Quan W L, Chia C K, Yim H B
Department of Gastroenterology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433.
Singapore Med J. 2006 Jun;47(6):525-8.
Data on safety issues and therapeutic outcomes of endoscopy in pregnancy remains limited especially in the local context. The concerns are that of safety in sedation and radiation to the foetus, effects on the pregnancy, the need for special precautions on mother and foetus during the procedure and long-term foetal outcome. We report a case series on four pregnant women to address these concerns and outline their therapeutic approaches.
We reviewed four patients who underwent oral gastroduodenoscopy (OGD) or endoscopic retrograde cholangiopancreatography (ERCP) during their pregnancies. Lead aprons were used to shield the foetuses in all patients that underwent ERCP. Sedation was given when necessary, and an anaesthetist was employed in one case for close patient monitoring. Fluoroscopy was minimised and radiographs were taken only when essential.
The mean patient age was 27.8 years (range 23-35 years). The mean gestation was 21.5 weeks (range 14-32 weeks), with two patients each being in their second and third trimesters. The indications for ERCP were cholangitis and pancreatitis (one), choledocholithiasis on ultrasonography (two), and that for OGD was persistent vomiting (one). Two patients underwent sphincterotomy and one had a biliary stent inserted. One patient was lost to follow-up. The other three had a full-term normal delivery and all babies were healthy at birth with good birth weight and normal Apgar scores.
Our series showed that endoscopic procedures in pregnancy are safe for both mother and foetus. However, these procedures should be restricted to cases with definite. indications and radiation exposure should be minimised with additional safety precautions such as minimal radiation exposure and the use of lead shield when applicable.
关于孕期内镜检查的安全性问题和治疗效果的数据仍然有限，尤其是在本地背景下。人们关注的问题包括镇静的安全性和对胎儿的辐射、对妊娠的影响、手术过程中对母亲和胎儿采取特殊预防措施的必要性以及胎儿的长期结局。我们报告了一组涉及四名孕妇的病例系列，以解决这些问题并概述她们的治疗方法。
我们回顾了四名在孕期接受口服胃十二指肠镜检查（OGD）或内镜逆行胰胆管造影（ERCP）的患者。在所有接受ERCP的患者中，均使用铅围裙来保护胎儿。必要时给予镇静，其中一例患者有麻醉师进行密切的患者监测。尽量减少荧光透视，仅在必要时拍摄X光片。
患者的平均年龄为27.8岁（范围为23 - 35岁）。平均妊娠周数为21.5周（范围为14 - 32周），其中两名患者分别处于孕中期和孕晚期。ERCP的指征为胆管炎和胰腺炎（1例）、超声检查发现胆总管结石（2例），OGD的指征为持续性呕吐（1例）。两名患者接受了括约肌切开术，一名患者插入了胆管支架。一名患者失访。其他三名患者足月顺产，所有婴儿出生时健康，出生体重良好，阿氏评分正常。
我们的病例系列表明，孕期的内镜检查对母亲和胎儿都是安全的。然而，这些检查应仅限于有明确指征的病例，并且应通过额外的安全预防措施将辐射暴露降至最低，例如尽量减少辐射暴露，并在适用时使用铅屏蔽。
