Taller András
Fővárosi Önkormányzat Uzsoki Utcai Kórháza, II. Belgyógyászat, Budapest.
Orv Hetil. 2011 Jun 26;152(26):1043-51. doi: 10.1556/OH.2011.29116.
There are only few data of gastrointestinal endoscopy in pregnant patients. Only 0.4% of all procedures are carried out during pregnancy. Case reports and some small retrospective studies are available. Because of physiological changes in pregnancy there might be special risks of endoscopy. There might be complaints which can be physiologic during pregnancy, but can be signs of gastrointestinal disorders, too. Therefore, indications for endoscopy are not always clear and easy. Safety of the procedures is also not well studied. Besides the risks of endoscopy, medication given to the mother, electrocoagulation and radiation exposure from fluoroscopy during endoscopic retrograde cholangiopancreatography might be harmful to the fetus. Endoscopy should only be done when indication is unquestionable and strong. Only FDA "A" and "B" category medication is allowed. Gastroscopy is necessary for bleeding and for patients with pyrosis going together with alarm signs. Nausea, vomiting, abdominal pain and fecal occult blood test positivity are not indications for endoscopy, only for gastroenterogical consultation. Sigmoidoscopy is recommended for indication of lower gastrointestinal bleeding and sigmoid or rectal mass. Only therapeutic endoscopic retrograde cholangiopancreatography should be performed. Obstructive jaundice and biliary pancreatitis need immediate endoscopic intervention. The fetus must be shielded from radiation exposure.
关于孕妇胃肠道内镜检查的数据很少。所有内镜检查中仅有0.4%是在孕期进行的。现有病例报告和一些小型回顾性研究。由于孕期的生理变化，内镜检查可能存在特殊风险。孕期可能出现的一些症状既可能是生理性的，也可能是胃肠道疾病的体征。因此，内镜检查的适应证并不总是明确且容易判断的。该检查的安全性也未得到充分研究。除了内镜检查本身的风险外，母亲使用的药物、内镜逆行胰胆管造影术中的电凝以及透视时的辐射暴露都可能对胎儿有害。只有在适应证明确且强烈时才应进行内镜检查。只允许使用美国食品药品监督管理局（FDA）的“A”类和“B”类药物。对于出血以及伴有警示体征的烧心患者，胃镜检查是必要的。恶心、呕吐、腹痛和粪便潜血试验阳性并非内镜检查的适应证，仅用于胃肠病咨询。对于下消化道出血以及乙状结肠或直肠肿物的适应证，建议进行乙状结肠镜检查。仅应进行治疗性内镜逆行胰胆管造影。梗阻性黄疸和胆源性胰腺炎需要立即进行内镜干预。必须保护胎儿免受辐射暴露。
