Tang Shou-Jiang, Mayo Marlyn J, Rodriguez-Frias Edmundo, Armstrong Luis, Tang Linda, Sreenarasimhaiah Jayaprakash, Lara Luis F, Rockey Don C
Division of Digestive and Liver Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Gastrointest Endosc. 2009 Mar;69(3 Pt 1):453-61. doi: 10.1016/j.gie.2008.05.024. Epub 2009 Jan 10.
ERCP is an important diagnostic and therapeutic tool in patients with biliary and pancreatic disease. Its utility and safety during pregnancy is largely unknown because it is not often required and because its use has been only infrequently reported in the published literature.
Our purpose was to report the clinical experience with ERCP during pregnancy.
Retrospective review, single academic center.
All (consecutive) pregnant women who underwent ERCP at Parkland Memorial Hospital from 2000 to 2006.
History, clinical data, hospital course, procedure-related complication rates and outcomes, and delivery and fetal outcomes were abstracted from medical records.
During the study period, 68 ERCPs were performed on 65 pregnant women. The calculated ERCP rate was 1 per 1415 births. The common indications for ERCP in pregnancy were recurrent biliary colic, abnormal liver function tests, and dilated bile duct on US. ERCP was technically successful in all patients. The median fluoroscopy time was 1.45 minutes (range 0-7.2 minutes). There was no perforation, sedation-related adverse event, postsphincterotomy bleeding, cholangitis, or procedure-related maternal or fetal deaths. Post-ERCP pancreatitis was diagnosed in 11 patients (16%). None of these 11 patients had local or systemic complications. Fifty-nine patients had complete follow-up. Endoscopic therapy at the time of ERCP was undertaken in all patients. Furthermore, 9 patients (32.1%) underwent cholecystectomy in the first and second trimesters for either acute cholecystitis (6) or symptomatic gallstones (3). Term pregnancy was achieved in 53 patients (89.8%). Patients having ERCP in the first trimester had the lowest percentage of term pregnancy (73.3%) and the highest risk of preterm delivery (20.0%) and low-birth-weight newborns (21.4%). None of the 59 patients with long-term follow-up had spontaneous fetal loss, perinatal death, stillbirth, or fetal malformation.
Retrospective review.
ERCP can be performed safely during pregnancy. Further, ERCP performed in pregnancy leads to specific therapy in essentially all patients. However, ERCP may be associated with a higher rate of post-ERCP pancreatitis than in the general population.
内镜逆行胰胆管造影术（ERCP）是诊断和治疗胆胰疾病患者的重要工具。其在孕期的效用和安全性很大程度上未知，因为孕期对其需求不高，且其应用在已发表文献中报道较少。
我们的目的是报告孕期行ERCP的临床经验。
回顾性研究，单学术中心。
2000年至2006年在帕克兰纪念医院接受ERCP的所有（连续的）孕妇。
从病历中提取病史、临床资料、住院过程、与操作相关的并发症发生率及结局，以及分娩和胎儿结局。
研究期间，65名孕妇接受了68次ERCP。计算得出的ERCP发生率为每1415例分娩中有1例。孕期行ERCP的常见指征为复发性胆绞痛、肝功能检查异常及超声显示胆管扩张。所有患者ERCP操作技术均成功。透视时间中位数为1.45分钟（范围0 - 7.2分钟）。无穿孔、镇静相关不良事件、括约肌切开术后出血、胆管炎或与操作相关的母婴死亡。11例患者（16%）诊断为ERCP术后胰腺炎。这11例患者均无局部或全身并发症。59例患者获得完整随访。所有患者在ERCP时均进行了内镜治疗。此外，9例患者（32.1%）在孕早期和孕中期因急性胆囊炎（6例）或有症状胆结石（3例）接受了胆囊切除术。53例患者（89.8%）足月妊娠。孕早期行ERCP的患者足月妊娠率最低（73.3%），早产风险最高（20.0%），低体重新生儿风险最高（21.4%）。59例接受长期随访的患者均无自然流产、围产儿死亡、死产或胎儿畸形。
回顾性研究。
孕期行ERCP可安全进行。此外，孕期行ERCP基本上能使所有患者得到特异性治疗。然而，与普通人群相比，ERCP术后胰腺炎的发生率可能更高。
