Commitment, confirmation, and clearance: new techniques for nonradiation ERCP during pregnancy (with videos).

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.