus sphincterotomy for common bile duct stones. Cochrane Database Syst Rev 18:CD004890
Bergman JJ, van Berkel AM, Bruno MJ, Fockens P, Rauws EA, Tijssen JG, Tytgat GN, Huibregtse K (2001) Is endoscopic balloon dilation for removal of bile duct stones associated with an increased risk of pancreatitis or a higher rate of hyperamylasemia? Endoscopy 33:416–420
Arnold JC, Benz C, Martin WR, Adamek HE, Riemann JF (2001) Endoscopic papillary balloon dilation vs. sphincterotomy for removal of common bile duct stones: a prospective randomized pilot study. Endoscopy 33:563–567
Disclosures
Drs. Galip Ersoz, Ilker Turan, Fatih Tekin, Omer Ozutemiz, and Oktay Tekesin have no conflicts of interest or financial ties to disclose.
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Ersoz, G., Turan, I., Tekin, F. et al. Nonradiation ERCP with endoscopic biliary sphincterotomy plus papillary balloon dilation for the treatment of choledocholithiasis during pregnancy. Surg Endosc 30, 222–228 (2016). https://doi.org/10.1007/s00464-015-4190-1
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DOI: https://doi.org/10.1007/s00464-015-4190-1