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Efficacy and Safety of Pancreatobiliary Endoscopic Procedures during Pregnancy.

Lee JJ, Lee SK, Kim SH, Kim GH, Park do H, Lee S, Seo D, Kim MH - Gut Liver (2015)

Bottom Line: Only one patient had a complication, which was postprocedural hyperamylasemia.Two patients underwent an artificial abortion, one according to her own decision and the other due to an adverse drug reaction.ERCP seems to be effective and safe for pregnant women.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

ABSTRACT

Background/aims: Endoscopic therapy with endoscopic retrograde cholangiopancreatography (ERCP) has been suggested as an effective diagnostic and therapeutic tool for biliary and pancreatic disorders during pregnancy. In this report, we describe our experiences with pancreatobiliary endoscopic procedures during pregnancy.

Methods: We reviewed ERCP and endoscopic ultrasonography (EUS) procedures that were performed at a single tertiary care referral center between January 2002 and October 2013. Medical records were reviewed for the procedure indication, the duration of fluoroscopy, postprocedure complications, etc. Pregnancy outcomes and fetal complications were identified by chart review and phone calls to patients.

Results: A total of 10 ERCPs and five EUSs were performed in 13 pregnant patients four of whom underwent the procedure in the first trimester, eight in the second trimester, and one in the third trimester. Indications for endoscopic therapy included gallstone pancreatitis, obstructive jaundice with common bile duct (CBD) stone, asymptomatic CBD stone, pancreatic cyst, choledochal cyst, and acute cholecystitis. Only one patient had a complication, which was postprocedural hyperamylasemia. Two patients underwent an artificial abortion, one according to her own decision and the other due to an adverse drug reaction.

Conclusions: ERCP seems to be effective and safe for pregnant women. Additionally, EUS can be an alternative to ERCP during pregnancy.

No MeSH data available.


Related in: MedlinePlus

After a large cystic dilatation was found on magnetic resonance imaging (A), an endoscopic ultrasonography (EUS) image was obtained (B), and simultaneous EUS-guided fine-needle aspiration was performed (case 12) (C).
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f2-gnl-09-672: After a large cystic dilatation was found on magnetic resonance imaging (A), an endoscopic ultrasonography (EUS) image was obtained (B), and simultaneous EUS-guided fine-needle aspiration was performed (case 12) (C).

Mentions: Before the procedure, abdominal ultrasound or magnetic resonance cholangiopancreatography (MRCP) was performed in all patients to make a diagnosis. We also used EUS to classify cystic structure or to examine spontaneous passage of stone (Fig. 2). Computed tomography (CT) was performed in one patient at the secondary general hospital as she did not inform of her pregnancy to medical team at that time (case 9). They found out from the CT image that she had a bile duct cyst and they transferred the patient to our medical center. After she was transferred, we found out about her pregnancy while taking the history. We used EUS to aspirate cyst and to avoid additional radiation exposure. Thereby we could classify it as mucinous cystic neoplasm. We explained to her about the standard radiation dose of CT in accordance with guidelines from The American Congress of Obstetricians and Gynecologists (ACOG). We also explained that fetal risks of anomalies and growth restriction are not usually increased with radiation exposure of less than 5 rad2 and that the estimated maximum fetal dose for CT of abdomen was estimated about 2 to 3 rad.3 After the explanation, she decided to maintain her pregnancy and fortunately no developmental disorder was found in her baby.


Efficacy and Safety of Pancreatobiliary Endoscopic Procedures during Pregnancy.

Lee JJ, Lee SK, Kim SH, Kim GH, Park do H, Lee S, Seo D, Kim MH - Gut Liver (2015)

After a large cystic dilatation was found on magnetic resonance imaging (A), an endoscopic ultrasonography (EUS) image was obtained (B), and simultaneous EUS-guided fine-needle aspiration was performed (case 12) (C).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4562786&req=5

f2-gnl-09-672: After a large cystic dilatation was found on magnetic resonance imaging (A), an endoscopic ultrasonography (EUS) image was obtained (B), and simultaneous EUS-guided fine-needle aspiration was performed (case 12) (C).
Mentions: Before the procedure, abdominal ultrasound or magnetic resonance cholangiopancreatography (MRCP) was performed in all patients to make a diagnosis. We also used EUS to classify cystic structure or to examine spontaneous passage of stone (Fig. 2). Computed tomography (CT) was performed in one patient at the secondary general hospital as she did not inform of her pregnancy to medical team at that time (case 9). They found out from the CT image that she had a bile duct cyst and they transferred the patient to our medical center. After she was transferred, we found out about her pregnancy while taking the history. We used EUS to aspirate cyst and to avoid additional radiation exposure. Thereby we could classify it as mucinous cystic neoplasm. We explained to her about the standard radiation dose of CT in accordance with guidelines from The American Congress of Obstetricians and Gynecologists (ACOG). We also explained that fetal risks of anomalies and growth restriction are not usually increased with radiation exposure of less than 5 rad2 and that the estimated maximum fetal dose for CT of abdomen was estimated about 2 to 3 rad.3 After the explanation, she decided to maintain her pregnancy and fortunately no developmental disorder was found in her baby.

Bottom Line: Only one patient had a complication, which was postprocedural hyperamylasemia.Two patients underwent an artificial abortion, one according to her own decision and the other due to an adverse drug reaction.ERCP seems to be effective and safe for pregnant women.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

ABSTRACT

Background/aims: Endoscopic therapy with endoscopic retrograde cholangiopancreatography (ERCP) has been suggested as an effective diagnostic and therapeutic tool for biliary and pancreatic disorders during pregnancy. In this report, we describe our experiences with pancreatobiliary endoscopic procedures during pregnancy.

Methods: We reviewed ERCP and endoscopic ultrasonography (EUS) procedures that were performed at a single tertiary care referral center between January 2002 and October 2013. Medical records were reviewed for the procedure indication, the duration of fluoroscopy, postprocedure complications, etc. Pregnancy outcomes and fetal complications were identified by chart review and phone calls to patients.

Results: A total of 10 ERCPs and five EUSs were performed in 13 pregnant patients four of whom underwent the procedure in the first trimester, eight in the second trimester, and one in the third trimester. Indications for endoscopic therapy included gallstone pancreatitis, obstructive jaundice with common bile duct (CBD) stone, asymptomatic CBD stone, pancreatic cyst, choledochal cyst, and acute cholecystitis. Only one patient had a complication, which was postprocedural hyperamylasemia. Two patients underwent an artificial abortion, one according to her own decision and the other due to an adverse drug reaction.

Conclusions: ERCP seems to be effective and safe for pregnant women. Additionally, EUS can be an alternative to ERCP during pregnancy.

No MeSH data available.


Related in: MedlinePlus